Postoperative respiratory failure requiring prolonged mechanical ventilation may occur following lung transplantation (LT). In this circumstance, tracheostomy is a valid treatment option. Bedside percutaneous tracheostomy (BPT) was developed as an alternative to avoid risks associated with transport and delays in the procedure. This is a description of our experience with BPT in patients requiring prolonged mechanical ventilation following LT.
A retrospective chart review was performed for 34 LT recipients performed at MCJ since 7/2/01. Medical records of patients whom underwent BPT were reviewed for renal function tests, coagulation profile, hemoglobin, indications for BPT, days on mechanical ventilation prior to BPT, PEEP, PaO2/FIO2, evidence of hemorrhagic or infectious complications, and thirty day mortality attributable to the procedure.
8 out of 34 transplant patients underwent BPT following LT. 5 received bilateral LT and 3 left single LT. Indications for transplantation included pulmonary fibrosis in 4 patients, COPD in 3, and cystic fibrosis. Indication for BPT was failure to wean due to neuromuscular weakness in 3 cases associated with dysfunctional chest cage or anastamotic ischemia or abundant secretions, ARDS, sepsis, airway dehiscence, purulent tracheobronchitis, and stroke. The average age was 50.1 years (range 27–62) and required an average of 8 days of mechanical ventilation prior to BPT. These patients were anemic Hgb 10.2(8.3–11.4), thrombocytopenic platelets 110 (69–173), azotemic BUN 81(39–168), had normal INR 1.2 (1.0–1.4) and PTT 30 (21.4–36.4), PaO2/FIO2 was 259 (170.4–411.4) and required 6.5cm PEEP (4–10). We performed fiberoptic bronchoscopy to visualize the tracheal puncture site. 30 days following BPT all patients were alive without hemorrhagic or infectious complications attributed to the procedure.
Patients requiring prolonged mechanical ventilation following LT can be considered candidates for BPT, which can be performed safely without hemorrhagic or infectious complications at the bedside.
BPT is an alternative to surgical tracheostomy in lung transplant recipients requiring prolonged mechanical ventilation and may offer an advantage in patients that are difficult to transport to the surgical suite.
M.C. DeArment, None.