OTOLARYNGOLOGISTS ROLE IN TRANSTRACHEAL OXYGEN-THERAPY - THE MINITRACH PROCEDURE

The modified Seldinger technique for transtracheal oxygen catheter ins ertion is relatively straightforward, but tract problems during subseq uent oxygen therapy are not uncommon. With the modified Seldinger tech nique method, transtracheal oxygen is not initiated until 1 week after the procedure. Six to 8 weeks are required for tract epithelializatio n, which allows routine catheter removal and cleaning by the patient. Without removal, mucus tends to collect and form balls on the catheter tip, creating a management problem. Previous studies suggest a signif icant incidence of tracheal chondritis, keloid formation, and inadvert ent catheter dislodgment. In 7% to 10% of patients, the epithelial tra ct cannot be recovered by medical personnel, and complete closure occu rs. We have developed a surgical technique for the creation of a contr olled tracheocutaneous tract. Highlights of the minitrach include skin flap elevation, cervical lipectomy, resection of a small window of tr acheal cartilage, and approximation of the skin flaps to the window. W e evaluated 33 patients who underwent the minitrach procedure as an ac cess method for receiving transtracheal oxygen. When compared with res ults from 64 patients followed up for a similar period with the modifi ed Seldinger technique, results with minitrach showed that transtrache al oxygen could be instituted sooner (<24 hours), and symptomatic mucu s balls were reduced because the tract matured more quickly (approxima tely 14 days), With the minitrach there were no inadvertent catheter d islodgments, as compared with 41% of modified Seldinger technique pati ents who had one or more episodes of catheter dislodgment. Twelve perc ent of minitrach patients had a single episode of chondritis, as compa red with 25% of the modified Seldinger technique patients, who had one or more episodes. The minitrach was well tolerated in this group of p atients with severe pulmonary and/or cardiovascular disease. In 12 of these patients, a minitrach revision of their previous modified Seldin ger technique tracts resolved recurrent problems with chondritis, lost tracts, and keloids. We conclude that the minitrach promotes early in stitution of transtracheal oxygen, simplifies an intense postprocedure educational and management process, facilitates tract maturation, and reduces the incidence of problems related to mucus balls, lost tracts , chondritis, and keloids. The minitrach can be used as a revision pro cedure to resolve tract problems encountered with modified Seldinger t echnique. We are now using the minitrach as the preferred procedure fo r the institution of transtracheal oxygen. The minitrach greatly impro ves and simplifies the transtracheal oxygen program, and the otolaryng ologist becomes an important member of the transtracheal oxygen team.