During November 95 to April 97, 45 percutaneous dilatational tracheostomies were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheostomy was performed as early as the 2nd postoperative day (median: 6th day), when extubation was not foreseen within the next few days. Duration of intubation was 13 days (mean). We observed 6 complications in 5 patients (13.3%), namely bleeding, misplacement of the tube, subcutaneous emphysema, and superficial infection of the tracheostoma. Mediastinitis and wound infection of the sternal wound did not occur in any single case. There was no death due to tracheostomy. Clinically evident tracheal stenosis and inadequate granulation of the stoma were not observed after extubation. In our opinion, percutaneous dilatational tracheostomy is justifiable, shows good results, and entails minimal risk if done early after cardiac surgery, and it is also superior to standard surgical tracheostomy. Increased incidence of mediastinitis was not seen.

Percutaneous dilatational tracheotomy early after eardiac surgery -Outcome and incidence of sternal infectionZusammenfassung Bei 2788 Patienten, die im Zeitraum von 11/95 bis 4/97 an unserer Klinik am Herzen operiert wurden, sind 45 (1,6 %) einer perkutanen Dilatations-Tracheotomie unterzogen worden. Die Indikationsstelltmg erfolgte ab dem zweiten postop. Tag, wenn eine Extubation in den n~ichsten Tagen nicht absehbar war. Die Tracheotomie erlblgte im Mittel am 6, postop. Tag, die Intubationsdauer lag im Mittel bei 13 Tagen. Wir sahen bei 5 Patienten insgesamt 6 Komplikationen (13,3%). Bei keiner der 45 durchgeffihrten Tracheotomien trat im weiteren Verlauf eine Mediastinitis oder eine Wundhei-lungsst6rung im Bereich der Sternotomie auf. Es gab keinen Todesfall aufgrund der Tracheotomie. Klinisch evidente AufF, illigkeiten im respirato¡ Bereich nach Extubation wurden nicht beobachtet. Die perkutane Dilatations-Tracheotomie ist frª nach herzchirurgischen Eingriffen eine schnelle, effiziente und risikoarme Methode. Die Methode ist unserer Ansicht nach der konventionellen chirurgischen Methode deutlich ª Summary From 11/95 until 4/97, 45 percutaneous dilatational tracheotomles were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheotomy was performed as early as postop, day 2 (mean 6), when extubation was not tbreseen within the next few days. Duration of intubation was 13 days (mean). In five patients 6 complications (13,3%) were observed, including bleeding, misplacement of the tube, subcutaneous emphysema, and superficial infection of the tracheostoma. Mediastinitis and wound infection of the sternal wound did not occure in a single case. No death occured because of tracheotomy. Clinically evident tracheal stenosis and inadequate granulation of the stoma were not seen after extubation. In our opinion, percutaneous dilatational tracheotomy is feasible with good results and minimal risk early after cardiac surgery and is superior to standard surgical tracheotomy. Increasing incidence of mediastinitis was not seen. SchlªPerkutane Tracheotomie, Her'zchirurgie -Mediastinitis -ICU -Luftwege

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