The use of a short-length transtracheal oxygen catheter in patients of small stature with restrictive lung disease.

Transtracheal oxygen therapy is being used with increasing frequency because it is an effective mode of oxygen delivery and is well tolerated by patients. An increase in cough and mild intermittent hemoptysis are not uncommon in the early postinsertion period but usually resolve spontaneously. Herein we present two individuals of short stature with restrictive lung disease who had persistence of excessive cough and mild hemoptysis after insertion of a standard catheter (SCOOP). Bronchoscopic evaluation in one revealed erosions of the mucosa over the carina and take-off of the right main-stem bronchus. Symptoms resolved in both individuals following placement of a shorter catheter. We suggest that greater consideration be given to matching transtracheal catheter length to patient lung size, particularly in the face of severe restrictive lung disease.

Does chest physical therapy work?

Postural drainage has usually been shown to be an effective component of chest physical therapy; there is currently no data showing a beneficial effect of percussion or vibration; directed coughing may be as efficacious as postural drainage (Table 3); the forced expiration technique may increase sputum clearance with or without postural drainage (Table 4).

Chest percussion and postural drainage in patients with bronchiectasis.

Patients with chronic obstructive pulmonary disease have been treated routinely with chest physical therapy for many years in spite of a lack of scientific validation of this procedure. Only recently have the indications for chest physical therapy been clarified. It is currently believed that such therapy is especially beneficial in patients with copious secretions, and that it is less effective in patients with scanty secretions. No study has specifically evaluated the efficacy of chest physical therapy in patients with bronchiectasis. We accordingly evaluated 13 patients with stable bronchiectasis to determine the effects of chest physical therapy on pulmonary function, arterial oxygenation, and sputum production and to assess whether this therapy was associated with any significant side-effects. We found that chest physical therapy was safe and well tolerated and assisted the patients in mobilization of their sputum. However, such therapy had no immediate delayed effects on pulmonary function or oxygen saturation.

Transtracheal delivery of oxygen: efficacy and safety for long-term continuous therapy.

Transtracheal (TT) oxygen delivery involves administration of oxygen percutaneously through a catheter inserted in the suprasternal trachea. Transtracheal oxygen delivery has been proposed as a means of overcoming the high visibility, inconvenience, and discomfort associated with nasal cannula use. This report describes our experience using TT delivery in 40 patients with chronic obstructive pulmonary disease (n = 32) and other types of lung disease (n = 8). Overall acceptance of TT catheter use was high and only 5 subjects elected to discontinue use. We believe the TT route is a relatively safe approach for oxygen administration and a promising method of improving patient compliance. It also offers the potential of more adequately oxygenating patients with refractory hypoxemia.