Sputum retention

Chest complications are common after major surgery and medical illness, and the confused or uncooperative patient may be unable to assist in expectoration. Additional options to stimulate coughing vary from nasopharyngeal suction, which is often poorly tolerated, direct sucker insertion by direct laryngoscopy, bronchoscopy, and finally tracheostomy. The unacceptable alternative is to allow secretions to build up which will lead to atelectasis with subsequent hypoxia, loss of consciousness, and inevitable death.

Minitracheostomy can prevent this downhill spiral if the clinical situation is appreciated and an early intervention is achieved before airway reflexes are lost, after which intubation is the only solution. Therefore this procedure should be considered after major surgery at the time of extubation or in the early stages of deterioration when the situation is reversible. There have been three small prospective randomized studies of minitracheostomy versus conventional care, all in postoperative thoracotomy cases, with favorable results (p < 0.05) (Rande].! e.L...,§L 1991).

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