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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
The Journal of Thoracic and Cardiovascular Surgery
|August 5, 2000
Summary
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.