Part 17: Breathing Lessons

R Adams Cowley's ideas about saving lives were often complex, expensive and controversial.

One illustrative anecdote from Shock Trauma is about respirators. Many patients developed lung failure days after an injury, with no apparent reason. They called it “shock lung.”

A Shock Trauma surgeon, Dr. T. Crawford McAslan, had a theory that University Hospital's cheap mechanical respirators did a bad job of keeping the lungs from collapsing between breaths.

McAslan believed that patients should be put on a respirator before shock lung developed with a device that kept the lungs partially inflated between breaths—called positive expiratory end pressure (PEEP) ventilation.

He went to the hospital's administrators and asked for the world's best respirator, the Engstrom, made in Sweden. At the time, an Engstrom cost about $8,000, compared to $500 for the dime-store model used at University Hospital.

McAslan was laughed out of the administrator's office, but Cowley took him seriously and made it happen. He got his Engstrom, and sure enough the incidence of shock lung plummeted.

The data led to one inescapable conclusion: There had to be Engstroms at every bed in Shock Trauma. And there were.

Today, PEEP ventilation is pretty much the standard of care.