The development of a plastic plug to maintain the tracheostoma in our postpoliomyelitic patients was begun in 1953. This resulted from the need to overcome the disadvantages of the conventional silver tracheotomy tube that was in use. The objections to the conventional tube are the size, shape, composition, and appearance. The standard silver tracheotomy tube is usually too long. The tip frequently impinges upon the anterior tracheal wall, producing partial airway obstruction in addition to local irritation at the site of contact. It may ride on the carina tracheae with resulting ulceration or slip into the right or left main-stem bronchus. Its composition of silver, although silver is one of the most inert metals available, causes tissue irritation and in addition frequently imparts an objectionable metallic taste and odor. The rigidity of the metal tube adds to its irritating qualities, and, finally, the large, rather dismal appearing external portion leaves
Jacobs HJ, Affeldt JE. REPORT ON THE USE OF A PLASTIC TRACHEOTOMY PLUG IN POSTPOLIOMYELITIC PATIENTS. JAMA. 1956;161(9):876–877. doi:10.1001/jama.1956.62970090017017i
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