Pope is put on respirator

(Correction: Because of incorrect information provided by an Italian news agency, a front-page story yesterday reported that Pope John Paul II had been put on a respirator. The Vatican denied those reports, saying the pope had not needed a respirator during his latest illness.)

ROME -- Pope John Paul II's slow recovery from influenza suffered a sharp setback yesterday when a respiratory crisis sent the pontiff to the hospital, where a breathing tube was inserted in his throat and he was put on a respirator.

Vatican officials said the surgical procedure last night had gone ''positively" and the pope was spending the night in the hospital.

''The surgery lasted thirty minutes and was successful," according to an official statement by the Vatican.

The 84-year-old pope, who suffers from Parkinson's disease and arthritis, which have left his frame hunched and his voice labored in recent years, was rushed to the Policlinico Gemelli hospital yesterday morning with a fever and congestion after several days of mounting breathing trouble, the Vatican said.

The official statement said the surgery was elective and that the pontiff was aware of his situation and consented to the procedure. The Italian news agency ANSA reported the pope was conscious when he arrived at Gemelli and that he was sitting upright in a stretcher. According to the report, people who saw him enter the hospital said his face looked ''quite relaxed."

Before the procedure, John Paul was well enough to joke with his medical team, Cabinet Undersecretary Gianni Letta told reporters. When doctors told the pope that the operation would be a small one, the pontiff retorted: ''Small, it depends for whom," he said, citing doctors' accounts.

The operation, called a tracheostomy, suggests that he will need help breathing or clearing secretions from his lungs over weeks or months, according to Dr. Susan Briggs, a surgeon at Massachusetts General Hospital who is following news about his care.

The increasingly frail pope had spent the first 10 days of February in the hospital recovering from an earlier attack of the flu. He had not returned fully to public life, appearing twice at his window in the Vatican and at only a few scheduled events.

Yesterday morning he had been expected to preside in person over a meeting with cardinals to approve candidates for sainthood. He was instead absent from the meeting, and the Vatican confirmed soon afterward that the pope had begun suffering relapses of his flu symptoms and been taken to the hospital.

A tracheostomy involves cutting a hole at the base of the neck and inserting a tube in the windpipe to allow unobstructed breathing with or without a respirator. Typically, doctors perform the procedure if the patient needs to be put on a mechanical breathing machine, called a respirator or ventilator, for an extended period or if doctors need to be able to regularly suction fluids from the lungs, said Briggs, an associate professor of surgery at Harvard Medical School and a trauma surgeon at MGH.

In an emergency, or if a patient was only likely to need help with breathing for a day or two, doctors would typically insert a breathing tube through the mouth and into the windpipe using a procedure called intubation, Briggs said. The fact that doctors chose to perform a tracheostomy, which requires general anesthesia and carries the usual surgical risks of bleeding and infection, suggests doctors are thinking long-term, she said.

''If he was in acute respiratory distress, they would (intubate) him first," she said. The tracheostomy, however, ''is a lot more comfortable than putting a breathing tube in, especially with him so hunched over."

Dr. Dawn Osborne, a Boston doctor who specializes in treating the elderly, said it was unlikely that John Paul could have contracted the flu again. There is usually only one dominant strain of the flu each year, and the body is able to fight off any additional exposure, said Osborne, medical director of Urban Medical Group in Jamaica Plain.

''He may not have had the flu the first time," she said. ''A lot of people call any viral illness the flu. If he did have it the first time, then most likely he has secondary pneumonia or has another viral infection."

The Vatican statement made no reference to pneumonia, saying that the pope suffered a narrowing of his larynx. ''Such a clinical situation indicated the necessity for an elective tracheotomy to ensure adequate ventilation of the patient and help resolve the laringeal malady," Vatican spokesman Joaquin Navarro-Valls said.

In addition, Parkinson's and arthritis can make it more difficult to breathe.

As with his previous hospitalization, yesterday's crisis fueled speculation about whether he could continue as pope, and what would happen if he was incapacitated. The pope might have a longer hospital stay this time, and he will not be able to speak while on a respirator.

During John Paul's earlier hospitalization on Feb. 1, the Vatican's secretary of state, Cardinal Angelo Sodano declined to rule out the possibility of a papal resignation, saying it was up to the pope's conscience.

Although the pope's absence and prolonged illness have left the church without the vigorous leader to which it has become accustomed since his election in 1978, many Catholics have come to see his situation as a powerful statement about human suffering and the will to continue in the service of his faith.

That symbolic power has not been lost on the Vatican, which last week convened a conference called ''Quality of Life and Medical Ethics," focusing on what Vatican theologians call the industrialized world's increasing tendency to value comfort and lifestyle over the more essential human needs of life, basic health, and spiritual wholeness.

At a Vatican press conference introducing the session, several church leaders delivered strongly worded statements reiterating the pope's stance against euthanasia. Asked by one reporter what relevance their statements had to the condition of the pope if he were to enter a vegetative state, a Vatican official declined to answer.

As news of the pope's condition spread yesterday, the Gemelli hospital, where the pope was spending the night, was once again swarmed by journalists, joined by small groups of pilgrims and curious neighbors.

Heuser reported from Rome; Dembner from Boston. Globe correspondent Alexandra Salamon contributed to this report. Material from the Associated Press was also used.