Tracheostomy: How and When Should It Be Done in Cardiovascular Surgery ICU?

Abstract

Background: The aim of this study was to assess the effect of timing and techniques of tracheostomy on mortality and morbidity in cardiovascular surgery patients. Methods: Between January 2000 and October 2007, a total of 19,559 cardiac and vascular operations were performed in our hospital, and 205 of these patients (1.04%) who underwent a tracheostomy procedure were included in this retrospective study. Results: Surgical tracheostomy (ST) was employed in 134 (65.4%) and percutaneous tracheostomy (PT) in 71 (34.6%) of the cases. There were 17 complications related to all tracheostomy procedures in 15 (7.3%) patients. Bleeding, requiring surgical intervention, occurred in five (3.7%) ST patients and in one (1.4%) PT patient. Cardiac arrest related to the procedure occurred in two (1.5%) ST patients. Pneumothorax occurred in three (2.2%) ST patients and in one (1.4%) PT patient, subcutaneous emphysema in three (2.2%) ST patients and in one (1.4%) PT patient, and tracheoesophageal fistula in one (0.7%) ST patient (p > 0.05). The postoperative infection rate was significantly lower, and cooperation of the patients, postoperative patient mobilization, and oral feeding rates were higher in the early tracheostomy group. The multifactorial mortality rates of early (<seven days) and late tracheostomies were 71.4% and 88.1%, respectively (p = 0.037). Conclusions: We believe that both techniques can be performed safely in the ICUs. Although the need of tracheostomy is one of the foremost causes of mortality and morbidity in cardiovascular surgery patients, an early application of the procedure may have favorable effects on the expected mortality and overall infection rates of the critically ill patients. doi: 10.1111/j.1540-8191.2008.00695.x (J Card Surg 2009;24:11-18) Tracheostomy is one of the oldest surgical operations and also one of the most commonly performed procedures among critically ill patients, yet the optimal timing and method of performing tracheostomies in this population remains to be established. 1,2 In 1,[3][4][5][6][7][8][9][10][11][12][13]

Early versus late tracheostomy in cardiovascular intensive care patients

“…Yavas et al published a single centre review of 205 patients and found that ET was associated with earlier mobilization, earlier enteral feeding, lower incidence of infections, and lower mortality. Furthermore, this study confirmed that percutaneous tracheostomy performed after the cardiac surgical procedure did not increase the incidence of sternal osteomyelitis and sternal wound dehiscence [15]. Trouillet and colleagues conducted a prospective cohort study of 163 patients who were still mechanically ventilated 3 days after cardiac surgery.…”

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

“…Recent work described an opposite picture; only a minority, 1.04% to 4.13% of patients underwent a tracheostomy, mostly performed at the bedside in a percutaneous approach. 3,4,[7][8][9][10][11][12][13][14] The overall survival rate is low in patients undergoing a tracheostomy after cardiac surgery. Walts et al 13 described a 1-year survival rate of 31%; Ballotta et al 2 described a 1-and 2-year survival rate of 29% and 31%, respectively.…”

Is Early Tracheostomy a Risk Factor for Mediastinitis after Median Sternotomy?

“…In any case the institutional protocols for prophylaxis were not changed during the study period and have guaranteed homogeneity of treatment among the study patients. The effect of dilatational percutaneous tracheostomy on the incidence of sternal wound complications should be addressed in dedicated investigations 13 …”