Tracheostomy and Open Heart Surgery

Robertson, D. S.

doi:10.1177/003591576405700943

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…1 It was first described after cardiac surgery in 1964. 2 The possible predictors of early-and longterm survival in these patients are not yet well established. 3 Devarian et al 4 concluded that early tracheostomy after cardiac surgery was associated with reduced morbidity and mortality.…”

mentioning

confidence: 99%

Tracheostomy After Cardiac Surgery: Timing of Tracheostomy as a Risk Factor for Mortality

Ben-Avi

Ben‐Nun

Levin

et al. 2014

Journal of Cardiothoracic and Vascular Anesthesia

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confidence: 99%

Tracheostomy After Cardiac Surgery: Timing of Tracheostomy as a Risk Factor for Mortality

Ben-Avi

Ben‐Nun

Levin

et al. 2014

Journal of Cardiothoracic and Vascular Anesthesia

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“…Two other similar series have been reported in recent years (Robertson, 1964;Trimble and Yao, 1966), but the series of McClelland (1965) and pf Neville, Spinazzola, Scicchitano, and Langston (1964) dealt with a wider selection of patients. Robertson, in his series in 1963, gave an overall incidence for tracheostomy of 32-4% in 389 patients undergoing open-heart surgery, which compares with the 38% in the present series.…”

Section: Discussionmentioning

confidence: 73%

“…The reasons for this are not clear but may be related to the longer mean duration of tracheostomy of 14-7 days, compared with 6 5 days (Robertson, 1964) and 6 days (Trimble and Yao, 1966). The only complications reported in the latter series were infection (not detailed) in seven patients; in the former series complications consisted of an obstructed airway in several patients, haemorrhage in two, and anoxia during suction in one.…”

Section: Discussionmentioning

confidence: 99%

The use of tracheostomy following major open cardiac surgery: a review of 64 cases

Nicholls

1968

Thorax

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in patients unfdergoing major open-heart surgery are reviewed. The indications and complications are classified, and the high incidence of secondary infection is discussed briefly. Tracheal stenosis or dilatation occurred in six patients (9 4%) and the contributory factors are discussed in greater detail.Tracheostomy is one of the oldest established procedures in surgical practice, but the indications for its use have undergone considerable changes, particularly in the last 25 years (Borman and Davidson, 1963). Its use is again under review (Lancet, 1967) and, as a result of the associated complications, many centres are using alternative methods, such as oro-tracheal and naso-tracheal intubation, even though they may have their own drawbacks (Tonkin and Harrison, 1966).It is therefore pertinent to review the use of tracheostomy in relation to one of the more recent indications-that is, after major open cardiac surgery. MATERIAL AND METHODSAll patients admitted to the intensive care unit at the Brompton Hospital from 1 September 1965 to 31 August 1966 were assessed. The minimum period of follow-up was four months to allow for the development of late complications. Of 179 patients submitted to cardiopulmonary bypass surgery 68 required a tracheostomy for intermittent positive pressure respiration.The case records of 64 of these patients were examined; four were untraced. They consisted of a mixed population whose ages ranged from 6 to 63 years (average 34 years). Two patients had a second tracheostomy, and these are included as separate entities, as they were separated by a sufficient period of time and were, in any case, performed for different indications. There were 41 survivors (65%).TECHNIQUE AND MANAGEMENT All tracheostomies in this series were performed by a member of the sur-1 Present address: West Herts Hospital, Hemel Hempstead, Herts gical team, and all followed a common technique. Under general anaesthesia the method of Bjork (1960), using a transverse skin incision and constructing an anterior tracheal wall flap stitched to the subcutaneous tissues, was used. A plastic (Portex) cuffed tracheostomy tube, of the standard pattern and appropriate size, was inserted and the cuff was inflated just sufficiently to make an airtight seal. A dry dressing only, or skin sutures, were used, and the tracheostomy tube was then connected to a sterile respirator of the intermittent positive pressure type.During the period under review the nursing staff observed the following instructions for the management of the tracheostomy:The cuff was not released for the first 12 hours, and was then released for one minute every four hours following pharyngeal suction. It was then inflated again with just sufficient air to make an airtight seal.Tracheal suction was applied hourly, or more frequently if necessary, via a sterile rubber catheter held by sterile forceps. A 'no-touch' technique was desirable but was not always possible.The wound was cleaned with chlorhexidine

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“…It is important to have just the right amount of air in the cuff and no more, and to fix the tube so that a minimum of movement occurs. Frequent deflation of the cuff would seem to be essential, though opinions differ widely as to how often this should be done (Robertson, 1964;Kodicek, 1960;Watts, 1963;Glossop, 1966). Intermittent inflation of the cuff during inspiration may be achieved by means of a valve inserted in the pressure line of the Bird respirator (Cosby, 1965).…”

Section: Discussionmentioning

confidence: 99%

Aetiology and repair of tracheal stenosis following tracheostomy and intermittent positive pressure respiration.

Gibson¹

1967

Thorax

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Tracheostomy and Open Heart Surgery

Cited by 10 publications

References 32 publications

Tracheostomy After Cardiac Surgery: Timing of Tracheostomy as a Risk Factor for Mortality

Tracheostomy After Cardiac Surgery: Timing of Tracheostomy as a Risk Factor for Mortality

The use of tracheostomy following major open cardiac surgery: a review of 64 cases

Aetiology and repair of tracheal stenosis following tracheostomy and intermittent positive pressure respiration.

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