title: Early tracheostomy following lung transplantation.
abstract: BACKGROUND
  Despite the common use of tracheostomy in lung transplant (LT) patients, little data exist regarding the indications, timing, periprocedural complications, and impact on outcomes of the procedure.
  
  
  METHODS
  We retrospectively analyzed some characteristics and timing of all tracheostomies performed in our lung transplant recipients during a 5-year period.
  
  
  RESULTS
  Between January 2004 and November 2009, 31 of 126 lung transplant patients (24.6%) underwent a tracheostomy. They included 14 men with a mean age of 42 years (range, 10 to 61 years) and 17 women with a mean age of 45 years (range, 10 to 64 years). Twenty eight patients undergoing a tracheostomy had a prior bilateral sequential LT and 4 had accepted a single lung. Tracheostomy was surgically performed (ST) in 6 of 31 patients (19.3%); percutaneous tracheostomy (PT) techniques were applied for the other 25 (80.6%) cases. The decision to perform a tracheostomy was made within 4 days from LT in 21 of 31 patients (67.7%), within 8 days in 6 (19.3%) and after 10 days for the other 4 (12.9%) cases. There were no major complications during the PT procedures; no conversion to ST, no loss of airway, no paratracheal insertion, and no accidental tracheal extubation. No pneumothorax, pneumomediastinum, hypotension, hypoxemia, or arrythmyas were recorded in the early post-procedural period. The mean post-LT duration of cannulation was 17 days (range, 5 to 72 days).
  
  
  CONCLUSIONS
  An early tracheostomy may be of considerable benefit for the debilitated patient who will likely require prolonged mechanical ventilation because of a complicated intraoperative course and poor recovery of graft function. PT was performed more quickly and was associated with fewer postoperative complications than ST. We recommend an aggressive strategy in the immediate posttransplant period when extubation fails or is delayed for various reasons.
authors.affiliation: Department of Pharmacology and Anestesiology, University Hospital of Padova, Italy. paolofeltracco@inwind.it
authors.forename: P
authors.initials: P
authors.lastname: Feltracco
authors.forename: M
authors.initials: M
authors.lastname: Milevoj
authors.forename: V
authors.initials: V
authors.lastname: Alberti
authors.forename: C
authors.initials: C
authors.lastname: Carollo
authors.forename: E
authors.initials: E
authors.lastname: Michieletto
authors.forename: F
authors.initials: F
authors.lastname: Rea
authors.forename: M
authors.initials: M
authors.lastname: Loy
authors.forename: G
authors.initials: G
authors.lastname: Marulli
authors.forename: C
authors.initials: C
authors.lastname: Ori
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007558:Italy; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult