Percutaneous dilatation tracheostomy in critically ill patients with documented coagulopathy

Introduction

Percutaneous tracheostomy techniques are gaining greater popularity in ICUs. Refinement of the percutaneous tracheostomy technique has made this a straightforward and safe procedure in appropriately selected patients. Generally, coagulopathy is a relative contraindication for surgical tracheotomy. We sought to determine its usage in high-risk patients with documented coagulopathy.

Methods

Twenty critically ill patients with coagulopathy (International Normalized Ratio (INR) ≥ 1.5) underwent elective percutaneous tracheostomy using a Portex percutaneous tracheostomy kit (Ultraperc). The Ciaglia Blue Rhino single-stage dilator set was used in all cases and the same intensivists performed all of the tracheotomies

Results

There were 17 patients with an INR > 1.5, two patients were on a heparin drip, and one patient had a platelet count <20,000. One patient included in the study met requirements for two categories with a platelet count of 17,000 and an INR of 1.7. The procedural times ranged from 3 to 5 minutes. Apart from minor bleeding episodes during and after the procedures in three patients, which were controlled promptly, no other complications occurred; average estimated blood loss was around 5–10 ml.

Conclusion

In trained hands with careful precautions, we believe that percutaneous tracheostomy is safe even in patients with documented coagulopathy.