Early tracheostomy after median sternotomy

Objective: Tracheostomy offers significant advantages in patients requiring long-term assisted ventilation. Percutaneous tracheostomy offers technical advantages since it can be easily performed on the ICU. There is still concern, whether cardiac surgical patients are at increased risk for developing mediastinitis, especially if tracheostomy is performed early (within 14 days) after a sternotomy.

Methods: We reviewed charts from patients operated at our institution with median sternotomy between January 2002 and June 2007. Patients requiring tracheostomy, the day of tracheostomy after median sternotomy and the patients developing mediastinitis were identified and analyzed.

Results: During this time period, we operated upon 4572 patients through a median sternotomy. 146 patients (3.2%) received tracheostomy due to prolonged or expected prolonged assisted ventilation, 130 patients (2.8%) had the procedure performed within 14 days (mean 8.2±2.78) after median sternotomy. In 120 patients (93.0%), tracheostomy was performed percutaneously with no major complication. 9 patients (7.0%) who were not suited for the percutaneous approach (anatomical reasons) underwent surgical tracheostomy in the OR. Deep sternal wound infection developed in 1 patient, but the identified microbes (staph. aureus) were different to those cultured from the trachea, excluding cross-contamination. Survivors (110/130, 84.6%) were successfully weaned after 11.7±9.4 days (2–58).

Conclusions: Our data show, that percutaneous tracheostomy can be performed safely with a very low periprocedural complication rate and without increased incidence of mediastinitis during the first 14 days after median sternotomy. It is therefore well suited for patients who are long term dependent on assisted ventilation after median sternotomy.