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Right arrow Trachea and bronchi

Ann Thorac Surg 2002;74:196-203
© 2002 The Society of Thoracic Surgeons

Original article: general thoracic

Sputum retention after lung operation: prospective, randomized trial shows superiority of prophylactic minitracheostomy in high-risk patients

Pramod Bonde, MS, FRCSa, Ioannis Papachristos, FRCSa, Aveen McCraith, BSb, Barry Kelly, FRCRc, Carol Wilson, MRCPd, James A. McGuigan, FRCSa, Kieran McManus, FRCS*a

a Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland
b Department of Physiotherapy, Royal Victoria Hospital, Belfast, Northern Ireland
c Department of Radiology, Royal Victoria Hospital, Belfast, Northern Ireland
d Department of Cardiology, Royal Victoria Hospital, Belfast, Northern Ireland

* Address reprint requests to Dr McManus, Royal Victoria Hospital, Grosevenor Rd, Belfast, BT12 6BA, Northern Ireland
e-mail: kieran.mcmanus{at}royalhospitals.n-i.nhs.uk

Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.

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.




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[Abstract] [Full Text] [PDF]


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