Tracheostomy and Assisted Ventilation: Use in Respiratory Insufficiency in the Postsurgical Patient

The therapeutic value of tracheostomy and ventilatory assistance by mechanical means, introduced by Bjork and Engstrom¹ to support individuals with limited pulmonary reserve following lung resection, has become accepted practice. Since then the advantages of this technique in the postoperative management of patients undergoing open heart surgery^2,3 and those with thoracic trauma^4,5 have been recognized. Despite this fact, there is still reluctance upon the part of many surgeons to employ this modality except in dire emergencies. The purpose of this paper is to present data in patients to support the efficacy of this procedure and correlate the physiologic responses observed in the experimental animal during anoxia and hypercapnia (hypercarbia) with that seen in man. In addition it is emphasized that in the older patient with emphysema and generalized arteriosclerosis undergoing major surgery this technique should be utilized before severe pulmonary difficulties occur. From a review of the