- Email: [email protected]
A TRACHEOTOMY TUBE FOR USE IN ACUTE POLIOMYELITIS
26 So far two healthy people have each received a and two patients with H.L.D. have received four and three trial doses, of penicillamine. The copper excretion has been estimated and, in the patients, compared with that produced by a dose of dimercaprol containing an approximately equimolar amount of sulphur. These preliminary tests suggest that dimethyl cysteine is as active as dimercaprol in promoting the removal of copper from the body. Dimethyl cysteine hydrochloride was given as three daily doses each of 300 mg. ; the drug was given about half an hour before meals in order to avoid its chelating with copper present in the diet. In these short-term experiments no toxic reactions were observed. A detailed report of this work is in course of preparation, and the possible use of this form of treatment for long-term maintenance of patients with
single dose,
THE maintenance of a tracheotomy tube during emergencies may lead to many difficulties, especially before the tracheostomy tract has properly formed : Fixation.—The normal movements of patient and attachments with intermittent positive-pressure inflation, routine posturing, and drainage may easily displace an ordinary
cut-down ansesthetic endotracheal tube which may cause If a longstemmed tube is used, a bronchus may become blocked, causing retention of carbon dioxide and respiratory embarrassment.
surgical emphysema and traumatic pneumothorax.
a
tracheo-
tomy tube may be more obvious, but no more lethal, than partial occlusion, which may often be produced in anaesthetic tubes ; even armoured tubes may close partially in the anteroThis may be detected before use by suction catheter (which has previously just passed easily) ; if it is gripped when the tube is bent, the latter should be discarded. Tracheal Ulceration.—In debilitated patients direct pressure of an inflated cuff may cause ischaemia of the tracheal mucosa ; and a tube without a rigid angle may rub the posterior tracheal wall owing to its relative inflexibility.
posterior trying to
diameter. withdraw
J. M. WALSHE Medical Unit, University College Hospital Medical School, London, W.C.1
M.A., M.B. Camb., M.R.C.P.
to suit the patient, are unlikely to - kink. However, the short intratracheal portion of these tubes, especially in the smaller sizes, does not allow easy fixation of slip-on cuffs, which in any case are clumsy and
A TRACHEOTOMY TUBE FOR USE IN ACUTE POLIOMYELITIS
occlusion of the lumen of
and the 2nd and 4th Medical Services (Harvard), Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston, Massachusetts. I am most grateful to Dr. C. S. Davidson for his advice and encouragement ; to Dr. D. Denny Brown for allowing me to study two of his patients ; and to Dr. Augustus Gibson, of Merck & Co., Rahwav, N.J., and to Prof. John Sheehan, of the Massachusetts Institute of Technology, for supplies of penicillamine.
fully selected
New Inventions
Kinking.—Complete
is discussed with reference to possible chronic toxicity and precautions which should be taken in undertaking a long-term study. Reference is also made to the treatment of other heavy metal poisonings with penicillamine. This work was done at the Thorndike Memorial Laboratory H.L.D.
a
Angulated rubber tracheotomy tubes (Morrant Baker) may be the best of those tubes readily available for use with intermittent positive-pressure inflation, and, care-
unsuitable for prolonged use. Moreover the fixation of connections to the flush external flange is difficult, especially when surgical dressings are present, as in the early postoperative stages. Some rubber tubes are of inconstant diameter, having an irregular inner wall which prevents the easy passage of a suction catheter. In the Portsmouth Poliomyelitis Centre a tracheotomy tube has been improvised by several members of the staff jointly which appears to have none of the aforementioned disadvantages and many additional advanNone of us accepts full responsibility or tages. claims any originality for this tube ; so we call it the Smith tube after the first patient in whom it served as a reliable non-traumatic airway during many days of intermittent positivepressure inflation. The Smith tube is essentially a suitably selected and cut-down anaesthetic endotracheal tube into which is slid, to make a tight fit, a similarly selected silver lining, which is the outer shell of a standard silver tracheotomy tube from which the external flange has been In the accompanying illustraremoved. tion the wall has been cut away from a Smith tube to show the lining. A latex rubber collar is attached. The advantages of the Smith tube are as follows :: (1) The fixed curve and attached collar make fixation easy and reliable. (2) The tube cannot be compressed or occluded in any diameter. (3) A smooth and regular inner wall allows the passage of the largest possible suction catheter at all times. (4) The fixed curve ensures that there is no pressure on the posterior tracheal wall. (5) Variable intratracheal and extratracheal lengths can be selected (above and below angle) to suit the portion of trachea available above the carina, and to make easy connection with anaesthetic or intermittent positive-pressure apparatus. (6) The Smith tube can be made of different sizes, lengths, shapes, and lumina and cuffed or uncuffed from ready-to-hand materials at low cost. R. J. HAMER HODGES F.F.A. R.C.S., D.A.
ROBERT MORLEY F.R.C.S.E.
W. B. O’DRISCOLL M.B. N.U.I.
Portsmouth Poliomyelitis Centre
IAN MCDONALD M.B.
Melb.,
D.A.
single dose,
THE maintenance of a tracheotomy tube during emergencies may lead to many difficulties, especially before the tracheostomy tract has properly formed : Fixation.—The normal movements of patient and attachments with intermittent positive-pressure inflation, routine posturing, and drainage may easily displace an ordinary
cut-down ansesthetic endotracheal tube which may cause If a longstemmed tube is used, a bronchus may become blocked, causing retention of carbon dioxide and respiratory embarrassment.
surgical emphysema and traumatic pneumothorax.
a
tracheo-
tomy tube may be more obvious, but no more lethal, than partial occlusion, which may often be produced in anaesthetic tubes ; even armoured tubes may close partially in the anteroThis may be detected before use by suction catheter (which has previously just passed easily) ; if it is gripped when the tube is bent, the latter should be discarded. Tracheal Ulceration.—In debilitated patients direct pressure of an inflated cuff may cause ischaemia of the tracheal mucosa ; and a tube without a rigid angle may rub the posterior tracheal wall owing to its relative inflexibility.
posterior trying to
diameter. withdraw
J. M. WALSHE Medical Unit, University College Hospital Medical School, London, W.C.1
M.A., M.B. Camb., M.R.C.P.
to suit the patient, are unlikely to - kink. However, the short intratracheal portion of these tubes, especially in the smaller sizes, does not allow easy fixation of slip-on cuffs, which in any case are clumsy and
A TRACHEOTOMY TUBE FOR USE IN ACUTE POLIOMYELITIS
occlusion of the lumen of
and the 2nd and 4th Medical Services (Harvard), Boston City Hospital, and the Department of Medicine, Harvard Medical School, Boston, Massachusetts. I am most grateful to Dr. C. S. Davidson for his advice and encouragement ; to Dr. D. Denny Brown for allowing me to study two of his patients ; and to Dr. Augustus Gibson, of Merck & Co., Rahwav, N.J., and to Prof. John Sheehan, of the Massachusetts Institute of Technology, for supplies of penicillamine.
fully selected
New Inventions
Kinking.—Complete
is discussed with reference to possible chronic toxicity and precautions which should be taken in undertaking a long-term study. Reference is also made to the treatment of other heavy metal poisonings with penicillamine. This work was done at the Thorndike Memorial Laboratory H.L.D.
a
Angulated rubber tracheotomy tubes (Morrant Baker) may be the best of those tubes readily available for use with intermittent positive-pressure inflation, and, care-
unsuitable for prolonged use. Moreover the fixation of connections to the flush external flange is difficult, especially when surgical dressings are present, as in the early postoperative stages. Some rubber tubes are of inconstant diameter, having an irregular inner wall which prevents the easy passage of a suction catheter. In the Portsmouth Poliomyelitis Centre a tracheotomy tube has been improvised by several members of the staff jointly which appears to have none of the aforementioned disadvantages and many additional advanNone of us accepts full responsibility or tages. claims any originality for this tube ; so we call it the Smith tube after the first patient in whom it served as a reliable non-traumatic airway during many days of intermittent positivepressure inflation. The Smith tube is essentially a suitably selected and cut-down anaesthetic endotracheal tube into which is slid, to make a tight fit, a similarly selected silver lining, which is the outer shell of a standard silver tracheotomy tube from which the external flange has been In the accompanying illustraremoved. tion the wall has been cut away from a Smith tube to show the lining. A latex rubber collar is attached. The advantages of the Smith tube are as follows :: (1) The fixed curve and attached collar make fixation easy and reliable. (2) The tube cannot be compressed or occluded in any diameter. (3) A smooth and regular inner wall allows the passage of the largest possible suction catheter at all times. (4) The fixed curve ensures that there is no pressure on the posterior tracheal wall. (5) Variable intratracheal and extratracheal lengths can be selected (above and below angle) to suit the portion of trachea available above the carina, and to make easy connection with anaesthetic or intermittent positive-pressure apparatus. (6) The Smith tube can be made of different sizes, lengths, shapes, and lumina and cuffed or uncuffed from ready-to-hand materials at low cost. R. J. HAMER HODGES F.F.A. R.C.S., D.A.
ROBERT MORLEY F.R.C.S.E.
W. B. O’DRISCOLL M.B. N.U.I.
Portsmouth Poliomyelitis Centre
IAN MCDONALD M.B.
Melb.,
D.A.