Intratracheal Atomization in the Treatment of Infectious Diseases of the Respiratory System

Preliminary Report

1) We have used a technique developed by us for mucosography of the respiratory tract and applied to the treatment of suppurative diseases of the lung.

2) This preliminary report covers a group of cases treated with penicillin which we have used in different concentrations, between 100,000 and 500,000 units disolved in isotonic saline solution. The application was made daily with progressive increase in the doses of penicillin.

3) We preferred crystalline penicillin because it is better tolerated; the volume used has been 5 cc. Larger amounts show no advantage, for it delays the method, and the patient develops pharyngeal irritation.

4) It is an easy method to use, with no risk or disturbance to the patient. The amount of anesthesia used is very small, atomization of 2 cc. of per cent pantocain solution is sufficient. In some patients we have sprayed without anesthesia, and noticed good tolerance.

5) We perform the atomization continuously. That is, in both phases of respiration, in order that the patient may keep open the glottis to avoid coughing and pharyngeal contractions.

6) We have used the supra and infraglottic technique. We prefer the supreglottic technique because it is better tolerated. [SEE FIGURE 6 IN SOURCE PDF]

7) The results obtained are definately encouraging. We have succeeded in improving and curing suppurative lung conditions some of which were of more than six month's duration and having been previously treated without success with penicillin and sulfa drugs.

8) It is Interesting to point out that the simultaneous study of sputum and blood in our patients shows high antibiotic action in the sputum and quite low antibiotic action in the blood. It is easy to see in our graphs that the antibiotic action of the sputum fluctuates between 130 units as maximum and 40 units as minimum, the antibiotic action of the blood fluctuates between 30 units as maximum and 2 units as minimum.

These facts bring forth certain questions which we shall try to explain:

(a) Does the high bacteriostatic power found in the sputum represent the whole penicillin concentration or is it related to any other antibiotic action?

(b) Does the high bacteriostatic action found correspond to acumulative or eliminative action?

(c) Do proteins of the expectoration (mucins, mucoids, etc.), have anything to do with the "delayed effect" in connection with the penicillin deposited in the bronchi?

9) The results obtained point toward the extraordinary importance of the topical action of antibiotics.

10) Finally, with this method we can direct to a certain pulmonary area the highest percentage in volume and concentration of the drug used, which, to our belief is not obtainable by any other method of inhalation used up to the present moméent. [SEE FIGURE 7 IN SOURCE PDF]