Coagulopathy and high ventilatory demand are considered contra-indications for Percutaneous Tracheostomy (PT). The purpose of this study is to evaluate the safety of PT in the presence of these risk factors.
Retrospective cohort study. All PTs done between 2006 and 2008 in the medical intensive care unit of a tertiary care center were included. High Ventilatory Demand (HVD) was defined as PEEP (Positive End Expiratory Pressure) ≥10cm H2O or FiO2 ≥70%; Coagulopathy was defined as INR ≥1.7 or platelet count ≤50k. All peri-procedural complications, including bleeding (>20ml) and hypotension (systolic blood pressure <100mm Hg), were recorded. We used single dilator COOK kit for all PTs. Fisher's exact test and Student's t-test with a two-tailed p value were used.
Out of 204 PTs performed, complete data were available on 177. 14 (8.4%) had HVD, and 16 (9.0%) were coagulopathic. No significant differences were observed in complications like hypoxia (7% vs. 6%), airway loss (14% vs. 4%), air-leak (7% vs. 3%), or para-tracheal placement (0% vs. 1%) between HVD and non-HVD groups. However, hypotension (36% vs. 8%; p=0.007) and extra long tracheostomy tube placement (43% vs. 12%; p=0.006) were significantly higher in the HVD group. Although not significant, HVD group was also more likely to be obese (50% vs. 25%; p=0.06). While comparing groups with and without coagulopathy, respiratory and hemodynamic complications including hypotension (6% vs. 11%) and bleeding (31% vs. 16%) were not significantly different, but there was a trend towards increased electrocautery use (31% vs. 13%; p=0.06) in the coagulopathic group. Major complications such as pneumothorax, surgical conversion, or bleeding requiring transfusion were not experienced.
Minor complications were similar in HVD group compared to non-HVD except for hypotension, which was more common in the HVD group. Obesity may be associated with higher ventilatory demand. Coagulopathy is not associated with increased bleeding, and electrocautery use may be protective.
PT is safe and should not be delayed in the presence of coagulopathy and high ventilatory demand.
Dilesh Patel, No Financial Disclosure Information; No Product/Research Disclosure Information