Indications for Tracheostomy

Summary Respiratory insufficiency is a frequent complication of major abdominal and thoracic surgery, although it is difficult to recognize. Its presence can only be established by an analysis of the arterial oxygen and carbon dioxide tensions. After open‐heart surgery, the patient's demands are usually increased significantly. This occurs at a time when pulmonary function is usually impaired and the energy necessary to breathe is significantly increased. Our studies in postoperative patients after open‐heart surgery indicate that the work of breathing in most patients is increased many fold and in some patients may be sufficient to produce acute congestive failure. Therefore, we advocate the use of controlled ventilation leaving an oral endotracheal tube in place, to treat respiratory insufficiency or excessive and compromising work of breathing. Occasionally, such therapy must be instituted prior to definitive surgery in order to rest the patient and give the patient enough reserve to withstand a major surgical procedure. If respiratory insufficiency has not been abolished within 72 hours after surgery, we advocate that a tracheostomy be performed and that respirator treatment be continued until respiratory insufficiency is eliminated and the work of breathing no longer places an intolerable work load on the cardiovascular system.