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Percutaneous dilatation tracheostomy in critically ill patients with documented coagulopathy
Critical Care volume 12, Article number: P334 (2008)
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.
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
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.
In trained hands with careful precautions, we believe that percutaneous tracheostomy is safe even in patients with documented coagulopathy.
Aoyagi M: Percutaneous tracheostomy to the patient with coagulopathy. Jpn J Anesthesiol 2005, 54: 153-155.
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Kakar, P., Govil, D., Gupta, S. et al. Percutaneous dilatation tracheostomy in critically ill patients with documented coagulopathy. Crit Care 12, P334 (2008). https://doi.org/10.1186/cc6555
- International Normalize Ratio
- Estimate Blood Loss
- Bleeding Episode
- Relative Contraindication
- Minor Bleeding