Prolonged Intubation vs Tracheotomy in Children

O'DWYER and others during the diphtheria epidemics of 60 years ago had success intubating patients with silver or vulconite tubes. Brandstetter, in 1960, at the Congress of Anesthesiology was the first to report encouraging results with prolonged intubation using polyvinyl nasotracheal tubes. During the past six years, other physicians have reported their experience with prolonged intubation using plastic nasotracheal tubes. Most have found intubation an effective way to maintain the airway and a satisfactory substitute for tracheotomy,1-3but some have serious reservations.4In this paper we describe our experience with prolonged nasotracheal intubation in 1965 and 1966 and compare the complications of nasotracheal intubation with those of the tracheotomies performed during the five previous years. Rubber endotracheal tubes have one serious fault which prohibits their use for prolonged intubation. They produce deep ulcerations of the larynx and trachea within 48 hours, often with subsequent laryngeal stenosis.4-7Polyvinyl