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Ann Thorac Surg 1989;48:850-852
© 1989 The Society of Thoracic Surgeons

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Articles

Percutaneous cricothyroidostomy (minitracheostomy) for bronchial toilet: Results of therapeutic and prophylactic use

Department of Thoracic Surgery, City Hospital, Edinburgh, Scotland

Accepted for publication August 31, 1989.

^_* Address reprint requests to Mr Au, Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, United Kingdom.

In the period 1984 to 1988, 2,448 patients underwent major thoracic operations in our unit. Of these patients, 144 (5.9%) underwent percutaneous cricothyroidostomy (minitracheostomy) using a 20F pediatric silver tracheostomy tube. Minitracheostomies were performed for the treatment of sputum retention in 81 patients, prophylactically in 62 patients, and as a route for high-frequency jet ventilation in 1 patient. Minitracheostomy tubes remained in situ a median of four days. Suction function was satisfactory in 99% of patients, with only 2 patients requiring subsequent suction bronchoscopy and no occurrence of tube blockage. Ninety-four percent of minitracheostomies performed were entirely uneventful. Bleeding was the most common complication (3.5%), and no instances of subglottic stenosis have occurred. During the review period, there was a significant increase in the percentage of patients requiring major operations undergoing prophylactic, but not therapeutic, minitracheostomy (p < 0.001). This was associated with a significant decrease in the percentage of patients requiring suction bronchoscopy (p < 0.001). We conclude that prophylactic minitracheostomy with the 20F pediatric silver tracheostomy tube is a safe and effective procedure in the prevention of postoperative sputum retention.

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