Does Tracheostomy Affect the Mortality and Morbidity Rate After Cardiac Surgery?

Yıl 2018, , 81 - 86, 13.06.2018

Serkan Burç Deşer

https://doi.org/10.5799/jcei.433810

Öz

Objective: This retrospective study aims to investigate the timing and outcomes of tracheostomy,

mortality and morbidity rates, length of in-hospital and cardiovascular intensive care unit (ICU)

stay in patients with post-cardiac surgery.

Patients and Methods: Between October 2014 and October 2016, a total of 401 cardiac surgery

were performed in our hospital. Thirteen patients who needed post-operative prolong

ventilation (7 female; 6 male; mean age was 67.7 ± 9.8 years; range 47 to 86 years) undergoing

tracheostomy procedure, were included in this retrospective study.

Results: The mean intubation time between the cardiac surgery and tracheostomy was 14.5±2.9

days (range 11 to 21). The mean intensive care unit stay time was 27.4 ±9.4 days (range 12 to

49) and the mean in-hospital stay was 43.1±23.7 days (range 16-91). 8 patients passed away

and the in-hospital mortality rate was 61%. After a mean follow-up of 161.4±151.1 days (range

57 to 417), 3 patients (7%) passed away while one patient (7%) was decannulated. One patient

(7%) is currently under follow-up at home using a home-type ventilator. Regarding patients

who passed away after discharge, the overall mortality rate was 84.6%. In addition, the number

of extubation attempts was 0.65±1.12 (range 0 to 4).

Conclusion: Tracheostomy is performed in need of prolonged mechanical ventilation in

patients with post cardiac surgery. We thought that tracheostomy does not decrease the

incidence of nosocomial pneumonia in hospital/ICU stay and morbidity/mortality as expected.

Anahtar Kelimeler

Cardiac surgery, tracheostomy, outcomes, intensive care unit, pneumonia

Kaynakça

• 1. Hsu CL, Chen KY, Chang CH, Jerng JS, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005;9:46-52.
• 2. Puentes W, Jerath A, Djaiani G, Sanchez, Wąsowicz M. Early versus late tracheostomy in cardiovascular intensive care patients. Anaest Int Therapy. 2016;48:89-94.
• 3. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: A systematic review and meta-analysis. Crit Care. 2006;10:55-60.
• 4. MacIntyre NR, Cook DJ, Ely EW Jr. et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120:375−95.
• 5. Rahmanian PB, Adams DH, Castillo JG, Chikwe J, Filsoufi F. Tracheostomy is not a risk factor for deep sternal wound infection after cardiac surgery. Ann Thorac Surg. 2007;84:1984−91.
• 6. Wouters R, Wellens F, Vanermen H, De Geest R, Degrieck I, De Meerleer F. Sternitis and mediastinitis after coronary artery bypass grafting. Analysis of risk factors. Tex Heart Inst J. 1994;21:183−8.
• 7. Stock MC, Woodward CG, Shapiro BA, Cane RD, Lewis V, Pecaro B. Perioperative complications of elective tracheostomy in critically ill patients. Crit Care Med. 1986;14:861-3.
• 8. Devarajan J, Vydyanathan A, Xu M, Murthy SM, McCurry KR, Sessler DI, et al. Early tracheostomy is associated with improved outcomes in patients who require prolonged mechanical ventilation after cardiac surgery. J Am Coll Surg. 2012;214:1008-16.
• 9. Alibrahim IJ, Kabbani MS, Abu-Sulaiman R, Al-Akhfash A, Mazrou KA. Outcome of tracheostomy after pediatric cardiac surgery. J Saudi Heart Assoc. 2012;24:163-8.
• 10. Wynne DM, Kong K, Berkowitz RG. Unplanned tracheostomy following pediatric cardiac surgery. Otolaryngol Head Neck Surg. 2009;140:933-5.
• 11. Heffner JE. Timing of tracheotomy in mechanically ventilated patients. Am Rev Respir Dis. 1993;147:768-71. 12. Mohr AM, Rutherford EJ, Cairns BA, Boysen PG. The role of dead space ventilation in predicting outcome of successful weaning from mechanical ventilation. J Trauma. 2001;51:843-8. 13. Durbin CG Jr. Indications for and timing of tracheostomy. Respir Care. 2005;50:483-7.
• 14. Yavas S, Yagar S, Mavioglu L et al. Tracheostomy: how and when should it be done in cardiovascular surgery ICU? J Card Surg. 2009;24:11−8.
• 15. Kansu L, Aydin E, Avci S. A percutaneous tracheotomy complication: tracheal stenosis: case report. Turkiye Klinikleri J Med Sci. 2008;28:773- 7.
• 16. Van Heeurn LWE, Mastboom WBJ, Scheeren CIE, et al. Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy. Intensive Care Med. 2001;27:292-5.
• 17. Turan S, Yavaş S, Ayık İ, Yamak B, Dilber E, Erdemli Ö. Does early tracheostomy decrease the nosocomial pneumonia incidence in cardiovascular surgery patients? Turk J Thorac Cardiovasc Surg. 2012;20:249-55.
• 18. Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008;36:2547-57.
• 19. Kollef MH. Prevention of hospital-associated pneumonia and ventilator-associated pneumonia. Crit Care Med. 2004;32:1396-405.
• 20. Blot F, Melot C. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127:1347-52.
• 21. Young D, Harrison DA, Cuthbertson BH et al. Effect of early vs. late tracheostomy placement on survival in patients receiving mechanical ventilation: The Trac Man randomized trial. JAMA. 2013;309:2121-9.
• 22. Enç Y, Aydemir N, Biçer Y, Yurtseven N, Orhan G, Özay B et al. Pediatrik ameliyat sonrası kardiyak yoğun bakımda trakeostomi endikasyonları ve sonuçları. Turk J Thorac Cardiovasc Surg 2008;16:24-8.
• 23. Ngaage DL, Cale AR, Griffin S, et al: Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections? Eur J Cardiothorac Surg. 2008;33:1076-9.
• 24. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32:1689-94.
• 25. Shaw JJ, Santry HP. Who Gets early tracheostomy?: evidence of unequal treatment at 185 academic medical centers. Chest. 2015;148:1242-50.
• 26. Ibrahim EH, Tracy L, Hill C, et al. The occurrence of ventilator-associated pneumonia in a community hospital: Risk factors and clinical outcomes. Chest. 2001;120:555-61.
• 27. Liu CC, Livingstone D, Dixon E, et al. Early versus late tracheostomy: Asystematic review and meta-analysis. Oto laryngol Head Neck Surg. 2015;152:219-27.
• 28. Saygı M, Öztürk E, Özden Ö, et al. Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences. Turk J Thorac Cardiovasc Surg. 2016;24:227-32.
• 29. Garcia-Urabayen D, Lopez-Fernandez YM, Pilar-Orive J, Nieto-Faza M, Gil-Anton J, Lopez-Bayón J et al. Analysis of tracheostomies in a Paediatric Intensive Care Unit during the period 2003-2013. An Pediatr (Barc). 2016;84:18-23.
• 30. Zagli G, Linden M, Spina R, et al. Early tracheostomy in intensive care unit: a retrospective study of 506 cases of videoguided Ciaglia Blue Rhino tracheostomies. J Trauma. 2010;68:367-72.