Washing Out Clogged Lungs
New Technique Helps Children Breathe
By David Williamson
Physicians at the medical center
have developed a new technique for
washing out the clogged • lungs of
children with severe respiratory
diseases.
The treatment has already resulted
in vastly improved breathing for two
youngsters suffering from a rare
condition known as alveolar
proteinosis, and the researchers
believe it may offer new hope for
others with cystic fibrosis, the most
common lethal disease seen by
pediatricians.'
Dr. Alexander Spock, professor of
pediatrics and director of Duke's
Cystic Fibrosis Center, described the
procedure to colleagues at a meeting
of the Southern Society for Pediatric
Research in New Orleans.
Breathe More Normally
Spock said the treatment flushes
mucous plugs from tiny
passageways and air sacs in the
lungs with salt solutions so that the
children can breathe more normally
until the plugs form again weeks or
months later.
Diseases like cystic fibrosis and
alveolar proteinosis can lead to
chronic infections and permanent
lung damage, sometimes bringing
on early death, he said.
Using the new treatment,
physicians place a plastic tube in the
child's trachea (windpipe) while he
or she lies on one side under
anesthesia, Spock explained. The
same tube fills one lung with the salt
(saline) solution, drains it and then
resupplies the organ with pure
oxygen, all within 60 seconds.
Physicians monitor the amount of
saline introduced into the lung and
also the amount that returns, he said.
The entire process is repeated until
the discharge is clear.
Disease Film
"Thirty Minutes on Infectious
Disease," a film produced by Bristol
Laboratories, will be shown by
Audiovisual Education at 2 p.m.
March 2 and 4.
Specialists on several aspects of
the problem are featured:
* Dr. Philip B. Mead, associate
professor of obstetrics and
gynecology at the University of
Vermont College of Medicine, on
"ABC: Anaerobic Bedside Culture."
* Dr. Donald Armstrong, professor
of medicine at Cornell University
Medical College and chief of the
Infectious Disease Service and
director of the Microbiology
Laboratory at Memorial
Sloan-Kettering Cancer Center, on
"Chemotherapy: Killer or Cure?"
* Dr. Lowell S. Young, associate
professor of medicine at the
University of California at "Los
Angeles School of Medicine, on
"Transmission of Pseudomonal
Infections."
* Dr. George A. Pankey, head of
the Section of Infectious Diseases at
Ochsner Medical Center and clinical
professor of medicine at Tulane
University School of Medicine, on
"Cutaneous Signs of Systemic
Disease."
The film will be shown in Room
M-406 on Wednesday, March 2, and
in Rooms M-406 and 2031 on Friday,
March 4.
"After one lung has been treated,
the patient is ventilated with oxygen
for about an hour and then the other
lung is Washed," Spock said.
"Gravity keeps the liquid from
entering the lung not being
washed."
The first patient was an
eight-year-old girl from Alabama
who has now had the treatment four
times, he said. Most recent results
from pulmonary function tests show
her lungs are working normally.
The second patient, a
nine-month-old infant flown here
from Oregon, weighed only 10
pounds when she was first seen last
autumn. Spock said since then her
weight has increased, and her
general condition has improved.
The pediatrician pointed out that a
similar technique has been used in
adults in this country for about 10
years, but because the tubes could
, not be made small enough for tiny
lungs, it could not be performed on
children younger than 14 years.
"You can make tubes srnaller in
diameter than the half inch now
used, but then you can't get the
mucous plugs out, and resistance to
the flow of air is so great that you
wouldn't be able to get proper
ventilation," he explained.
In the adult treatment, tubes go to
both lungs so that one can be
ventilated while the other is being
cleaned.
iiimiiiiiics
CLEARING THE LUNGS OF CHILDREN—This drawing illustrates the critical no
oxygen interval in a new technique scientists at the medical center have devised to
wash out the clogged lungs of children with severe respiratory disorders. A single
tube tills the lower lung with a salt solution, drains It using the same principle that
aljows gasoline to be siphoned from an automobile and then resupplies the organ
with oxygen, all within 60 seconds. The process is repeated until each lung is clear of
mucous plugs.
Spock said that he and his
associates. Dr. Johannes Kylstra,
professor of medicine and Dr.
Charles Lanning, assistant professor
of anesthesiology, found the
simultaneous washing and
ventilating was not necessary.
Patients Don't Drown
"Many people have believed that
you can't put fluid in the lungs
because you will drown the patient,"
he said. "We have demonstrated that
under carefully controlled
conditions, that isn't true.
"All iiifants reported to have been
born with alveolar proteinosis have
died, usually within a year after
birth," he said. "We know this
technique can prevent these early
deaths."
The physician said that roughly a
third of the adults who develop the
condition eventually lost symptoms
of it with treatment, and the goal is to
get the children to the age where
they may have a chance to recover as
well.
Reversing Downhill Course
"We also believe that by doing this
treatment early and often enough in
cystic fibrosis cases, it may be
possible to reverse the progressive
downhill course many patients face,"
Spock said. "We don't have enough
information on this yet, but we are
currently evaluating patients to get
more data."
He said cystic fibrosis, which
ranks behind cancer as a disease
killer of children, is a hereditary
disorder striking about one in every
1,600 individuals. In the general
population, one person of every 20 is
a carrier of the disease, and when
carrier couples have children,
statistically one in every four
off-spring will have cystic fibrosis.
Scientists don't know yet why the
disease causes the production of too
much mucus, nor how to cure the
condition, Spock said. If they can
develop a test to determine who
carries the trait, perhaps one day
genetic counseling will help to
eradicate it.
In the meantime, researchers at
Duke and elsewhere are analyzing
proteins in the mucus to leam their
composition and origin, he added.
What Do You Think? : Employee Survey Schedule
(Continued from page 1)
(Wed.-Thurs., 2:30 p.m.) will be held
in the laundry building,, and
employees there have these two
options.
Peck said that as much as possible
the sessions set up for Friday and
Saturday, March 11-12, would be
used as make-up times for those
unable to participate at the times
they were originally scheduled.
"But those who have to miss their
scheduled time shouldn't wait until
Friday or Saturday," he explained.
"They should check with their
supervisors right away about an
alternate time."
And he added that to insure that
everyone has a chance to participate,
"We'll add some sessions on Friday,
if need be.''
Meeting rooms in the hospital are
the Hospital Amphitheater (yellow
zone, first floor). Room 3031, (purple
zone, third floor) and Room M^4,
Davison Building (green zone,
second floor).
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