One of the objectives of tracheostom y in cases of advanced pulm o n ary em physem a is a reduction in anatom ical dead space [4,5,6,9,14,18]. I t is held th a t tracheostom y should be postponed u n til an acu te d eterioration of the p a tie n t's condition m akes its in stitu tio n m an d ato ry [6,18].