Respiratory Infection following Tracheostomy.

Tracheostomy has been practised for centuries for the relief of respiratory tract obstruction. Its use has increased very markedly since the introduction of intermittent positive pressure respiration Its value has since been proved for other conditions associated with respiratory paralysis, such as tetanus (Cole, 1959; Smythe and Bull, 1961) and myasthenia gravis. It is also used in respiratory failure characterized by secretional ventilatory obstruc-are enthusiastic advocates of tracheostomy, and they stress the urgency of performing the operation when indicated and the undoubted benefits obtained from its use. Little attention has been paid to the post-operative respiratory sequelae. We have been impressed by the frequency with which these patients have become infected with hospital cross-infecting organisms, particularly staphylococci. They are very susceptible to infection and, when infected, form a reservoir dangerous to other patients. We have traced all cases of tracheostomy performed in the Queen Elizabeth Hospital in 1961 in order to assess the incidence and significance of infection following tracheostomy. METHODS CLINICAL MATERIAL Patients on whom tracheostomy had been performed in 1961 were identified from the operating theatre records for that year. Tracheo-stomy is normally performed in an operating theatre by a surgical registrar, but any tracheostomy performed in the wards would not be recorded and could not be included in this survey. Patients whose clinical records were inadequate for assessment were also excluded. Four additional selected patients had a 89 tracheostomy performed in 1962 and have been used for illustrative but not statistical purposes. BACTERIOLOGICAL MATERIAL This was assessed from the patients' notes, laboratory records, and any epidemiological data available. The phage types of all staphylococci isolated from patients were included and examined in relation to staphylococci isolated throughout the hospital. This was possible as all staphylococci are phage typed as a routine. NECROPSY MATERIAL Full reports and histological preparations were examined from all patients who had been submitted to necropsy. An attempt was made to correlate these findings with the incidence of post-operative infection. RESULTS OF THE STUDY INDICATIONS FOR TRACHEOSTOMY Forty patients underwent tracheostomy in the operating theatre but only 29 of these could be included in the survey. For the remaining 11 patients the data available were inadequate for an assessment to be made.