Early Tracheotomy in Anterior Poliomyelitis

Tracheotomy in bulbar poliomyelitis and spinal poliomyelitis with respiratory failure has only one purpose, and that is to keep the airway open and accessible. With an assured airway, secretions can easily be removed at all times, prevention of atelectasis and consolidation becomes a more likely possibility, and oxygen delivery to and carbon dioxide removal from the alveoli are more certain to occur. The usual indications for tracheotomy in poliomyelitis have been the accumulation of secretions in the tracheobronchial tree, abrupt closure of the airway from laryngospasm, and hypoxia and hypercapnia, with cyanosis, delirium, restlessness, and coma.1Through blocking of the airway, hypoxia and hypercapnia may be sudden in onset, dramatic in character, and easily detected by observation. More often the filling of the airway with secretions and symptoms of hypoxia and hypercapnia have a gradual and insidious development, which may often be mistakenly attributed to progression of the infectious