Safety of percutaneous tracheostomy in coagulopathic patients

Aim

To determine whether percutaneous tracheostomy is safe in coagulopathic patients.

Study design

A prospective, observational study.

Setting

A 450-bed tertiary cancer referral center with a nine-bed ICU and 10 HDU beds.

Patients and methods

One hundred and ninety patients underwent percutaneous tracheostomy between November 1996 and September 2001, using the Griggs technique. Of these, 23 patients were deemed to be coagulopathic (platelet count < 70,000 or PT > 18, PTT > 60). We determined the incidence of bleeding and other complications in these patients.

Results

Only one patient had major bleeding, requiring surgical intervention and conversion to surgical tracheostomy. This patient also had a difficult tracheostomy complicated by pneumothrorax. Twenty patients required perioperative transfusion of platelet concentrates or fresh frozen plasma. Five patients received single donor platelets (average 1 ± 0), eight patients received random donor platelets (average 3.6 ± 1.30), and 15 patients received fresh frozen plasma (average 3.8 ± 2.7). Minimal blood loss was observed in the 22 other patients. Of the 167 patients without coagulopathy, four patients had significant bleeding. There was no difference in the incidence of hemorrhagic complications between coagulopathic and noncoagulopathic patients (P > 0.05, chi-square test).

Conclusion

Percutaneous tracheostomy is a safe procedure in coagulopathic patients with adequate coagulation factor replacement.