AIrway Management in Patients With Poliomyelitis

There is controversy, at present, concerning the place of early (so-called elective or prophylactic) tracheotomy in the supportive treatment of acute anterior poliomyelitis with severe respiratory involvement. Those who oppose its use, exemplified in the literature by Stimson1and Sweet,2claim comparable results with conservative treatment, with tracheotomy used as a last resort. Galloway,3Weiland,4Brown and associates,5and West and Bower,6on the other hand, favor it as the most effective means of combating obstruction of the airway by secretions and vocal cord palsy. It would appear the trend in recent years has been toward the latter approach, particularly in the larger poliomyelitis centers. It seems apparent that two phases of the problem exist. Initially, the patient must be protected from early asphyxial death resulting from high respiratory tract obstruction, pulmonary edema, and hypoventilation. Later, lower respiratory tract obstruction with its subsequent atelectasis