Figure 60-12 When a child has upper airway obstruction caused by laryngospasm (A) or mechanical obstruction (B), the application of approximately 10 cm H₂ O of positive end-expiratory pressure (PEEP) during spontaneous breathing often relieves the obstruction. That is, PEEP helps keep the vocal cords apart (A) and the airway open (B, broken lines). If this simple maneuver does not relieve the obstruction, more vigorous positive-pressure ventilation may be necessary. Airway obstruction caused by the tongue requires insertion of an appropriately sized oral airway. (Redrawn with modification from Coté CJ, Todres ID: The pediatric airway. In Coté CJ, Ryan JF, Todres ID, et al [eds]: A Practice of Anesthesia for Infants and Children. Philadelphia, WB Saunders, 1992, p 55.)