DIAGNOSIS AND TREATMENT: NASOTRACHEAL INTUBATION AS A SUBSTITUTE FOR TRACHEOSTOMY

Abstract

THE OBVIOUS advantages of tracheostomy must always be weighed against the hazards and complications with which it may be associated. The initial performance of the operation may entail complete airway occlusion, hemorrhage, or cardiac arrest secondary to sudden reduction of carbon dioxide concentration. Maintenance of the tracheostomy may involve pneumothorax, pneumomediastinum, sepsis, and occlusion or dislocation of the tube, and final removal can be followed by such problems as tracheal collapse or stenosis. To avoid some of these difficulties a new concept has been introduced whereby a smooth, sterile endotracheal tube is introduced through the nose and maintained in place for several days, or even weeks. Undoubtedly the method had been used in many individual situations throughout the world, but the idea was first tried on a large scale in Australia. In the Adelaide Children's Hospital and in The Royal Children's Hospital of Melbourne tracheostomy has been largely abandoned and only endotracheal intubation has been used for the past two years in children with laryngotracheitis, croup, and various other types of reversible respiratory inadequacy. In these hospitals tracheostomy is reserved for inindividual situations where secretions are especially heavy or in some patients with severe laryngotracheitis. Nasotracheal intubation has been adopted throughout many parts of the British empire and has recently been employed widely throughout the United States. The indications for nasotracheal intubation are similar to those for tracheostomy. Children in whom airway obstruction results in retraction, stridor and, finally, increasing pulse rate constitute one group of patients who require such assistance.