To the Editor

Perhaps one day you will quit sending me the APSF Newsletter because of my persistence. In spite of this, I write, about a letter to the Editor which appears in the Fall 1990 issue on Page 30. I preface further comments with the realization that a Letter to the Editor is by definition information from the outside. I am aware that this is not a letter from the Editor.

Drs. Kataria and Nicodemus provide a protocol and algorithm or at least a protocol as to what one does when confronted with lungs which are difficult to inflate following intubation. If I may assume they are discussing a situation in which ventilation was not difficult prior to intubation, I believe they neglect what has served many of us well as a basic principle over the past several years. No where do these doctors mention that if ventilation were not difficult before the tube was inserted and was difficult after the tube was inserted, one of the wry early things which should be done is to remove the tube and reestablish ventilation by mask. It seems wise to me that this be done before such time consuming things as chest x-ray and, in most institutions, fiberoptic bronchoscopy are attempted

Unfortunately I have no absolute data, but it is a clinical impression for many of my colleagues and me that this has prevented much hypoxia and other sequelae of inadequate ventilation by connecting the problem quickly and allowing further assessment to be done in an atmosphere of adequate ventilation.

William K. Hamilton, M.D.

Vice Dean, University of California, San Francisco