Background
Minitracheostomy (MT) facilitates suction of tracheal secretion in the extubated patients. After lung surgery, prophylactic MT has been reported as an effective device to treat or prevent sputum retention. However, its efficacy in cardiac surgical patients remains unknown.  The aim of this study was to assess whether prophylactic MT shortens hospital　and ICU stays by preventing extubation failure in cardiac surgical patients who needed prolonged mechanical ventilation postoperatively. 
Methods
We retrospectively analyzed the data of those patients who were admitted to the intensive care unit of Yokohama City University Hospital from 2009 to 2016 and needed mechanical ventilation for more than 48 hours after cardiac surgery. The decision to place MT was at the discretion of the clinicians in charge of each case. The patients were classified into two groups: MT group who received MT with extubation and Ex group who were extubated without MT. Primary outcome was the duration of hospital stay, and the secondary outcomes were reintubation rate, ventilator free days (VFD), and the days of ICU stay. 
Results
Of 120 patients enrolled to the study, MT and Ex groups included 36 and 84 patients, respectively. The median (Interquartile range ) duration of hospital stay (days) was similar between the two groups. (MT: 50(36-74) vs Ex: 37 (27-67), p=0.49, Mann-Whitney U test) . Cox proportional hazards model revealed that, when compared to the Ex group, the MT group was associated with shorter VFD (MT: 20 (17-22) vs. Ex: 24(23-25), hazard ratio (HR) 3.46(1.86–6.42), p<0.001), longer ICU stay (MT:10(8 to 15) vs. Ex: 5(4-7), HR 2.44 (1.29-4.62), p=0.006), and higher reintubation rate (MT: 13/34(38%) vs. Ex: 10/87(11%), p=0.002). 
 Discussion and Conclusions
Our data demonstrated that, although the MT group was sicker and had worse secondary outcomes, the primary outcome (the hospital stay) was similar to that of the Ex group. These results suggest that MT may facilitate hospital discharge in patients who need　prolonged mechanical ventilation after cardiac surgery.

Minitracheostomy may facilitate hospital discharge of cardiac surgical patients who require prolonged postoperative mechanical ventilation: a single-centre retrospective cohort study