title: Introduction of a new tracheostomy exchange device after percutaneous tracheostomy in a patient with coagulopathy.
abstract: Presented is a case of a 22-year-old male bone marrow transplant recipient who developed severe methotrexate-induced oropharyngeal mucositis and respiratory insufficiency caused by sepsis. Coagulopathy and severe thrombocytopenia precluded surgical tracheostomy; however, dilatational percutaneous tracheostomy was performed uneventfully. The tracheostomy tube was later changed using a newly developed exchange device permitting intraprocedural oxygenation and stomal redilatation. We conclude that severe thrombocytopenia and coagulopathy are not an absolute contraindication for percutaneous tracheostomy and that the new tracheostomy exchange device optimizes airway management and safety during this procedure.
authors.affiliation: Division of Critical Care Medicine, Harper Hospital, Detroit, Michigan 48201, USA.
authors.forename: M
authors.initials: M
authors.lastname: Weinmann
authors.forename: J J
authors.initials: JJ
authors.lastname: Bander
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000150:complications; D016026:Bone Marrow Transplantation; D004867:Equipment Design; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D009061:Mouth Mucosa; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D013280:Stomatitis / Q000139:chemically induced / Q000150:complications; D013921:Thrombocytopenia / Q000150:complications; D014139:Tracheostomy / Q000295:instrumentation* / Q000379:methods
chemical_list: D008727:Methotrexate