The longest case of total dependence on NVA was that of a 17-year-old boy (patient 1) who fell from a horse in a school gymnasium on March 10, 1967, and sustained a fracture dislocation of Cl,2 and complete C2 quadriplegia. He was immediately and permanently dependent on supported ventilation with no free time. On Sept 27, 1967, a phrenic pacemaker was placed but it was ineffective bilaterally. He remained in a local intensive care unit for ten months with multiple pulmonary infections. He was transferred for rehabilitation in February 1968 with a 16 mm diameter Rausch tracheostomy tube and cuff inflated with 12 ml. He had severe trachiectasis with a cuff-to-trachea diameter ratio of 3:1. He continued to have frequent formation of purulent mucous plugs while on the Rausch tube which led to one respiratory arrest resulting in partial blindness and two near arrests. Because of these difficulties, he was very motivated for tracheostomy closure. flovent inhaler
He began daytime mouth IPPV with a volume ventilator at a rate of 18 and pressure 20 cm H20 on April 17, 1968. He also began to use an iron lung on July 3, 1968, at a rate of 18 and pressure — 17 cm H20 which gave him a delivered volume of 660 ml, minute volume of 11.8 L, and normal blood gas values. On July 10, 1968, he was placed on a portable pressure ventilator for daytime mouth IPPV.
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