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Eur Respir J 2002; 20:112-117
Copyright ©ERS Journals Ltd 2002

Effects of tracheotomy on respiratory mechanics in spontaneously breathing patients

V. Moscovici da Cruz1, S.E. Demarzo1, J.B.B. Sobrinho2, M.B.P. Amato2, L.P. Kowalski1 and D. Deheinzelin1

1 Centre for Treatment and Research, Cancer Hospital, Antonio Prudente Foundation and 2 Faculty of Medicine, University of São Paulo, São Paulo, Brazil

CORRESPONDENCE: V. Moscovici da Cruz, Unidade de Terapia Intensiva, Hospital do Câncer, Rua Prof. Antonio Prudente, 211 6° andar, São Paulo SP, Brasil, CEP 01509-010. Fax: 55 1130219787. E-mail: vasco77@hotmail.com

Keywords: intrinsic positive-pressure respiration, physiopathology, respiratory mechanics, tracheotomy, work of breathing

Received: August 16, 2001
Accepted January 14, 2002

This study was supported by grants from the Fundação de Amparo à Pesquisa >do Estado de São Paulo (FAPESP).

Tracheotomy is a method of intubating the trachea, which is employed in several clinical settings, including the treatment of head and neck neoplasms. Tracheotomy is believed to facilitate weaning through changes in respiratory mechanics. Existing information concerning functional changes associated with tracheotomy are limited to comparisons with orotracheal intubation.

In this study, respiratory mechanics were monitored in seven spontaneously breathing patients, before and after an elective tracheotomy was performed for surgical treatment of cancer. Campbell diagrams were constructed by plotting pressure, obtained with an oesophageal balloon catheter, against volume, obtained from a pneumotachograph placed at the airway opening. Work of breathing was calculated as the internal area of the Campbell diagram and was partitioned into its elastic and inspiratory and expiratory resistive components. Oesophageal pressure was also used to quantify intrinsic positive end-expiratory pressure (PEEPi) and the pressure-time product (PTP), which is considered to be proportional to the oxygen cost of breathing. PTP was divided into its resistive and elastic components.

Inspiratory resistive work, PEEPi, inspiratory PTP, as well as its resistive and elastic components were significantly reduced by tracheotomy.

Tracheotomy significantly reduces work of breathing and pressure-time product in spontaneously breathing patients.






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Copyright © 2002 by the European Respiratory Society.