Obstruction of the lower respiratory tract by retained bronchial secretions has become a frequent indication for tracheostomy during the past decade. Although tracheostomy initially permits effective clearing of the airway, it subsequently induces certain physiological disturbances which may lead to severe and even fatal complications. These physiological disturbances may be lessened by meticulous attention to details of tracheostomy care and by use of a new type of tracheostomy tube1 designed to preserve the patient's ability to speak and to raise his own secretions by effective coughing. Early experience with this new tracheostomy tube in 17 patients forms the basis for this report.
Before presenting the case material, we should review the new tracheostomy tube and the rationale of its use in secretional obstruction. The tube is a short, straight cylinder of inert polyvinyl acetate rendered malleable for the sake of easy insertion along the tract of the tracheostomy (Fig.