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DOI: 10.1055/s-2004-816826
Percutaneous dilatation tracheostomy (PDT) in cardiac surgery patients
Objectives: Percutaneous dilatational tracheotomy (PDT) is an increasingly used technique in the management of critical ill patients. Here we describe our experience with a modified PDT technique according to Griggs in the postoperative management of patients following cardiac surgery. The study focuses on the utility of PDT in cardiac surgery patients by means of perioperative complications and long term results.
Methods: From 1997 through 2002. 558 patients required postoperative ventilatory support for more than five days at the ICU of the Cardiac Surgery Department. 241 patients (mean age: 66.8yrs.; 88 female (36.5%)) underwent PDT, using the guidewired dilatating forceps technique (Portex) with slight modifications in certain techniqual steps. Experienced endoscopical guidance was essential during the PDT procedures. The perioperative complications were evaluated retrospectively by chart review. The long-term results were studied by an interdisciplinary team consisting of a head and neck surgeon, an anesthesiologist and a cardiac surgeon.
Results: PDT has been performed at mean of 12.7 days after translaryngeal intubation. Despite occasionally peristomal oozing, no peri- and postoperative complication were noted. The incidence of tracheal stensosis as the most important long-term complication were evaluated laryngotracheoscopically (>6 months after PDT). Relevant tracheal stenosis were found only in 2 cases (0.8%) and could mainly be traced back to lesions of the cricoid cartilage during PDT.
Conclusions: The low perioperative complication rate and the good long-term results after PDT seem to identify this technique as a beneficial method in the postoperative managment of critical cardiac surgery patients with prolonged ventilation. The results justify an earlier application of PDT to improve the further clinical course of the patient.