Tracheostomy in cardiosurgical patients: Surgical tracheostomy versus Ciaglia and Fantoni methods

Background. Patients requiring prolonged mechanical ventilation are not unc ommon in a cardiosurgical intensive care unit. Elective tracheostomy is con sidered the airway treatment of choice in these patients. Methods. To evaluate different techniques for tracheostomy, we prospectivel y investigated 120 patients who had conventional open (n = 40), minimally i nvasive percutaneous dilatational (n = 40), or translaryngeal (n = 40) trac heostomy techniques. The main areas of investigation included oxygenation i ndex (partial pressure of arterial oxygen divided by fraction of inspired o xygen), complications, infection, and cost. Results. The oxygenation index decreased in almost every patient, regardles s of the technique used, but the extent of decrease was significantly lower in both minimally invasive techniques compared with the conventional metho d. Overall complication rate was 12.5% both in open tracheostomy and in per cutaneous dilatational tracheostomy, whereas no complications occurred in t ranslaryngeal tracheostomy procedures. Bacterial contamination of the trach eostomy site was found in 35% of the open tracheostomies, whereas no infect ion was seen in percutaneous dilatational or translaryngeal tracheostomies. In terms of costs, PDT ($506) and TLT ($362) were both much cheaper than o pen tracheostomy ($699). Conclusions. Percutaneous dilatational and translaryngeal tracheostomies ar e safe and cost-effective procedures that can be done easily at the patient 's bedside and thus are attractive alternatives to conventional surgical tr acheostomy in long-term airway access in a cardiosurgical intensive care un it. (C) 1999 by The Society of Thoracic Surgeons.