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Clinical Investigations in Critical Care |

Percutaneous Tracheostomy Is Safe in Patients With Severe Thrombocytopenia*

Stefan Kluge, MD; Andreas Meyer, MD; Peter Kühnelt, MD; Hans Jörg Baumann, MD; Georg Kreymann, MD
Author and Funding Information

*From the Department of Medicine, University Hospital Eppendorf, Hamburg, Germany.

Correspondence to: Stefan Kluge, MD, Department of Medicine, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; e-mail: skluge@uke.uni-hamburg.de



Chest. 2004;126(2):547-551. doi:10.1378/chest.126.2.547
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Study objectives: Severe thrombocytopenia has been described as a contraindication for percutaneous tracheostomy (PT). The objective of this study was to assess the safety of PT in mechanically ventilated patients with severe thrombocytopenia (defined by a platelet count of < 50 × 109 cells/L).

Design: Retrospective, single-center cohort study.

Setting: Medical ICU of the University Hospital Hamburg-Eppendorf, Germany.

Patients: Forty-two medical patients with acute respiratory failure and severe thrombocytopenia.

Interventions: Bedside PT under bronchoscopic guidance using the Griggs guidewire forceps technique.

Measurements and main results: The mean (± SD) intubation time prior to undergoing PT was 6.7 ± 3.9 days (range, 1 to 20 days). The mean platelet count was 26.4 ± 11.6 × 109 cells/L (range, 1 × 109 to 47 × 109 cells/L). The median transfusion of platelets before the procedure in 40 of the 42 patients was 6 ± 2.5 U (range, 3 to 12 U). Twenty-two patients (52%) had an additional coagulopathy (activated partial thromboplastin time [APTT], > 40 s; international normalized ratio, > 1.5). PT was safely performed in all 42 patients. Only two (5%) patients developed major postprocedural bleeding complications that required suturing. Both of these patients had an elevated APTT due to heparin therapy.

Conclusions: When performed by experienced personnel, PT with bronchoscopic guidance has a low complication rate in patients with severe thrombocytopenia, provided that platelets are administered beforehand. However, in order to minimize bleeding complications heparin infusions should be temporarily interrupted during the procedure.


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