Treatment of sputum retention by minitracheotomy

Retention of sputum is a major cause of morbidity and mortality following thoracic surgery and regular access to the trachea for suction can only be obtained either by tracheostomy or endotracheal intubation, both of which have significant disadvantages. A simple method of percutaneous tracheal cannulation for suction has therefore been developed in which a 4 mm Portex paediatric endotracheal tube is inserted through a 1 cm incision in the cricothyroid membrane, using a guarded knife and an introducer. The procedure can be performed in the ward or theatre, using local or general anaesthesia. Twenty-four patients have been treated between October 1981 and June 1982. Ages ranged from 19-80 years and the duration of cannulation from 1-45 days. No patient subsequently required any further treatment for sputum retention. Twenty-one patients made an uneventful recovery and 3 died from unrelated causes. Following decannulation healing occurred within 6 days and there were no late sequelae. The method is much simpler and less invasive than existing alternatives and can therefore be used at an early stage and before the consequences of sputum retention become irreversible.