Original Articles
Tracheostomy in cardiosurgical patients: surgical tracheostomy versus Ciaglia and Fantoni methods

https://doi.org/10.1016/S0003-4975(99)00565-2Get rights and content

Abstract

Background. Patients requiring prolonged mechanical ventilation are not uncommon in a cardiosurgical intensive care unit. Elective tracheostomy is considered the airway treatment of choice in these patients.

Methods. To evaluate different techniques for tracheostomy, we prospectively investigated 120 patients who had conventional open (n = 40), minimally invasive percutaneous dilatational (n = 40), or translaryngeal (n = 40) tracheostomy techniques. The main areas of investigation included oxygenation index (partial pressure of arterial oxygen divided by fraction of inspired oxygen), complications, infection, and cost.

Results. The oxygenation index decreased in almost every patient, regardless of the technique used, but the extent of decrease was significantly lower in both minimally invasive techniques compared with the conventional method. Overall complication rate was 12.5% both in open tracheostomy and in percutaneous dilatational tracheostomy, whereas no complications occurred in translaryngeal tracheostomy procedures. Bacterial contamination of the tracheostomy site was found in 35% of the open tracheostomies, whereas no infection was seen in percutaneous dilatational or translaryngeal tracheostomies. In terms of costs, PDT ($506) and TLT ($362) were both much cheaper than open tracheostomy ($699).

Conclusions. Percutaneous dilatational and translaryngeal tracheostomies are safe and cost-effective procedures that can be done easily at the patient’s bedside and thus are attractive alternatives to conventional surgical tracheostomy in long-term airway access in a cardiosurgical intensive care unit.

Section snippets

Material and methods

Between January 1996 and July 1998, 2,909 patients were admitted to our cardiosurgical ICU, of whom 120 (4.13%) required elective tracheostomy because of the necessity of long-term mechanical ventilation. Tracheostomy was performed conventionally (n = 40) or according to the technique of Ciaglia and colleagues (n = 40) or Fantoni and Ripamonte (n = 40). The leading diagnoses for admission of these patients are shown in Table 1. Consecutive muscular insufficiency, adult respiratory distress

Results

A total of 120 patients on long-term ventilation in our cardiosurgical ICU received elective tracheostomy during a 31-month period. Tracheostomy was done in 40 patients by OT and in 40 patients each by the minimally invasive PDT and TLT techniques. Open tracheostomy was performed in the operating room, PDT, and TLT at the patient’s bedside. Mean age of the patients who had tracheostomy, coagulation factors, and time intervals between endotracheal intubation and tracheostomy are shown in Table 2

Comment

All tracheostomy procedures represent a potential risk for critically ill ICU patients. Impairment of gas exchange and oxygen desaturation are considered the most dangerous complications. Open tracheostomy is a procedure that can be detrimental to the patient. Besides a decrease in oxygen saturation during the procedure itself, patients scheduled for open tracheostomy often must be transportated from the ICU to the operating room. Minimally invasive techniques, as described by Ciaglia and

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