There is controversy, at present, concerning the place of early (so-called elective or prophylactic) tracheotomy in the supportive treatment of acute anterior poliomyelitis with severe respiratory involvement. Those who oppose its use, exemplified in the literature by Stimson1 and Sweet,2 claim comparable results with conservative treatment, with tracheotomy used as a last resort. Galloway,3 Weiland,4 Brown and associates,5 and West and Bower,6 on the other hand, favor it as the most effective means of combating obstruction of the airway by secretions and vocal cord palsy. It would appear the trend in recent years has been toward the latter approach, particularly in the larger poliomyelitis centers.
It seems apparent that two phases of the problem exist. Initially, the patient must be protected from early asphyxial death resulting from high respiratory tract obstruction, pulmonary edema, and hypoventilation. Later, lower respiratory tract obstruction with its subsequent atelectasis