3. Patients were advanced to the use of 24-h tracheostomy IPPV with a deflated cuff. The use of partial cuff deflation was discouraged because of the tendency of the nursing staff to gradually increase the amount of air in the cuff with time. Some patients were introduced to ventilatory support by an iron lung or chest shell with the tracheostomy tube open. Care was taken to maintain the tracheostomy tube above the iron lung collar. ventolin inhaler
4. All patients were trained in the use of mouth IPPV for daytime ventilatory support with the tracheostomy tube plugged. Each patient learned to close off the nasopharynx with his soft palate to prevent nasal leakage. Temporarily pinching the nostrils helped the patient to understand why this was necessary. Patients who had had their cuffs inflated for long periods of time initially maintained their vocal cords fully adducted during attempts at mouth IPPV. Each patient was unaware that he was obstructing flow. This was not infrequently mistaken for tracheal stenosis. Each patient successfully relearned the reflex vocal cord abduction that permitted effective mouth IPPV This took from minutes to up to several weeks of daily attempts, but once mastered, the three times daily sessions of mouth IPPV were prolonged until it was tolerated throughout daytime hours.
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