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The Annals of Thoracic Surgery, Vol 49, 881-885, Copyright © 1990 by The Society of Thoracic Surgeons

ARTICLES

Clinical experience with minitracheostomy

JC Wain, DJ Wilson and DJ Mathisen
Thoracic Surgery Unit, Massachusetts General Hospital, Boston 02114.

Minitracheostomy is a technique to assist in the removal of airway secretions while maintaining glottic function. A flanged, reclosable cannula 4.0 mm in internal diameter is inserted through the cricothyroid membrane into the trachea. Sixty procedures were performed in 56 patients from July 1988 to June 1989. Indications for placement included excessive postoperative secretions (46/60), difficulty with endotracheal suctioning (4/60), preoperative secretions (4/60), postpneumonic secretions (5/60), and acute airway obstruction (1/60). Successful intratracheal placement was possible in all instances, and the device was well tolerated. Major intratracheal bleeding necessitating endotracheal intubation occurred in 2 patients. Minor complications included local hematoma (5 patients), subcutaneous emphysema (2 patients), and hoarseness (1 patient). No deaths occurred. Cannulas remained in place for one day to 35 days. Removal resulted in closure within 48 hours. No adverse laryngeal effects were seen. A successful result, not requiring other invasive methods to remove secretions, was obtained in 43 (72%) of the 60 procedures. Minitracheostomy is a useful adjunct for secretion removal in the hospitalized patient.

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