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To the Editor.—
After reading the article entitled "Intensive Respiratory Care Unit: Review of Ten Years' Experience" (233:34, 1975), I got the impression that the authors were unfamiliar with mechanical ventilation techniques other than those via a tracheostomy or an endotracheal tube.There are a number of ways of enabling individuals to breathe without compromising the trachea, and I think it would have been important to include these other techniques. For example, the tank respirator, the chest-abdomen cuirass, the pneumobelt, positive pressure by mouth, and the rocking bed are available today and should be used as alternatives to a tracheostomy tube or positive-pressure or volume ventilators. The complications of artificial ventilation by endotracheal tube or tracheostomies were not mentioned. They include tracheoesophageal fistula, tracheostenosis, and erosion of the tracheal tube into the innominate artery. All of these complications are reported in the literature and should be considered when mechanical respiration
Johnson EW. Mechanical Ventilation Techniques. JAMA. 1975;234(10):1018. doi:10.1001/jama.1975.03260230018008