The Surgeon in a Respiratory Intensive Care Unit

¹ Associate Professor of Surgery, State University of New York at Buffalo, School of Medicine

The functions and responsibilities of a surgeon in a respiratory intensive care unit are discussed. He should be a competent thoracic and general surgeon and a skilled bronchoscopist. His responsibilities will include the maintenance of a patent tracheobronchial airway, proper ventilation, and satisfactory cardiovascular function. The surgeon will also be concerned with methods of maintaining tracheo-bronchial humidity, aerosolization, and mechanical ventilation.

Indications for bronchoscopy are discussed with particular reference to the use of copious saline bronchial lavage for mucus impactions in intractable asthma. The indications, techniques, and complications of tracheostomy are also outlined. Tracheostomy is being used with increasing frequency for lower respiratory tract disease with obstructing secretions and as a means of providing assisted or controlled respiration with mechanical ventilators. In special situations such as barbiturate poisoning, tracheostomy can be avoided and respiration can be maintained through a cuffed orotracheal tube. As discussed in the paper, the ultimate place of the surgeon in any one respiratory intensive care unit will vary considerably depending on a number of factors that may operate in that specific unit.