TREATMENT OF PULMONARY COMPLICATIONS IN NEUROSURGICAL PATIENTS BY TRACHEOTOMY

Abstract

SINCE the advent of modern surgery, prevention and treatment of postoperative pulmonary complications have been subjects of intensive interest and research. In 1924 Leopold¹first pointed out the similarity of physical findings in postoperative atelectasis and in instances of foreign bodies obstructing a bronchus. This led to the original work of Lee and Tucker,²who successfully treated postoperative atelectasis by bronchoscopy. In attempting to reproduce the condition experimentally, Tucker, Lee and Clerf³inserted secretions which had been previously aspirated from a patient into one of the main bronchi of dogs. They found that atelectasis could be produced by this method, but only after the animal was anesthetized deeply enough to abolish the cough reflex. From these experiments was developed the present concept that two factors are responsible for postoperative atelectasis: (1) suppressed or ineffectual cough and (2) presence of abnormal secretion in the tracheobronchial tree. Management of