Abstract:

Tracheostomies are commonly performed procedures on ICU on mechanically ventilated subjects; percutaneous dilatational tracheostomy (PDT) and open surgical tracheostomy (OST) are the two methods used. The proportion of leuko- and thrombocytopenic subjects on ICU increased over the last years. Severe thrombocytopenia and coagulopathy have been described as contraindications for PDT.

The aim of this study was to analyze the feasibility of PDT for subjects with thrombocytopenia or coagulopathy.

We retrospectively analyzed the course of 38 adult subjects having received PDT. Most of these subjects suffered from a hematological or oncological disease, leading to severe thrombocytopenia in 19 subjects. Five subjects had a hepatic coagulopathy and two subjects were under continuous heparin infusion due to extracorporeal life support. All PDTs were planned procedures.

Periprocedural bleeding complications occurred in one case. Severe postprocedural bleeding complications were observed in two cases (one under severe thrombocytopenia, one under continuous heparin infusion). All bleeding complications could be treated without harm to the subjects.

Percutaneous dilatational tracheostomy in subjects with predominantly severe thrombocytopenia and coagulopathy is a safe procedure.