Tracheal fenestration: a critical evaluation.

Surgery often serves as a valuable adjunct in the management of chronic obstructive pulmonary emphysema. The operation of tracheostomy contributes to treatment by: (1) reducing the respiratory dead space, (2) diminishing the collapse of the bronchi on expiration, (3) facilitating tracheobronchial aspiration, and (4) permitting the local instillation of therapeutic agents. Recently modifications have been advocated to substitute for the standard tracheostomy because of certain alleged inconveniences of the latter procedure. One such proposal has been to create a tracheal fenestration1” which would lend itself to intermittent aspiration and local therapy, but remain closed at other times. The purpose of this report is to compare tracheal fenestration and standard tracheostomy in the treatment of chronic obstructive pulmonary emphysema by evaluation of the clinical course and the determination of blood gas studies in a series of patients.