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Early percutaneous tracheostomy after median sternotomy
1Department of Anesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe-University Hospital Center, Frankfurt, Germany. c.byhahn@em.uni-frankfurt.de
Objective:
Tracheostomy offers significant advantages over endotracheal intubation in patients requiring long-term assisted ventilation. However, in patients who have undergone median sternotomy, it is believed that the danger of microbial contamination and consecutive infection of the sternal wound with microbes from the tracheostomy is high when conventional tracheostomy is performed. In contrast, percutaneous techniques are less likely to result in tracheostomy infection and thus bacterial contamination of neighboring structures. Nonetheless, to date there has been no prospective study confirming or disproving this assumption. Our study evaluated outcome after percutaneous tracheostomy in patients with a median sternotomy.
Methods:
A total of 144 cardiac surgical patients had elective percutaneous tracheostomy at the bedside until postoperative day 14, with 4 different techniques. Systematic microbiologic monitoring of the sternal and tracheal wounds was used.
Results:
In 13 patients sternal wound infection was suspected, but was confirmed in only 4 (2.8%) patients who actually showed microbial contamination of the sternum. In 2 of these patients, the identified microbes were not identical to those cultured from the trachea. The other 2 patients had sternal and tracheal cultures positive for methicillin-resistant Staphylococcus aureus. Cross-contamination of the sternotomy with microbes from the patient's airways was therefore ruled out. No patient had clinical signs of tracheostomy infection. Likewise, there were no cases of mediastinitis.
Conclusions:
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.
Insights
Percutaneous tracheostomy is safe for patients after median sternotomy. This study found no increased risk of sternal wound infection or cross-contamination from the airway, confirming its safety.
Area of Science:
- Medicine
- Surgery
- Infectious Diseases
Background:
- Tracheostomy is preferred over endotracheal intubation for long-term ventilation.
- Conventional tracheostomy poses a high risk of sternal wound infection in patients with median sternotomy.
- Percutaneous tracheostomy may reduce infection risk, but evidence is limited.
Purpose of the Study:
- To evaluate the safety and outcomes of percutaneous tracheostomy in patients who have undergone median sternotomy.
- To determine the risk of sternal wound infection and cross-contamination after percutaneous tracheostomy in this patient group.
Main Methods:
- A prospective study involving 144 cardiac surgical patients.
- Elective percutaneous tracheostomy performed within 14 days post-surgery using 4 techniques.
- Systematic microbiologic monitoring of sternal and tracheal wounds.
Main Results:
- Only 4 (2.8%) patients developed confirmed sternal wound microbial contamination.
- Cross-contamination from the trachea to the sternal wound was ruled out in all cases.
- No clinical signs of tracheostomy infection or mediastinitis were observed.
Conclusions:
- Percutaneous tracheostomy is a safe procedure for patients within 14 days of median sternotomy.
- Cross-contamination of the sternal wound with microbes from the trachea is not a significant concern.
- This technique minimizes the risk of infection in post-sternotomy patients requiring tracheostomy.