[The value of mini-tracheotomy as a new interventional technique in treatment of postoperative tracheobronchial retention of secretions. Results of a prospective study of 152 surgical intensive care patients].
OBJECTIVE
Since minitracheotomy has been established in 1984 for prophylaxis and therapy of postoperative sputum retention, numerous publications represent technical descriptions, case reports or empirical results, but only few specific facts related to this method have been investigated. In this study we review the efficiency, complications and late follow-up results of minitracheotomy in a department of general surgery.


METHODS
Between 1987 and 1991 we prospectively included 152 intensive-care patients who received minitracheotomy. The average follow-up was 24.2 +/- 6.1 (4-50) months.


RESULTS
Endotracheal secretion could be sucked off significantly more often after mini-tracheotomy. The rate of endotracheal suction increased from 5.9 +/- 4.5/d to 18.4 +/- 6.1/d (p < or = 0.01). The pulmonary gas exchange improved at the same time. PaO2 level of 78.9 +/- 9.9 mmHg that decreased to critical values of 60.7 +/- 8.9 mmHg, rose after minitracheotomy above the original levels. Although the PaCO2 level remained constant, a compensatory hyperventilation with a rate of 27.3 +/- 6.9/min was normalised by minitracheotomy. Furthermore, the various methods of minitracheotomy were opposed in this study. In the group of minitracheotomy by cricothyroideal stab incision (n = 55) we recorded 5.4% serious complications. In contrast minitracheotomy by the Seldinger technique (n = 87) could be accomplished without any disturbance.


CONCLUSIONS
Minitracheotomy seems to be an effective and safe treatment for therapy and prophylaxis of postoperative complications due to tracheobronchial sputum retention in critically ill patients. Manipulation was simplified and rendered more safe by the technique of transcutaneous bouginage.
Joosten
U
U
Chirurgische Universitätsklinik, Ruhr-Universität Bochum, Marienhospital Herne.
Meyer
G
G
Rupp
D
D
Hohlbach
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000503:physiopathology / Q000601:surgery*; D001980:Bronchi / Q000378:metabolism*; D002245:Carbon Dioxide / Q000097:blood; D003422:Critical Care; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012086:Reoperation; D013396:Suction; D014140:Tracheotomy / Q000295:instrumentation / Q000379:methods*
D002245:Carbon Dioxide; D010100:Oxygen
Die Bedeutung der Minitracheotomie als neue interventionelle Technik zur Behandlung der postoperativen tracheobronchialen Sekretretention. Ergebnisse einer prospektiven Untersuchung mit 152 chirurgischen Intensivpatienten.