Beta-haemolytic streptococci in South-west Essex, with particular reference to tetracycline resistance.

The value of tracheostomy was assessed for each patient in relation to the subsequent progress of the underlying disease, to complications of the tracheostomy, and to mortality. Three grades of value were distinguished: (1) the patient would have died had tracheostomy not been performed-211 (54%); (2) the tracheostomy was of definite value to the patient and contributed materially to recovery, even if death eventually occurred as a result of the underlying disease-105 (27%) ; and (3) tracheostomy was of no value in that the patient died as a result of a complication of that procedure, or the complication was a closely related cause of death, or, more usually, tracheostomy was carried out on an already moribund patient73 (19%). This rather arbitrary grading of tracheostomies emphasizes the value of the operation and justifies, in part, the present enthusiasm for it. However, it should be remembered that almost half the complications were infective in origin and onequarter were due to loss of a patent airway through the tracheostomy tube. In addition, many of the complications occurred in the first 48 hours after tracheostomy. It is probable, therefore, that complications could be significantly reduced by a barrier-nursing technique in a specialized unit such as an intensive therapy or respiration unit. Because of the particularly high complication rate in children the use of nasal endotracheal tubes might be considered as an acceptable alternative to tracheostomy. Summary