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Background: In recent years, bedside perutaneous dilation tracheostomy (PDT) has become routine practice in many hospitals. The aim of this tudy is t determine the safety and efficacy of PDT in comparison to open formal tracheostomy (OT) in reducing complications especially trachoestomy associated medastinitis in sternotomy patients.
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Nirav Patel1, Amit Jain2, Ramchandra C. Reddy1, Klaus D. Lessnau3, Didier Loulmet1, Valavanur Subramanian1.
1Cardiothoracic Surgery, Lenoxhill Hospital, New York, NY, USA, 2Surgery, Lenoxhill Hospital, New York, NY, USA, 3Pulmonary Medicine, Lenoxhill Hospital, New York, NY, USA.
Methods: During last 7 years, 155 tracheostomies were performed in 6,627 (2.3%) in patients who underwent cardiac surgery. All OT were performed during 3 and 2/3 years of the study period and all PDT were consecutively performed during the later part of the study period. All the PDT were performed at the bedside in the ICU. Video bronchoscope was routinely used for optimal placement of the PDT. All the OT were performed in the operating room.
Results: Eighty-one patients had OT and 75 patients had PDT. The complications associated with both the groups are shown in the tableComplications OT (n=81) PDT (n=75) P value Paratracheal insertion 0(0.0%) 1 (1.3%) 0.480 Bleeding 6 (7.4%) 4 (5.3%) 0.748 Tracheoinnominate fistula 2 (2.5%) 2 (2.7%) 1.0 Stomal infection 8 (9.9%) 1 (1.3%) 0.035 Mediastinitis 12 (14.8%) 3 (4%) 0.026 Tracheomalacia 2 (2.5%) 2 (2.7%) 1.0 Tracheoesophageal fistula 2 (2.5%) 0 (0.0%) 0.498
Conclusion: Our experience suggests that PDT is associated with significantly reduced incidence of stomal infection and medastinitis compared to OT. PDT has smaller skin incision leading to better fitting of the tube in the wound, thus reducing in the dead space for infection. Also, less tissue dissection and separation of anatomical planes in PDT prevents migration of infection to mediastinum.
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