Percutaneous dilatational tracheostomy in patients with severe coagulopathy or thrombocytopenia

Introduction

Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, patients with severe coagulopathy or thrombocytopenia might have an increased risk of periprocedural bleeding.

Methods

We retrospectively reviewed the records of all patients who underwent PDT (using the Ciaglia technique with bronchoscopic guidance) on our cardiothoracic ICU between January 2004 and February 2013. Patients were stratified into two groups: no coagulopathy (group 1), and coagulopathy/thrombocytopenia defined as international normalized ratio >1.5, partial thromboplastin time >50 seconds and/or platelet count <50 × 10⁹/l (group 2).

Results

From a total of 1,001 patients (46% male, mean age 68.1 years) that underwent PDT, we identified 441 patients (44.1%) with a severe coagulopathy (group 2). There were no procedure-related deaths. Major procedure-related complications included a severe bleeding (requiring transfusion and/or surgery) in two patients in each group (one laceration of the brachiocephalic trunk, one venous bleeding, two bleedings from a thyroid vessel), injury of the membranous wall of the trachea in two patients in group 2 as well as a pneumothorax and a device failure in group 1. The incidence of moderate periprocedural bleeding was comparable between the two groups (n = 43 (9.75%) vs. n = 41 (7.3%), P = NS).

Conclusion

Periprocedural bleeding complications during and after PDT are rare, even in patients with a severe coagulopathy, and thus PDT can be safely performed in these patients.