title: The efficacy of minitracheostomy for the management of sputum retention: a systematic review.
abstract: BACKGROUND
  Suction via a minitracheostomy is a safe procedure, but its efficacy in facilitating sputum clearance in individuals with an acute condition has not been systematically reviewed.
  
  
  OBJECTIVE
  The aim of this study was to identify and synthesise the efficacy of the insertion of a minitracheostomy and tracheal suction via minitracheostomy for sputum clearance in adults who have undergone surgery or have an acute condition characterised by sputum retention.
  
  
  METHODS
  A systematic literature search using the electronic databases MEDLINE, CINAHL, EMBASE, Cochrane Library and PEDro, with searches limited to English language journal articles published between 1984 and September 2011.
  
  
  METHODS
  All study designs were included. Two independent reviewers used pre-defined inclusion and exclusion criteria to identify all eligible articles.
  
  
  RESULTS
  Six studies in six patient groups met the inclusion criteria, with two randomised controlled trials and four case series included. These studies presented the results of 278 patients following surgery and 13 with acute medical conditions. There were a range of criteria that defined the efficacy of minitracheostomy for sputum retention. Studies reporting the adjunctive role found a reduced incidence of complications associated with sputum retention following thoracic surgery. Other studies reported limited benefit in overall respiratory status with minitracheostomy. Heterogeneity among the studies was evident, with major limitations identified.
  
  
  CONCLUSIONS
  Limited evidence suggests that minitracheostomy may be a useful adjunct in optimising sputum clearance in adults following thoracic surgery, but the effects in adults with an acute condition and other types of surgery are inconclusive.
authors.affiliation: Physiotherapy Department, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia. Electronic address: Lisa.Beach@mh.org.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Beach
authors.forename: Linda
authors.initials: L
authors.lastname: Denehy
authors.forename: Annemarie
authors.initials: A
authors.lastname: Lee
mesh_terms: D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013183:Sputum / Q000378:metabolism; D013396:Suction / Q000379:methods*; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Minitracheostomy; Sputum retention