title: Percutaneous dilatational tracheostomy done early after cardiac surgery--outcome and incidence of mediastinitis.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Bad Rothenfelde, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Hübner
authors.forename: W
authors.initials: W
authors.lastname: Rees
authors.forename: K
authors.initials: K
authors.lastname: Seufert
authors.forename: M
authors.initials: M
authors.lastname: Böckelmann
authors.forename: U
authors.initials: U
authors.lastname: Christmann
authors.forename: H
authors.initials: H
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass; D003422:Critical Care; D004106:Dilatation; D019723:Endoscopes; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008480:Mediastinitis / Q000209:etiology*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000628:therapy; D013530:Surgical Wound Infection / Q000209:etiology*; D014139:Tracheostomy / Q000295:instrumentation*; D016896:Treatment Outcome