An Evaluation of Tracheostomy in Pulmonary Emphysema

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Abstract
Fourteen patients have been studied in whom a tracheostomy was performed for severe pulmonary emphysema. Total ventilation, alveolar ventilation, oxygen consumption, physiological dead space, and arterial blood gases were determined while breathing through the mouth alone and through the tracheostomy alone in all fourteen. In addition, pulmonary resistance breathing through the mouth and the tracheostomy was measured in six of these patients. The arterial blood gases and alveolar ventilation were the same breathing through the mouth as through the tracheostomy even though the total ventilation and physiological dead space were reduced when breathing through the tracheostomy. Oxygen consumption was reduced in half the patients when breathing through the tracheostomy. Three patients could not maintain ventilation through the mouth alone, but there were none who could not breathe through the tracheostomy alone. Pulmonary resistance was slightly greater breathing through the tracheostomy than through the mouth. Arterial blood gases were determined approximately one hour before, one hour after, and twenty-four hours after tracheostomy in six patients. There was often a deterioration in the values for blood gases immediately post-operatively but they were often improved twenty-four hours later. It is believed that tracheostomy reduces the burden of ventilation in patients with severe pulmonary emphysema and that its value is not just limited to facilitating the removal of pulmonary secretions.