Four and One-Half Years' Experience in the Treatment of Emphysema and Other Respiratory Insufficiencies by Tracheal Fenestration

¹ Associate in Surgery, New York Medical College.
² Medical Director, St. Anthony's Hospital.
³ Associate Professor of Surgery, New York Medical College.
⁴ Senior Resident in Thoracic Surgery, Metropolitan Hospital.

Experience with 36 consecutive cases of respiratory cripples treated with tracheal fenestration and repeated tracheobronchial aspirations and self-aspirations is reported. Twenty-nine had diffuse emphysema, and three had bullous emphysema. Eleven of the 32 emphysema cases had so-called "dry" emphysema. Three had active pulmonary tuberculosis; one of them had active silicotuberculosis. Two had cystic fibrosis of the pancreas. Among these end stage cases of respiratory insufficiencies, the best response to this form of therapy was obtained in diffuse emphysema. Eleven of these cases were rehabilitated, and the rest of them were palliated or markedly palliated with two exceptions. One of these two gained no benefit and the other died before the operation could be completed. Pulmonary function determinations with early follow-up studies are reported. The present indications for tracheal fenestration are enumerated. Our observations during the past four and one half years confirm the initial impression that the major source of disability in advanced diffuse emphysema, including so-called "dry" emphysema, is secretional occlusion of the peripheral bronchi and bronchioles rather than bronchial and bronchiolar spasm.