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