RD: A review of the management of 140 elective tracheostomies following open-heart surgery. Thorax

A retrospective survey of 140 cases of elective tracheostomy following open-heart surgery has been undertaken. All the tracheostomies were performed by surgeons of the Cardiac Unit using a standard technique during the years 1962 to 1966 inclusive. The indications during this period are discussed and possible reasons for the high incidence of tracheostomy are considered. The complications have been carefully assessed. The results indicate that, although there is room for improvement, a reduction in the number and severity of complications has been achieved. In particular there have been few late sequelae, which is attributed to good surgical technique and the adoption of the Bjork operation. In 60 % of the patients there were no complications; one death was directly attributable to tracheostomy. The experience of Lassen (1953) in the polio-myelitis epidemic which occurred in Copenhagen in 1952 led to the general adoption of artificial ventilation by intermittent positive pressure (I.P.P.V.) in the treatment of respiratory failure, and, in consequence, the tank respirator has bee