Early percutaneous tracheostomy after median sternotomy

Objective: Tracheostomy offers significant advantages over endotracheal int ubation in patients requiring long-term assisted ventilation. However, in p atients who have undergone median sternotomy, it is believed that the dange r of microbial contamination and consecutive infection of the sternal wound with microbes from the tracheostomy is high when conventional tracheostomy is performed. In contrast, percutaneous techniques an less likely to resul t in tracheostomy infection and thus bacterial contamination of neighboring structures. Nonetheless, to date there has been no prospective study confi rming or disproving this assumption. Our study evaluated outcome after perc utaneous tracheostomy in patients with a median sternotomy. Methods: A total of 144 cardiac surgical patients had elective percutaneous tracheostomy at the bedside until postoperative day 14, with 4 different t echniques. Systematic microbiologic monitoring of the sternal and tracheal wounds was used. Results: In 13 patients sternal wound infection was suspected, but was conf irmed in only 4 (2.8%) patients who actually showed microbial contamination of the sternum. In 2 of these patients, the identified microbes were not i dentical to those cultured from the trachea. The other 2 patients had stern al and trachea) cultures positive for methicillin-resistant Staphylococcus aureus. Cross-contamination of the sternotomy with microbes from the patien t's airways was therefore ruled out. No patient had clinical signs of trach eostomy infection. Likewise, there were no cases of mediastinitis. Conclusions: On the basis of our data, we conclude that cross-contamination of the sternal wound with microbes from the trachea is not a problem. Elec tive percutaneous tracheostomy is safe, even if performed during the first 14 days after median sternotomy.