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Percutaneous Tracheostomy Is Safe in Patients With Severe Thrombocytopenia^*

^* 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{at}uke.uni-hamburg.de

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 x 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 x 10⁹ cells/L (range, 1 x 10⁹ to 47 x 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.

Key Words: bone marrow transplantation • coagulopathy • complications • mechanical ventilation • percutaneous tracheostomy • thrombocytopenia

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				J E Heffner Management of the chronically ventilated patient with a tracheostomy Chronic Respiratory Disease, July 1, 2005; 2(3): 151 - 161. [Abstract] [PDF]

				F. Blot, C. Melot, and for the Commission d'Epidemiologie et de Recherche Indications, Timing, and Techniques of Tracheostomy in 152 French ICUs Chest, April 1, 2005; 127(4): 1347 - 1352. [Abstract] [Full Text] [PDF]