Repeated pulmonary collapse and changes suggestive of a severe alveolar-capillary diffusion defect were observed over a period of 20 days in a patient who was receiving artificial ventilation because of status epilepticus. Profound cyanosis followed attempts to discontinue assisted ventilation. The Bird Mark 8 respirator employed was found to be delivering approximately 90% oxygen on the air-mix setting and pulmonary oxygen toxicity was suspected. Radiological improvement and progressive resolution of the alveolar-capillary block followed gradual reduction of the inspired concentration over nine days. The management and prevention of this complication are discussed. The inspired oxygen concentration should be routinely monitored in patients receiving intermittent positive pressure ventilation, and the concentration should not be higher than that required to maintain adequate oxygenation. The Bird Mark 8 respirator has an inherent tendency to develop high oxygen concentrations on the air-mix setting, and the machine should therefore be driven from a compressed air source unless high concentrations of oxygen are essential.
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