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Use of temporary tracheostomy occlusion to reduce the risk of sternal wound infection after sternotomy in congenital cardiac surgery

Published online by Cambridge University Press:  27 February 2024

Julien B. Azimzadeh Open the ORCID record for Julien B. Azimzadeh [Opens in a new window] ,
Douglas R. Sidell ,
Karthik Balakrishnan ,
Roshni Mathew ,
Ritu Asija ,
Michael J. Rutter  and
Kara D. Meister
Julien B. Azimzadeh
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
Douglas R. Sidell
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
Karthik Balakrishnan
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
Roshni Mathew
Affiliation:
Department of Pediatric Infectious Diseases, Stanford University, Palo Alto, CA, USA
Ritu Asija
Affiliation:
Department of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA
Michael J. Rutter
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
Kara D. Meister*
Affiliation:
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, USA
*
Corresponding author: K. D Meister; Email: meister4@stanford.edu
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Abstract

Objective:

To describe a method of reducing the risk of sternal wound infection after sternotomy in children with a pre-existing tracheostomy. To report our outcomes using this method from 1 January, 2013 to 31 August, 2023.

Methods:

We describe a method for temporarily occluding the tracheal stoma with a removable implant with the primary goal of reducing the risk of sternotomy wound infection by preventing soilage due to tracheostomal secretions. We then performed a retrospective review of all children who underwent temporary tracheostomal occlusion between 1 January, 2013 and 31 August, 2023 at our quaternary care children’s hospital. Clinical variables were extracted from the hospital medical records. The rates of antibiotic use and minor and major complications during the period when the stoma plug was in place were recorded.

Results:

Totally, 19 patients underwent tracheal stoma plugging prior to sternotomy and were included in our analysis. There were two cases of sternal wound infection; one case occurred while the stoma plug was in place, and one developed four days following plug removal. There was one minor complication, with one patient requiring stoma revision via serial dilation at bedside at the time of recannulation. There were no deaths.

Conclusion:

Temporary occlusion of the tracheal stoma with an impermeable plug is a viable option for reducing the risk of sternal wound infection in children with a pre-existing tracheostomy who are undergoing sternotomy.

Keywords

Sternotomytracheostomymediastinitissternal wound infection
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 6
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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