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Critical Care |

Feasibility of Percutaneous Tracheostomy in Patients With Ventricular Support Devices and/or Total Artificial Heart on Bivalirudin

Ehab Hussein*, DO; Ray Shepherd, MD; Hans Lee, MD; Rajiv Malhotra, DO; Vigneshwar Kasirajan, MD; Ashutosh Sachdeva, MBBS
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Virginia Commonwealth University, Richmond, VA


Chest. 2012;142(4_MeetingAbstracts):388A. doi:10.1378/chest.1389849
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Abstract

SESSION TYPE: Invasive Procedures and Hemodynamic Monitoring Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: There are no reports on safety and feasibility of bedside percutaneous dilational tracheostomy (PDT) in cardiothoracic intensive care patients with ventricular support devices or total artificial heart. This study was conducted to evaluate safety and feasibility of PDT in this patient population requiring long term mechanical ventilation.

METHODS: A retrospective chart review of our 3 year experience with bedside PDT in patients with ventricular support devices or total artificial heart, on anticoagulation with bivalirudin and requiring long term mechanical ventilation.

RESULTS: Bedside PDT was done in 11 patients in the cardiothoracic intensive care unit. Two patients had total artificial hearts, 2 with biventricular assist devices, and 7 had left ventricular assist devices. Anticoagulation with bivalirudin was held 2 hours before and 6-12 hours after the procedure. There was no pneumothorax and no life threatening bleeding. Three patients had minor oozing from tracheostomy stoma site within the first 48 hours following the procedure. One patient required administration of topical silver nitrate. One patient stopped bleeding without intervention. One patient required administration of Surgicel® (Ethicon).

CONCLUSIONS: Bedside PDT is both safe and feasible in patients with ventricular assist devices and/or total artificial heart. Only complication seen in this small patient sample was surgical site oozing which was easily treated with minor intervention. No life threatening complications.

CLINICAL IMPLICATIONS: Percutaneous dilational tracheostomy (PDT) can be done safely in patients with ventricular support devices and total artificial hearts on bivalirudin.

DISCLOSURE: The following authors have nothing to disclose: Ehab Hussein, Ray Shepherd, Hans Lee, Rajiv Malhotra, Vigneshwar Kasirajan, Ashutosh Sachdeva

No Product/Research Disclosure Information

Virginia Commonwealth University, Richmond, VA

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