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Tracheostomy Decannulation

Tracheostomy Decannulation

Tracheostomy decannulation is a significant milestone in the liberation of mechanically ventilated patients. Despite its importance, there is no universally accepted protocol for this procedure. This demands an evidence-based, individualized approach.
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...

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Trauma Sternotomy Closure: Drain Size May Matter.

Corey Ambrose¹, Brandon Nakashima¹, Amanda Hambrecht¹

¹Division of Acute Care Surgery, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA.

The American Surgeon

|April 30, 2025

Summary

Sternotomy for trauma (ST) closure with small bore drains (SBD) was linked to more mediastinal reinterventions than large bore drains (LBD). Larger drains may reduce cardiac tamponade risk after ST.

Keywords:

cardiac injuries cardiac tamponade mediastinal drain size sternotomy

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Area of Science:

Trauma Surgery
Thoracic Surgery
Critical Care Medicine

Background:

Sternotomy for trauma (ST) is a life-saving procedure.
Optimal chest closure techniques and their impact on outcomes after ST are not well-defined.
The role of mediastinal drain size in preventing complications requires investigation.

Purpose of the Study:

To examine the association between mediastinal drain size during ST closure and patient outcomes.
To determine if larger bore drain placement can mitigate the need for reintervention after definitive chest closure.

Main Methods:

Retrospective review of all sternotomy for trauma patients (2015-2023) at a Level 1 trauma center.
Exclusion of intraoperative deaths.
Categorization of patients based on mediastinal drain size: small bore drains (SBD, ≤15 French) vs. large bore drains (LBD, >15 French).
Primary outcome: mediastinal reintervention (redo sternotomy or percutaneous drainage).

Main Results:

Forty-four patients were included (18 SBD, 26 LBD).
Mediastinal reintervention for cardiac tamponade occurred more frequently in the SBD group (22%) compared to the LBD group (4%) (P=0.07).
Penetrating trauma was the primary mechanism of injury.

Conclusions:

Small bore drain placement was associated with a higher incidence of mediastinal reintervention compared to large bore drains after sternotomy for trauma.
Larger bore drains may potentially reduce the risk of postoperative cardiac tamponade.
Further multicenter studies with larger sample sizes are warranted.