کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5883758 1150139 2015 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Original ArticleTracheostomy After Cardiac Surgery With Median Sternotomy and Risk of Deep Sternal Wound Infections: Is It a Matter of Timing?
ترجمه فارسی عنوان
مقاله علمی تراکئوستومی پس از عمل جراحی قلب با استریتومی متوسط ​​و خطر ابتلا به عفونت های زخمی عمیق: آیا این موضوع زمان بندی است؟
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیهوشی و پزشکی درد
چکیده انگلیسی

ObjectiveTo assess the impact of timing of percutaneous dilatational tracheotomy (PDT) on incidence of deep sternal wound infections (DSWI) after cardiac surgery with median sternotomy.DesignRetrospective study between 2003 and 2013.SettingSingle-center university hospital.ParticipantsEight hundred seventy-nine patients after cardiac surgery with extracorporeal circulation and median sternotomy.InterventionsPDT using the Ciaglia-technique with direct bronchoscopic guidance.Measurement and Main ResultsMean time from surgery and (re)intubation to PDT was 6.7±9.9 and 3.8±3.3 days, respectively. Incidence of DSWI was 3.9% (34/879). The incidence of DSWI was comparable between patients with PDT performed before postoperative day (POD) 10 and those with PDT after POD 10 (29/755 [3.8%] v 5/124 [4.0%], p = n.s.). However, the authors observed an association of timing of PDT and DSWI: The incidence of DSWI was significantly higher in patients with PDT performed≤POD 1 compared to those with PDT after POD 2 (12/184 [6.52%] v 22/695 [3.16%], p = 0.046). In multivariate analysis, obesity, use of bilateral internal mammary arteries, ICU stay>30 days and PDT<48 hours after surgery (OR 3.519, 95% CI 1.242-9.976, p = 0.0018) were independent predictors of DSWI. In 15/34 patients (44.1%), similarity of microorganisms between sternotomy site and tracheal cultures was observed, indicating a possible cross-contamination.ConclusionsPDT within the first 10 postoperative days after cardiac surgery with median sternotomy can be performed safely without an increased risk of DSWI. In contrast, very early PDT within 48 hours after surgery is associated with an increased risk of mediastinitis and should, therefore, be avoided.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Cardiothoracic and Vascular Anesthesia - Volume 29, Issue 6, December 2015, Pages 1573-1581
نویسندگان
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