Sputum retention after lung operation: prospective, randomized trial shows superiority of prophylactic minitracheostomy in high-risk patients.
BACKGROUND
Sputum retention after lung operation is a potentially life-threatening condition. The minitracheostomy (Minitrach II, SIMS Portex, Hythe, Kent, UK) is a 4-mm percutaneous cricothyroidotomy device, which allows immediate and repeated aspiration of the tracheobronchial tree by minimally trained staff, and can effectively treat sputum retention. This trial was designed to test the hypothesis that prophylactic minitracheostomy could prevent sputum retention in a high-risk group.


METHODS
Between March 1997 and October 1999, 102 patients undergoing lung procedures and considered to be at high risk were prospectively randomized to postoperative, prophylactic minitracheostomy insertion in the recovery room with regular aspiration, or to standard postoperative respiratory therapy.


RESULTS
Sputum retention developed in 15 patients (30%) in the standard group (n = 52) compared to 1 patient (2%) in the minitracheostomy group (n = 50) (p < 0.005). There were three deaths related to sputum retention in the standard group compared to none in minitracheostomy group during the perioperative period.


CONCLUSIONS
It is possible to identify a group of patients at high risk for sputum retention who will benefit from prophylactic therapy. Minitracheostomy is effective as prophylaxis and treatment.
Bonde
Pramod
P
Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland.
Papachristos
Ioannis
I
McCraith
Aveen
A
Kelly
Barry
B
Wilson
Carol
C
McGuigan
James A
JA
McManus
Kieran
K
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011182:Postoperative Care; D011184:Postoperative Period; D011446:Prospective Studies; D012138:Respiratory Therapy; D013183:Sputum / Q000378:metabolism*; D014139:Tracheostomy / Q000379:methods