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An "unprecedented respirator patient load at Los Angeles County Hospital [LACH] in 1948 (294 respirator cases)" arose from a seasonal increase in poliomyelitis cases to nearepidemic proportions. A finding by physician Albert Bower and his team that respiratory acidosis was frequent in patients receiving intermittent negative pressure ventilation (INPV), together with their awareness of a previous high mortality rate due to the standard treatment of polio ventilatory failure with Drinker-Collins respirators, led to multiple advances in equipment technology for LACH. Most important was biomedical engineer V Ray Bennett's positive pressure respirator attachment, in use after September 1948, which converted an INPV machine, the Drinker, into one capable of supplying "intratracheal" intermittent positive pressure ventilation (IPPV), supplementary to its NPV.

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An operative technique is presented for acquired tracheosophageal fistula including cervical esophagostomy, division and closure of the distal esophagus, and use of the cervical and thoracic esophageal segment as a patch to close the posterior trachea wall. Later coloesophagoplasty is used to establish gastrointestinal continuity. An external negative-pressure ventilator (Drinker-Collins iron lung) is used in combination with a conventional positive-pressure ventilator to diminish airway pressure after the tracheal repair.

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