Clinical application of continuous monitoring of respiratory failure.

The management of respiratory failure has improved greatly in recent years. This has been due to some extent to an improved understanding of respiratory physiology, but the major reason lies in the application of this knowledge to patients, particularly in intensive care units. Why the creation of such specialized areas ' was so long delayed is a mystery, the need having been obvious for so many years. Historically, it is probably fair to say that coronary intensive care units were the first to achieve widespread accep­ tance. In these units continuous monitoring was relatively easy to achieve, requiring electrocardiography and, less often, the continuous recording of arterial and central venous pressures. Equipment had been standardized, was relatively uncomplicated, and could be understood readily by medical and paramedical personnel. The patient in respiratory failure presents a more difficult challenge. His condition can deteriorate in seconds, and for reasons which are hard to un­ derstand graduates of medical and nursing schools continue to this day to be depressingly unaware of the measures needed to prevent and treat such de­ terioration. Respiratory depression and obstruction are poorly understood, and the necessity for adequate removal of CO2 from and the addition of O2 to blood in the lungs is often given little heed. Even in respiratory intensive care areas it is common to note a gradual decrease in pulmonary compliance during the night as the result of inadequate suctioning of respiratory tract secretions. It may require several hours in the morning to recover the ground lost during the night. This review wiIl deal with the continuous monitoring of patients in re­ spiratory failure, although it must be admitted at once that the state of the art is primitive. At this moment, for example, there is not available a satis­ factory method for the continuous measurement of the most essential pa­ rameter in respiratory care-arterial blood oxygen tension. Nonetheless, much has been learned, and recent visits to various laboratories suggest that the future will see gratifying developments in the field, hopefully, soon.