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The evolution of acute respiratory failure was studied in 27 patients with generalized peritonitis. The natural history of pulmonary failure indicates an incidence of 74% of atelectasis progressing to pneumonitis in the majority of patients. In 21 patients, similar aerobic microorganisms were recovered from the sputum and abdominal focus of infection. The emergence of gram negative pneumonia by the third day of onset of peritonitis appeared to add significantly to respiratory failure. In the management of respiratory failure, early use of positive and expiratory pressure with mechanical ventilation was associated with improvement or reversal of hypoxia. A high fatality (89%) was attributed to uncontrolled sepsis rather than to respiratory failure.
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