title: A survey of tracheostomy practice in a cardiothoracic intensive care unit.
abstract: OBJECTIVE
  The purpose of this study was to assess current practice of performing tracheostomies in critically ill cardiac surgical patients, to establish complication rates, and to identify areas of this clinical practice that could be improved.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  A cardiothoracic intensive care unit in a teaching hospital.
  
  
  METHODS
  The most recent series of 100 tracheostomies performed in patients admitted to the intensive care unit.
  
  
  METHODS
  Percutaneous or surgical tracheostomy for respiratory management.
  
  
  RESULTS
  A total of 95 patients had 1 tracheostomy performed. One patient had a tracheostomy performed twice, and 1 patient had a tracheostomy performed 3 times; these repetitions were caused by recurrent respiratory failure. The median time from tracheal intubation to tracheostomy was 5 days (range, 1-23 days; interquartile range, 4-8 days), and median period between insertion and decannulation was 20 days (range, 2-77 days; interquartile range, 12-25 days). The most common reason for insertion was an anticipated long weaning time (55%) followed by insertion after failed extubation (32%). The Ciaglia percutaneous dilational technique was used for 89% of tracheostomies, whereas surgical techniques were used for 8%. The most common complication was either complete or partial obstruction of the tracheostomy tube (24%) followed by infection of the tracheostomy site in 18% (17/94) and bleeding at the time of insertion (11%).
  
  
  CONCLUSIONS
  The percutaneous dilational technique of tracheostomy was used predominantly in this unit. The median time from tracheal intubation to tracheostomy was 5 days. The most common complications were bleeding at the time of insertion, obstruction of the tracheostomy tube, and stomal infection.
authors.affiliation: Department of Anaesthesia, Southampton General Hospital, Southampton, Hampshire, United Kingdom. dr.spike@virgin.net
authors.forename: Spike
authors.initials: S
authors.lastname: Briggs
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ambler
authors.forename: David
authors.initials: D
authors.lastname: Smith
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D003422:Critical Care / Q000592:standards; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007902:Length of Stay; D011183:Postoperative Complications; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D006113:United Kingdom