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

Ben-Avi, Ronny; Ben‐Nun, Alon; Levin, Shany; Simansky, David; Zeitlin, Nonna; Sternik, Leonid; Raanani, Ehud; Kogan, Alexander

doi:10.1053/j.jvca.2013.10.031

Cited by 18 publications

(15 citation statements)

References 23 publications

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“…The mortality rate at 3 months, 6 months, 1 year, and 2 years was 37%, 48%, 56%, and 58% in ET group and 58%, 70%, 74%, and 77% in LT group, respectively. They also report lower incidence of deep sternal wound infection (1.11% ET vs 8.26% LT), but no difference in ICU and hospital length of stay or days on MV [20]. Hosseinian et al published a retrospective cohort evaluating the impact of timing of tracheostomy on outcomes of patients with respiratory failure after cardiac surgery [21].…”

Section: Discussionmentioning

confidence: 99%

Early versus late tracheostomy in cardiovascular intensive care patients

Puentes

Jerath

Djaiani

et al. 2016

Anaesthesiol Intensive Ther

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Background: Benefits of tracheostomy have been well established. Most of the literature, refers these benefits to general intensive care population, excluding cardiac surgery or including only small number of these patients. On the other hand, there is no clear definition describing the proper time to perform the procedure and defining what are potential benefits of early compared to late tracheostomy. This retrospective cohort aims to assess the potential benefits of early tracheostomy on post-operative outcomes, length of stay and post-tracheostomy complications within cardiac surgical population. Methods: After obtaining REB approval, we conducted a retrospective chart review in a single, tertiary care institution, identifying patients who underwent tracheostomy after cardiac surgery from 1999 to 2006. Time-to-tracheostomy was defined as "early" if < 7 days or "late" if ≥ 7 days post-cardiac surgery). Results: 14,101 patients underwent cardiac surgery over the 7-year study period; from those, 147 (1.36%) received tracheostomy. 32 (22%) patients underwent early tracheostomy and 115 (78%) late tracheostomy. Incidence of atrial fibrillation (31.2% vs 61.7%; P = 0.003), kidney dysfunction (6.3% vs 27.2%; P = 0.015) and kidney failure 18.8% vs 43.5%; P = 0.013) were lower in the early tracheostomy group. There were no differences on post tracheostomy infection or presence of acute respiratory distress syndrome. Both the ICU and hospital length of stay were significantly shorter in early tracheostomy group, 21.5 (ET) vs 36.9 (LT) days and 37.5 (ET) vs 57.6 (LT) days respectively. There were no differences in mortality between groups. Conclusions: There are significant benefits in reduction of postoperative morbidities with overall shorter ICU and hospital stay. These benefits may promote faster patient rehabilitation with reduced healthcare costs.

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Section: Discussionmentioning

confidence: 99%

Early versus late tracheostomy in cardiovascular intensive care patients

Puentes

Jerath

Djaiani

et al. 2016

Anaesthesiol Intensive Ther

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“…Subgroup analysis was performed by reporting the proportion of SWI based on type ( Figure 2) and timing of tracheostomy ( Figure 3). The proportion of SWI after percutaneous tracheostomy was 3% (95% CI, [1][2][3][4][5][6][7][8], whereas after open tracheostomy this was 9% (95% CI, 5-14) ( Figure 2). Heterogeneity persisted in the open tracheostomy group (I 2 ¼ 94.0%, Q-stat ¼ 151, P < .0001) but slightly decreased in the percutaneous group (I 2 ¼ 84.8, Q-stat ¼ 43, P < .001).…”

Section: Resultsmentioning

confidence: 99%

“…Respiratory complications after cardiac surgery resulting in prolonged ventilation are common, particularly in high-risk subgroups. 1 Tracheostomy can be performed in these patients to improve patient comfort and hasten ventilator weaning. 2,3 Although respiratory insufficiency or prolonged intubation dominate as the main reasons for tracheostomy, heart failure and neurologic dysfunction are additional indications.…”

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confidence: 99%

“…Detailed reasons for exclusion of 19 articles are shown in Table E3. A total of 13 articles were included for the analysis ( Figure E1), 1,4,[7][8][9][10][11][12][15][16][17][18][19] All 13 studies underwent primary data extraction by 2 authors (HT and DF). Any discrepancy between the data extracted from individual studies was resolved by the involvement of a third author.…”

Section: Information Source Search Strategy and Data Extractionmentioning

confidence: 99%

“…The incidence of sternal wound infection across all studies reported was 7% (95% confidence interval [CI], [4][5][6][7][8][9][10]. The percutaneous tracheostomy group had a sternal wound infection proportion of 3% (95% CI, [1][2][3][4][5][6][7][8], and the open tracheostomy group had a sternal wound infection proportion of 9% (95% CI, [5][6][7][8][9][10][11][12][13][14]. The incidence of sternal wound infection with early (<14 days) (7%; 95% CI, 3-11) versus late (14 days) (7%; 95% CI, 4-10) tracheostomy was similar.…”

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confidence: 99%

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Incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery: A systematic review and meta-analysis

Toeg

French

Gilbert

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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The incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after cardiac surgery is a feasible option because the incidence of sternal wound infection and short-term mortality are comparable. Moreover, the timing of tracheostomy (early or late) had comparable rates of sternal wound infection and short-term mortality.

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Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review

Adly

Youssef

El-Begermy

et al. 2017

Eur Arch Otorhinolaryngol

139

103

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The objective of this article is to evaluate the appropriate timing of tracheostomy in patients with prolonged intubationregarding the incidence of hospital-acquired pneumonia, mortality, length of stay in intensive care unit (ICU) and duration of artificial ventilation. The study included published articles yielded by a search concerning timing of tracheostomy in adult and pediatric patients with prolonged intubation. The search was limited to articles published in English language in the last 30 years (between 1987 and 2017). For the 690 relevant articles, we applied our inclusion and exclusion criteria and only 43 articles were included. 41 studies in the adult age group including 222,501 patients and 2 studies in pediatric age group including 140 patients met our criteria. Studies in adult age group were divided into three groups according to the methodology of determining the cut off timing for early tracheostomy, they were divided into studies that considered early tracheostomy within the first 7, 14 or 21 days of endotracheal intubation, while in pediatric age group the cut off timing for early tracheostomy was within the first 7 days of endotracheal intubation. There was a significant difference in favor of early tracheostomy in adults' three groups and pediatric age group as early tracheostomy was superior regarding reduced duration of mechanical ventilation, with less mortality rates and less duration of stay in ICU. Regarding hospital-acquired pneumonia, it was significantly less in adult groups but with no significant difference in pediatric age group (3 patients out of 72 pediatric patient with early tracheostomy had pneumonia compared to 11 patients out of 68 with late tracheostomy). Studies defining early tracheostomy as that done within 7 days of intubation had better results than those defining early tracheostomy as that done within 14 or 21 days of intubation. In conclusion, early tracheostomy within 7 days of intubation should be done for both adults and pediatric patients with prolonged intubation.

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

Cited by 18 publications

References 23 publications

Early versus late tracheostomy in cardiovascular intensive care patients

Early versus late tracheostomy in cardiovascular intensive care patients

Incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery: A systematic review and meta-analysis

Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review

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