Technics for Minimizing Trauma to the Tracheobronchial Tree after Tracheotomy

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Abstract
OBSTRUCTION of the upper respiratory airway due to laryngopharyngeal paralysis is frequent in acute poliomyelitis, extensive polyneuritis, head injuries, myasthenic crises or coma induced by drug poisoning. Coughing force is impaired, and cough reflexes are often depressed. A tracheotomy relieves the upper respiratory obstruction, but the tracheobronchial tree must then be aspirated directly through the tracheotomy to keep the lower airway patent. Under these circumstances, tracheobronchial secretions often increase markedly during the first few hours after tracheotomy. Blood-tinged aspirate is sometimes observed for several days after surgery when repeated suctioning is carried out. Tracheobronchitis often ensues. Antibiotic-resistant bacterial pathogens are . . .