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Ann Thorac Surg 2002;73:2033
© 2002 The Society of Thoracic Surgeons

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Correspondence

Reduction in tracheostomy-associated risk of mediastinitis by routine use of percutaneous tracheostomy

^a The Cardiothoracic Centre, Liverpool, Thomas Dr, Liverpool L14 3PE, UK

To the Editor

We congratulate Curtis and colleagues [1] for an excellent report in the August 2001 issue of The Annals of Thoracic Surgery. We shared a similar experience as theirs prior to introduction of routine use of percutaneous tracheostomy. We reviewed our database for the last 5 years and can divide our patients into 2 groups: Group A contains 5,691 consecutive patients undergoing cardiac surgery when open surgical tracheostomy was used routinely for patients needing tracheostomy; group B contains 1,556 consecutive patients undergoing cardiac surgery when percutaneous tracheostomy was used routinely for patients needing tracheostomy. Both groups were identical in terms of major demographic characteristics. The overall incidence of tracheostomy was 1.4% (80 out of 5,691) for group A and 1.5% (24 out of 1,556) for group B, and the overall incidence of mediastinitis was 1.01% (58 out of 5,691) in group A and 1.15% (18 out of 1,556) in group B. However, after excluding the patients who had mediastinitis prior to tracheostomy, the incidence of mediastinitis associated with tracheostomy was lower in group B (4.1%, 1 out of 24) compared to group A (15%, 12 out of 80). This difference did not reach statistical significance (p = 0.15) due to small numbers. Thus, our experience suggests that percutaneous tracheostomy is associated with reduced incidence of mediastinitis after cardiac surgery compared to open surgical tracheostomy. This could be explained on the basis of less tissue dissection and less separation of anatomical planes in percutaneous tracheostomy, which in turn leads to decreased migration of infection from neck to mediastinum. Also, percutaneous tracheostomy has a smaller skin incision leading to better fitting of the tube to the wound, thus reducing the dead space for infection. We recommend routine use of percutaneous tracheostomy when needed following cardiac surgery, and it should be considered as the standard of care in this clinical situation.

References

1. Curtis J.J., Clark N.C., McKenney C.A., et al. Tracheostomy: a risk factor for mediastinitis after cardiac orperations. Ann Thorac Surg 2001;72:731-734.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nirav C. Patel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Patel, N. C. Articles by Scawn, N. Search for Related Content PubMed PubMed Citation Articles by Patel, N. C. Articles by Scawn, N. Related Collections Related Articles