Real-time Ultrasound-guided Percutaneous Dilatational Tracheostomy for Patients after Cardiac Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 GEMin , CHENTao , YUWen-da

Intensive Care Unit, Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing 210008, P. R. China;

Corresponding author：

GEMin, Email: gemin2000@gmail.com

Keywords：

Percutaneous dilatational tracheostomy; Ultrasound; Cardiac surgery

DOI：

10.7507/1007-4848.20140232

Video：

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Objective To evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. Methods From July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. Results All PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. Conclusion Real-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.

Citation： GEMin, CHENTao, YUWen-da. Real-time Ultrasound-guided Percutaneous Dilatational Tracheostomy for Patients after Cardiac Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 807-812. doi: 10.7507/1007-4848.20140232 Copy

1.	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(2):R55.
2.	Rudas M, Seppelt I. Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients:a systematic review. Crit Care Resusc, 2012, 14(4):297-301.
3.	宁辉, 赵励.经皮穿刺扩张气管切开术与传统气管切开术效果比较.中国危重病急救医学, 2009, 21(10):621-623.
4.	Jackson LS, Davis JW, Kaups KL, et al. Percutaneous tracheostomy:to bronch or not to bronch--that is the question. J Trauma, 2011, 71(6):1553-1556.
5.	Hatfield A, Bodenham A. Portable ultrasonic scanning of the anterior neck before percutaneous dilatational tracheostomy. Anaesthesia, 1999, 54(7):660-663.
6.	Sustic A, Kovac D, Zgaljardic Z, et al. Ultrasound-guided percutaneous dilatational tracheostomy:a safe method to avoid cranial misplacement of the tracheostomy tube. Intensive Care Med, 2000, 26(9):1379-1381.
7.	Rajajee V, Fletcher JJ, Rochlen LR, et al. Real-time ultrasound-guided percutaneous dilatational tracheostomy:a feasibility study. Critical Care, 2011, 15(1):R67.
8.	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(6):1076-1079.
9.	Guinot PG, Zogheib E, Petiot S, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care, 2012, 16(2):R40.
10.	Komatsu T, Sowa T, Fujinaga T, et al. Tracheo-Innominate artery fistula:two case reports and a clinical review. Ann Thorac Cardiovasc Surg, 2012, 19(1):60-62.
11.	Force SD, Miller DL, Petersen R, et al. Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients. Ann Thorac Surg, 2005, 80(2):618-622.
12.	Gaudino M, Losasso G, Anselmi A, et al. Is early tracheostomy a risk factor for mediastinitis after median sternotomy? J Card Surg, 2009, 24(6):632-636.
13.	Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope, 2007, 117(3):447-454.
14.	Koitschev A, Graumueller S, Zenner HP, et al. Tracheal stenosis and obliteration above the tracheostoma after percutaneous dilational tracheostomy. Crit Care Med, 2003, 31(5):1574-1576.
15.	Klussmann JP, Brochhagen HG, Sittel C, et al. Atresia of the trachea following repeated percutaneous dilational tracheotomy. Chest, 2001, 119(3):961-964.
16.	Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med, 2003, 24(3):457-471.
17.	Norwood S, Vallina VL, Short K, et al. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg, 2000, 232(2):233-241.
18.	Raghuraman G, Rajan S, Marzouk JK, et al. Is tracheal stenosis caused by percutaneous tracheostomy different from that by surgical tracheostomy? Chest, 2005, 127(3):879-885.
19.	Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol, 2010, 27(8):676-682.
20.	Reilly PM, Sing RF, Giberson FA, et al. Hypercarbia during tracheostomy:a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy. Intensive Care Med, 1997, 23(8):859-864.
21.	Imperiale C, Magni G, Favaro R, et al. Intracranial pressure monitoring during percutaneous tracheostomy"percutwist. in critically ill neurosurgery patients.Anesth Analg, 2009, 108(2):588-592.

1. 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(2):R55.
2. Rudas M, Seppelt I. Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients:a systematic review. Crit Care Resusc, 2012, 14(4):297-301.
3. 宁辉, 赵励.经皮穿刺扩张气管切开术与传统气管切开术效果比较.中国危重病急救医学, 2009, 21(10):621-623.
4. Jackson LS, Davis JW, Kaups KL, et al. Percutaneous tracheostomy:to bronch or not to bronch--that is the question. J Trauma, 2011, 71(6):1553-1556.
5. Hatfield A, Bodenham A. Portable ultrasonic scanning of the anterior neck before percutaneous dilatational tracheostomy. Anaesthesia, 1999, 54(7):660-663.
6. Sustic A, Kovac D, Zgaljardic Z, et al. Ultrasound-guided percutaneous dilatational tracheostomy:a safe method to avoid cranial misplacement of the tracheostomy tube. Intensive Care Med, 2000, 26(9):1379-1381.
7. Rajajee V, Fletcher JJ, Rochlen LR, et al. Real-time ultrasound-guided percutaneous dilatational tracheostomy:a feasibility study. Critical Care, 2011, 15(1):R67.
8. 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(6):1076-1079.
9. Guinot PG, Zogheib E, Petiot S, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care, 2012, 16(2):R40.
10. Komatsu T, Sowa T, Fujinaga T, et al. Tracheo-Innominate artery fistula:two case reports and a clinical review. Ann Thorac Cardiovasc Surg, 2012, 19(1):60-62.
11. Force SD, Miller DL, Petersen R, et al. Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients. Ann Thorac Surg, 2005, 80(2):618-622.
12. Gaudino M, Losasso G, Anselmi A, et al. Is early tracheostomy a risk factor for mediastinitis after median sternotomy? J Card Surg, 2009, 24(6):632-636.
13. Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope, 2007, 117(3):447-454.
14. Koitschev A, Graumueller S, Zenner HP, et al. Tracheal stenosis and obliteration above the tracheostoma after percutaneous dilational tracheostomy. Crit Care Med, 2003, 31(5):1574-1576.
15. Klussmann JP, Brochhagen HG, Sittel C, et al. Atresia of the trachea following repeated percutaneous dilational tracheotomy. Chest, 2001, 119(3):961-964.
16. Sue RD, Susanto I. Long-term complications of artificial airways. Clin Chest Med, 2003, 24(3):457-471.
17. Norwood S, Vallina VL, Short K, et al. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg, 2000, 232(2):233-241.
18. Raghuraman G, Rajan S, Marzouk JK, et al. Is tracheal stenosis caused by percutaneous tracheostomy different from that by surgical tracheostomy? Chest, 2005, 127(3):879-885.
19. Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol, 2010, 27(8):676-682.
20. Reilly PM, Sing RF, Giberson FA, et al. Hypercarbia during tracheostomy:a comparison of percutaneous endoscopic, percutaneous Doppler, and standard surgical tracheostomy. Intensive Care Med, 1997, 23(8):859-864.
21. Imperiale C, Magni G, Favaro R, et al. Intracranial pressure monitoring during percutaneous tracheostomy"percutwist. in critically ill neurosurgery patients.Anesth Analg, 2009, 108(2):588-592.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Real-time Ultrasound-guided Percutaneous Dilatational Tracheostomy for Patients after Cardiac Surgery

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