Bronchial Aspiration


Categories: TRACHEOTOMY
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

As mentioned above, bronchial aspiration is

often necessary. When the patient is unable to get up secretions, he

will, as demonstrated by the author many years ago, drown in his own

secretions. In some cases bronchoscopic aspiration is required

(Peroral Endoscopy, p. 483). Occasionally, very thick secretions will

require removal with forceps. Pus may become very thick and gummy from

the administration of morphin. Opiates do not lessen pus formation,

but they do lessen the normal secretions that ordinarily increase the

quantity and fluidity of the pus. When to this is added the

dessicating effect of the air inhaled through the cannula, unmoistened

by the upper air-passages, the secretions may be so thick as to form

crusts and plugs that are equivalent to foreign bodies and require

removal with forceps. Diphtheritic membrane in the trachea may require

removal with bronchoscope and forceps. Thinner secretions may be

removed by sponge-pumping. In most cases, however, secretions can be

brought up through an aspirating tube, connected to a bronchoscopic

aspirating syringe (Fig. 11), an ordinary aspirating bottle, or

preferably, a mechanical aspirator such as that shown in Fig. 12. In

this, combined with bronchoscopic oxygen insuflation (q.v.), we have a

life-saving measure of the highest efficiency in cases of poisoning by

chlorine and other irritant and asphyxiating gases. An aspirating tube

for insertion into the deeper air passages should be of copper, so

that it can be bent to the proper curve to reach into the various

parts of the tracheobronchial tree, and it should have a removable

copper-wire core to prevent kinking, and collapse of the lumen. The

distal end should be thickened, and also perforated at the sides, to

prevent drawing-in of the mucosa and trauma thereto. A rubber tube may

be used, but is not so satisfactory. The one shown in Fig. 10 I had

made by Mr. Pilling, and it has proved very satisfactory.





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