High-Level PEEP in Severe Asthma

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Abstract
To the Editor: We were intrigued by the ideas of Qvist et al. (Nov. 18 issue),1 who reported on the use of high-level positive end-expiratory pressure (PEEP) to treat patients with asthma.1 However, we found the therapy of their first patient unsettling.They described a 34-year-old asthmatic patient who required peak airway pressures of more than 80 cm H2O for adequate oxygenation. Subcutaneous and mediastinal emphysema developed, and the patient suddenly became cyanotic and hypotensive, with poor breath sounds on auscultation. His chest radiograph showed marked caudal displacement of the left hemidiaphragm. Because the position of the heart . . .

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