Percutaneous tracheostomy is safe in patients with severe thrombocytopenia.
OBJECTIVE
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 10(9) cells/L).


METHODS
Retrospective, single-center cohort study.


METHODS
Medical ICU of the University Hospital Hamburg-Eppendorf, Germany.


METHODS
Forty-two medical patients with acute respiratory failure and severe thrombocytopenia.


METHODS
Bedside PT under bronchoscopic guidance using the Griggs guidewire forceps technique.


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 10(9) cells/L (range, 1 x 10(9) to 47 x 10(9) 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.
Kluge
Stefan
S
Department of Medicine, University Hospital Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. skluge@uke.uni-hamburg.de
Meyer
Andreas
A
Kühnelt
Peter
P
Baumann
Hans Jörg
HJ
Kreymann
Georg
G
D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D017713:Platelet Transfusion; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000628:therapy; D012189:Retrospective Studies; D012449:Safety; D013921:Thrombocytopenia / Q000150:complications*; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods*
D006493:Heparin