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Editorial comment

Danger of early percutaneous tracheostomy in cardiac surgical patients

University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA

^_* Corresponding author. Address: P.O. Box 016960 (r-114) 1611 N.W. 12th Avenue, ET 3072, Jackson Memorial Hospital, Miami, FL 33136, USA. Tel.: +1 305 5855271; fax: +1 305 5472185. (Email: tsalerno@med.miami.edu).

The first 20% of the full text of this article appears below.

In the current manuscript, Ngaage et al. [1], retrospectively reviewed a series of 7002 patients undergoing heart surgery through median sternotomy, and identified 100 patients (1.4%) who received percutaneous dilatational tracheostomy (PDT) due to continued ventilator-dependency. A variety of procedures were performed, such as aortic valve surgery, mitral valve surgery, coronary artery surgery, and others. The median time interval between cardiac surgery and tracheostomy was only 7 days (IQR 6–9 days). Also, in 43% of the patients, PDT was performed after re-intubation for respiratory failure. The authors found that the risk factors for tracheostomy were NYHA class III/IV, chronic obstructive pulmonary disease (COPD), renal failure, low cardiac index, prior stroke, poor ejection fraction (EF), and cardiopulmonary bypass time. The incidence of superficial and deep sternal wound infection was significantly higher in the PDT patients than in non-tracheostomy patients [1]. Multivariate analysis showed that percutaneous tracheostomy was a predictor for deep sternal wound infection (OR . . . [Full Text of this Article]