Cases Developed Poorly Prognosis after Tracheotomy in Cases of Subglottic and Tracheal Lesion.

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Three cases of severe dyspnea following tracheotomy for subglottic and tracheal lesions. Case 1 was a 46-year-old woman with relapsing polychondritis and narrow trachea; Case 2 was a 74-year-old man with a malignant thyroid lymphoma and bronchial asthma; Case 3 was a 42-year-old man with bronchial adenocarcinoma. These cases had their main problem in the lower bronchus. In a pre-operative blood-gas analysis, no hypercapnia were observed.<BR>In these cases, the peripheral bronchi were filled with a mucous secretion, and the mucosa of the bronchus showed swelling due to long term hypoxemia. Following tracheotomy, dry and unheated air came entered the bronchus, resulting in the collapsed peripheral bronchi and the dysfunction in respiration. Thus, these 3 cases developed severe dyspnea at the time of tracheotomy, and 2 of them died in a very short time.<BR>Very important function of the upper respiratory system is humidifying and warming the air of inhaling air. This function normalize cilia movement and cycle of mucous gland in the peripheral bronchus. We speculated that severe dyspnea in these cases were occurred by defect of the function in the upper respiratory system, and inability of ventilation in the peripheral bronchi. Necessity of an autonomic respiratory system should be considered, when tracheotomy is performed in such cases, because main problem exist in lower respiratory system.
特定非営利活動法人日本気管食道科学会の論文