Tracheotomy in the management of respiratory failure

ABSTRACT

In less than a century indications for tracheotomy have been extended from laryngeal obstruction to respiratory failure due to secretory obstruction [RFSO] in the lower airway. Of the 242 patients who have undergone tracheotomy during 1961-1992, 119 cases required the procedure for RFSO. According to the cause RFSO patients were divided into five subgroups[a] neuromuscular diseases; [b] coma; [c] chemical burns, foreign body, or infection in lower airway [d] reduced mobility of the ribcage [e] adjacent compression in the mediastinum. Secretions collected in lower airway can be deterimental to life. RFSO is seen in lots of comatosed patients. They usually die of drown-lung and asphyxia instead of underlying disorders as the major problem for RFSO is hypercapnia rather than simply hypoxemia oxygen inhalation is useless and even harmful. The key measure to break up this pernicious circle is to aspirate secretion accumulated in lower airway to promote alveolar gas exchange. Once RFSO is diagnosed a timely tracheotomy is helpful to assist ventilation, frequent bronchial toilet and artificial respiration. It provides better chance to rescue suffocated patients. Only Sixteen patients [13.4%] developed complications in this series