Minitracheotomy in the treatment of postoperative sputum retention and atelectasis

Abstract

Minitracheotomy (MT) is a new method for the treatment of sputum retention and atelectasis. Through a 1-cm incision in the cricothyroid membrane (coniotomy), a specially designed tube is placed in the trachea, allowing suction to be performed. Fifteen patients, aged 37-78 years (median 62 years), with postoperative sputum retention, atelectasis and imminent respiratory failure, were treated with suction by MT. Thirteen of the patients recovered from their respiratory problems, while two patients had to be treated with intermittent positive pressure ventilation (IPPV). During insertion, one case of external bleeding and one case of subcutaneous and mediastinal emphysema were seen, while no complications were seen during cannulation. The duration of cannulation was 4-38 days (median 10 days). Following decannulation the incisions were airtight within 1 day and healed within 3 days. Ten patients left hospital in good health and five died because of surgical complications and/or cardiovascular failure. MT seems to be effective in the treatment of sputum retention and atelectasis. Advantages over other invasive methods make it a method of first choice. The method involves few complications and is often so effective that avoidance of intubation and IPPV is possible.

An unusual complication of minitracheostomy

“…These wings could potentially tear through and become detached with possible aspiration of the minitracheostomy and so the Minitrach II (Portex®, Hythe, Kent, UK) was introduced which has a flange that is held in place with conventional tracheostomy tapes [2]. Minitracheostomy insertion gained acceptance for the management of sputum retention and atelectasis and also for emergency transtracheal ventilation [3–5]. However, insertion was not without complications.…”

Die Bedeutung der Minitracheotomie als neue interventionelle Technik zur Behandlung der postoperativen tracheobronchialen Sekretretention.

“…So entwickelte sich unter der Behandlung bei keinem der Patienten eine C, nosokomiale Lungenmfektion, bestand diese bereits vor der Behandlung, konnte sie in 90 O/ O der Fälle gebessert oder zur Ausheilunggebracht werden. Auch andere Arbeitsgruppen berichten über ähnlich gute Ergebnisse (20,27,33).…”

“…Dieses wird durch zahlreiche Publikationen unterstrichen, die vor allem die technisch einfache Handhabung und die Effektivität hervorheben (20,27,29,30,31). Die inzwischen vorliegenden Mitteilungen in der Literatur haben jedoch weit überwiegend den Charakter kasuistischer Erfahningsberichte (30,33) oder Methodik-Präsentationen (10,31). Es fehlen bislang weitgehend objektive Parameter und Nachbeobachtungen der Patienten.…”

Position of minitracheostomy tube verified fiberoptically – a report of 2 cases

“…Minitracheostomy provides access to the trachea for removal of mucous secretions from the airway in patients unable to cough (1,2). Inserting a cannula percutaneously through the cricothyroid membrane is considered easy, but complications related to the method have been reported, e.g.…”