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Poster presentation | Open | Published:

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.

References

  1. 1.

    Aoyagi M: Percutaneous tracheostomy to the patient with coagulopathy. Jpn J Anesthesiol 2005, 54: 153-155.

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Keywords

  • International Normalize Ratio
  • Estimate Blood Loss
  • Bleeding Episode
  • Relative Contraindication
  • Minor Bleeding