MICROTRACHEOSTOMY (Greek mikros small + a tracheostomy) — transdermal catheterization of a trachea for the purpose of intra bronchial administration of medicines, and also stimulation of expectoration of a phlegm.
In m it is offered by Kyyun (K. K. to Keown, 1960). The method allows is long to maintain high concentration of antibacterial agents in a bronchial tree, to administer the mucolytic drugs and proteolytic enzymes for fluidifying of a phlegm and simplification of its otkhozhdeniye.
Indication to M. the purulent diseases of lungs which are not giving in to other types of bronkhologichesky treatment, such as are aerosoltherapies (see), medical bronkhoskopiya (see). M it is reasonable by preoperative training of patients with hron, suppuration of lungs or in the postoperative period at patients with the broken mechanism of expectoration at the increased bronchial secretion. Most often indications to M. arise in connection with inefficient expectoration that is often observed at the children of younger age operated concerning diseases of lungs. Indications to M. can arise at multiple heavy injuries of a thorax.
Contraindications: disturbance of coagulability of blood; artificial suppression of a tussive reflex at patients during the carrying out artificial ventilation of the lungs and an anesthesia. Technical difficulties at M.'s performance can take place at a hypertrophy of an isthmus of a thyroid gland and an anchylosis of joints of a cervical part of a backbone, and also at very corpulent people.
Make M. under local anesthesia or under anesthetic. The patient is stacked on a back, enclose the roller under a neck that allows to cast away as much as possible the head back. The place of a puncture — is strict on the centerline of a trachea, otstupya on 0,5 — 1,5 cm from bottom edge of a thyroid cartilage that corresponds to the first or second interchondral interval. The trachea is pierced with a thin trocar or a thick needle, through a gleam a cut carry out a soft plastic catheter to dia. 0,8 — 2 mm with several side openings on the distal end. Other way M. (is more often applied at children) technically more difficult on performance, but allows to fix more densely the catheter in fabrics is followed by development of hypodermic emphysema and suppuration of the wound channel less often. The trachea is punktirut a needle, through to-ruyu enter rather elastic conductor into a gleam of a trachea — kapron or nylon «vein» (fig. 1, and, b). Having removed a needle, the twisting movements on the conductor enter a polyethylene catheter (fig. 1, in, d) so that its end was in a primary bronchus of struck easy (fig. 2). At bilateral process the catheter is established over bifurcation of a trachea. For the correct orientation of a catheter of M. it is recommended to carry out under control of the bronchoscope.
During the first hours after M. painful cough, especially strong can disturb the patient if the end of a catheter concerns bifurcation of a trachea. If cough does not abate after small pulling up of a catheter, through it it is possible to enter 2 — 3 ml of 10% of solution of novocaine or 1 ml of 1% of solution of Dicainum. Further the patient gets used to a catheter and cough arises only at administration of medicines through it. The catheter can be in a trachea (bronchial tube) a long time. Take it after recovery of normal expectoration or reduction of inflammatory process in bronchial tubes, and also in case of development of complications. At an uncomplicated current the wound after removal of a catheter sews up independently.
Complications and their prevention
the injury of a back wall of a trachea at the time of a puncture of a trachea, bleeding Is possible at damage of a vessel of a neck, development of hypodermic emphysemas (see) in the field of a puncture, inflammatory process in the wound channel. At any of the specified complications the catheter should be removed from a trachea immediately.
Prevention of these complications consists in strict observance of an asepsis, care during the performance of a puncture of a trachea, good fixing of a catheter, bronchoscopic control. It is regularly necessary to carry out a toilet and change of the bandages fixing a catheter.
Bibliography: Gadzhiyev S.A., etc. Transdermal constant catheterization of a trachea after a pneumonectomy concerning a bronchietasia, Vestn, hir., t. 96, No. 6, page 18, 1966; To l and m to about in and the p I. G. An intensive care and surgical treatment of nonspecific diseases of lungs at children, M., 1975; The Guide to pulmonology, under the editorship of N. B. Putov and G. B. Fedoseyev, L., 1978; Pods V. I. and Lokhvitsky S. V. Bronkhologicheskiye methods at diseases of lungs, M., 1972; To e own K. To. A method of removing tracheobronchial secretions by the production of effective coughing, Anesth. Analg. Curr. Res., v. 39, p. 570, 1960.
A. A. Ovchinnikov.