Minitracheotomy in the early respiratory management of patients with spinal injuries

Abstract

SummaryMinitracheotomy is a new technique of tracheal suction by the introduction under local anaesthetic of a small bore tube into the trachea through the cricothyroid membrane. The use of minitracheotomy in the early management of respiratory problems in patients with spinal injuries is described with a few illustrative cases.This technique is an adjunct to good physiotherapy in clearing secretions from the trachea. Its advantages and disadvantages are discussed.

The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review

“…[21][22][23][24][25][26][27] There was moderate evidence to support the use of an assist cough to improve cough efficacy by significantly increasing peak expiratory flow 21 and that the use of trans-tracheal open ventilation (mechanical ventilation through minitracheostomy) 22 was effective in maintaining gas exchange and respiratory mechanics for an initial 24 h period. There was also moderate evidence for the provision of respiratory muscle resistance training to improve maximum inspiratory pressure 24,25 and vital capacity.…”

“…There was limited evidence because of poor study quality to support the use of insufflation/exsufflation 26 and minitracheostomy. 23 Incidence of respiratory complications Seven papers reported the effect of various interventions on the incidence of respiratory complications. 10,[28][29][30][31][32][33] Respiratory complications were defined as pneumonia, atelectasis, or respiratory insufficiencyFa diagnosis that included respiratory failure, pneumonia, respiratory infection, and oxygen desaturation.…”

Physiologic comparison between conventional mechanical ventilation and transtracheal open ventilation in acute traumatic quadriplegic patients*

“…The use of a small-bore tube (minitracheotomy) inserted through the cricothyroid membrane was initially introduced to treat postoperative sputum retention (7) and was later successfully applied in acute quadriplegia (8). More recently, the use of positive-pressure ventilation through a small, uncuffed tracheotomy tube, referred to as transtracheal open ventilation (TOV), has been reported as an alternative means of providing mechanical ventilatory assistance (9 -11).…”

Percutaneous dilatational tracheotomy

“…These secretions are generally aspirated with the help of a minitracheotomy cannula [47][48][49][50]. This cannula with an inner diameter of four mm is usually introduced through the cricothyroid membrane either as an open procedure or percutaneously with the help of a guide wire, but can be inserted into the trachea in the subcricoid position [51][52][53].…”