Recognition and Management Of Airway Obstruction

Peter Safar, MD
JAMA. 1969;209(11):1722. doi:10.1001/jama.1969.03160240078034.
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To the Editor:—  Dr. Berry's statement, "the use of tracheal tubes for more than a few hours is to be condemned," is contrary to many years of world-wide experience with prolonged tracheal intubation and a decrease in the use of early tracheotomy. Both techniques may result in life-threating complications. Most physicians who are experienced in respiratory intensive care have seen more serious complications from tracheotomy than from the placement of endotracheal tubes up to about one week. This is particularly the case in small children and infants. Our present feeling is that early tracheotomy is rarely needed and is dangerous unless performed under controlled conditions in the well-oxygenated patient; and that a switch from endotracheal tube to tracheostomy tube be considered after about 72 hours when the likelihood of causing laryngotracheal damage increases. With ideal technique and care, including maximal humidification, aseptic and atraumatic suction, and cuff inflation only to


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