Fatal Complication of Transtracheal Aspiration

Accurate bacteriologic studies of sputum are essential to the proper management of pulmonary infection, especially as infections with gram-negative and other unusual pulmonary pathogens become more common. The interpretation of both the microscopic examination of expectorated sputum, so important to the initial choice of antibiotic, and bacteriologic examination is complicated by contamination in the oropharynx. Both examinations may yield potential pathogens that are often found in the oropharynx, but that have little relationship to the pathologic process in the lungs. 1,2 Furthermore, overgrowth of normal flora may conceal the true pathogens. 3 Because peroral and nasal catheters are inevitably soiled, bronchoscopy too cumbersome for routine clinical use, and washing of the sputum not always effective, 4 transtracheal aspiration has become increasingly popular. First described and developed by Pecora 2,5,6 as a modification of the technique of transtracheal anesthesia, transtracheal aspiration is now widely used to obtain more accurate bacteriologic diagnoses.