Zusammenfassung
Die Tracheotomie, insbesondere die Dilatationstracheotomie bietet Vorteile bei der Therapie langzeitbeatmeter Patienten. Trotzdem gibt es bei herzchirurgischen Patienten Vorbehalte gegen diese Therapie aufgrund der Befürchtungen, das Risiko einer Mediastinitis dadurch zu erhöhen.
Wir untersuchten die Daten unserer Patienten über einen 3–Jahreszeitraum hinsichtlich durchgeführter Tracheotomien und gegebenenfalls daraus entstandenen Komplikationen.
Von Januar 2002 bis Dezember 2004 wurden 2556 Patienten mittels medianer Sternotomie operiert. 62 (2,8%) davon wurden in den ersten 14 Tagen nach der Operation tracheotomiert (58 Dilatationstracheotomie, 4 konventionell).
Eine Mediastinitis trat bei den tracheotomierten Patienten einmal (1,6%) gegenüber 32 (1,25%) bei den nichttracheotomierten Patienten auf (p = n.s.).
Somit kommt es auch bei herzchirurgischen Patienten, die in den ersten 2 Wochen nach Sternotomie tracheotomiert werden, zu keiner höheren Inzidenz an Sternuminfektionen.
Summary
Objective
Tracheotomy offers significant advantages in patients requiring long–term assisted ventilation. Percutaneous tracheotomy offers advantages since it can be easily performed in the ICU. There is still concern, whether patients after median sternotomy are at increased risk for developing mediastinitis, especially if tracheotomy is performed early (within 14 days) after the sternotomy.
Methods
We reviewed the charts from patients operated at our institution with median sternotomy between January 2002 and December 2004. Patients requiring tracheotomy, the day of tracheotomy after median sternotomy and the patients developing mediastinitis were identified and analyzed.
Results
During this time period, we operated upon 2556 patients through a median sternotomy. From 72 patients (2.8%) receiving tracheotomy due to prolonged or expected prolonged assisted ventilation, 62 patients (2.4%) had the procedure performed within 14 days (mean 8.2 ± 2.7) after median sternotomy. In 58 patients (93.6%), tracheotomy was performed percutaneously with no major complication. Four patients (6.4%), who were not suited for the percutaneous approach (anatomical reasons), underwent surgical tracheotomy in the OR. Deep sternal wound infection devel oped in 1 patient, but the identified microbes (Staph. aureus) were different to those cultured from the trachea, excluding cross–contamination. Survivors (52/62, 83.9%) were successfully weaned after 10.4 ± 7.4 days (2–30).
Conclusions
Our data show that percutaneous tracheotomy 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.
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Sirch, J., Pfeiffer, S., Wenzl, M. et al. Frühtracheotomie nach medianer Sternotomie. Z Herz- Thorax- Gefäßchir 19, 189–192 (2005). https://doi.org/10.1007/s00398-005-0503-3
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DOI: https://doi.org/10.1007/s00398-005-0503-3