Management of Respiratory Failure

Abstract

To the Editor.— Newsum et al (242:1650, 1979) provide clinically important information regarding their experience with intubation rather than tracheostomy in the treatment of respiratory failure caused by the Guillain-Barre syndrome. There is another alternative that has received little attention in the medical literature. The iron lung or cuirass respirator can be employed with much less discomfort to the patient. The disadvantage is that suctioning may be more difficult. However, intubation or tracheostomy could be withheld as a possible second step. When intubation is clearly necessary, some patients can be extubated earlier and placed in the iron lung or cuirass respirator before they are ready to breathe entirely on their own. The difference in terms of patient comfort should lead to attempts to use these alternatives whenever possible. Availability of these devices may limit their use, though I have noted that several hospitals have stored away such equipment from the