title: Percutaneous dilatational tracheotomy in intensive care unit patients with increased bleeding risk or obesity. A prospective analysis of 1000 procedures.
abstract: BACKGROUND
  Percutaneous dilatational tracheotomy (PT) is safe and cost effective, and has become a routine method in intensive care units (ICU), but safety concerns persist for obese patients and for patients with a high risk of bleeding. In this prospective study of 1000 PTs, we have investigated whether such patient characteristics were associated with an increased procedural risk.
  
  
  METHODS
  We prospectively recorded all PTs performed in our ICU from 2001 to 2009. Data on blood transfusion were entered from a central database. The association of risk factors with bleeding and other complications was analysed with logistic regression.
  
  
  RESULTS
  The total number of PTs and surgical tracheotomies was 1.454. The median number of days on a ventilator until PT was 6 in 2001, decreasing to 3 in 2009. A procedure-related complication was reported in 17.5%. There was no PT-related mortality. The rate of potentially life-threatening complications was 1.2%. Three patients developed pneumothorax and one of these had circulatory arrest and was successfully resuscitated. Three hundred and twelve patients had one or more units of blood transfused, but only 19 (1.9%) were PT related. Increased INR was the most important risk factor for bleeding [odds ratio (OR) 2.99], followed by low platelets (OR 1.99). The rate of complications in patients with high body mass index was not increased.
  
  
  CONCLUSIONS
  PT is a safe procedure that can be performed with a low complication rate in patients with increased risk of bleeding as well as in obese patients.
authors: Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Norway. l.a.rosseland@medisin.uio.no
authors: Leiv Arne
authors: LA
authors: Rosseland
authors: J H
authors: JH
authors: Laake
authors: A
authors: A
authors: Stubhaug