Mortality and Airway Obstruction

Sir.—Liston et al alerted physicians caring for children that bacterial tracheitis may be an important cause of acute, infectious upper-airway obstruction.¹ Some conclusions drawn by the authors were not supported by their data.

The report included the following statements.

1. Pneumothorax occurred in two of nine children with bacterial tracheitis who received tracheostomies. A third child died when the tracheostomy tube came out and could not be replaced.

2. Two of five endotracheally intubated children had problems involving the suctioning of thick secretions, with the subsequent development of acute respiratory insufficiency because of mechanical obstruction of the endotracheal tube.

3. Two of five endotracheally intubated children who had bacterial tracheitis suffered total airway obstruction at the time of extubation; one child died.

The authors recommended that elective tracheostomy be performed at the time of the diagnosis of bacterial tracheitis in children, in preference to performing an endotracheal intubation.