Early percutaneous tracheostomy after median sternotomy

Abstract

On the basis of our data, we conclude that cross-contamination of the sternal wound with microbes from the trachea is not a problem. Elective percutaneous tracheostomy is safe, even if performed during the first 14 days after median sternotomy.

Weaning from ventilator after cardiac operation using the Ciaglia percutaneous tracheostomy

“…Much of this controversy originates from the difficulty of accurately predicting both the length of time that patients will likely require mechanical ventilation, and the kind of patients that will gain one or more of the benefits ascribed to tracheostomy versus the probability they will suffer from any reported procedural complications. Although some authors prefer early tracheostomy [13,20], there is no adequate comparative study as to the advantages of this approach [24]. Decreased airway resistance, more effective airway suctioning and mouth care, enhanced patient mobility and comfort with free nose and pharynx, ability to speak and eat orally, more secure airway control, quicker and safer tube replacement, and more secure fixation are the recognized advantages of tracheostomy versus prolonged translaryngeal intubation.…”

“…In addition to this, while off-pump cardiac surgery is becoming widespread, most cardiac operations are still performed on cardiopulmonary bypass that has long been recognized as one of the main causes of a complex systemic inflammatory response contributing to postoperative complications and organ dysfunction. Out of the accepted advantages of percutaneous versus open tracheostomy [5,7], ease of performance at the patient's bedside in ICU, rapidity of execution, lesser reduction of the oxygenation index early after procedure [12], lower risk of cross-contamination of the sternal wound with microbes from the trachea [13], and generally lower complications rates are the most important to cardiosurgical patients.…”

Percutaneous Tracheostomy After Mechanical Ventricular Assist Device Implantation

“…22 This advantage of PDT may be attributable to the small size of the incision and the tight fit that results from dilation. 10 The PDT procedure also takes significantly less time than conventional tracheostomy. 20 Furthermore, PDT can be performed in the ICU, eliminating the use of valuable operating suite time and resources.…”

Association between post-sternotomy tracheostomy and deep sternal wound infection: a retrospective analysis

“…It could be argued that in principle, delaying the tracheostomy could interfere less with early phase of sternal and incisional healing. However, this has not be uniformly supported by clinical data, with reports refuting the association between tracheostomy and DSWI (5,7,8).…”