Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 2 ( February, 2020 ) > List of Articles

Original Article

Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience

Sachin P Sasane, Madhavi M Telang, Zeyad F Alrais, Ali HNS Alrahma, Khalid I. Khatib

Keywords : Bleeding complications, Intensive care, Percutaneous dilatational tracheostomy

Citation Information : Sasane SP, Telang MM, Alrais ZF, Alrahma AH, Khatib KI. Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience. Indian J Crit Care Med 2020; 24 (2):90-94.

DOI: 10.5005/jp-journals-10071-23341

License: CC BY-NC 4.0

Published Online: 00-02-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims: To study the bleeding complications in patients undergoing percutaneous tracheostomy and who are at high risk of these complications (due to thrombocytopenia, use of anticoagulant or antiplatelet agents, and difficult anatomy). Materials and methods: A retrospective study was undertaken, which included all patients undergoing percutaneous tracheostomy in the medical intensive care unit (MICU) of Rashid Hospital, Dubai, over a period of 15 months. Percutaneous tracheostomy was performed by senior medical intensivists using the single-tapered dilator technique under fiber optic bronchoscopic guidance. All patients underwent ultrasonographic evaluation of the neck to look for difficult anatomy and to determine the size of tracheostomy tube, etc. Patients were divided into two groups, those who were deemed to be at high risk of bleeding complications were compared with patients without any risk factors for bleeding complications. Other complications such as pneumothorax and tracheal leak were also looked for and were documented, if present. The data were summarized using descriptive statistics and the Fischer\'s exact test of significance was used for frequency distribution cross tables, at 5% level of significance (p value cutoff <0.05). Results: One hundred and fifty-nine patients underwent percutaneous tracheostomy during the period of study. The age-group of patients ranged from 21 years to 104 years and males were predominant (65.41%). Of the 87 (54.71%) patients with one or more risk factors for bleeding, 53 (60.92%) patients had at least one risk factor for bleeding complications, while 34 (39.08%) had more than one risk factors. Bleeding was seen in total of two patients out of which one patient was in the group at risk of bleeding complications. Conclusion: Percutaneous tracheostomy is a relatively safe procedure with very low rate of complications when performed with due precautions. Even in patients deemed to be at high risk of complications, the rate of complications is very low.


  1. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000;118(5):1412–1418. DOI: 10.1378/chest.118.5.1412.
  2. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg 2007;32(3):412–421. DOI: 10.1016/j.ejcts.2007.05.018.
  3. Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy vs surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care 2006;10(2):R55. DOI: 10.1186/cc4887.
  4. Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care 2014;59(6):895–915. DOI: 10.4187/respcare.02971.
  5. Madsen KR, Guldager H, Rewers M, Weber SO, Jacobsen KK, White J. Danish guidelines 2015 for percutaneous dilatational tracheostomy in the intensive care unit. Dan Med J 2015;61(3):B5042.
  6. Cabrini L, Landoni G, Greco M, Costagliola R, Monti G, Colombo S, et al. Single dilator vs. guide wire dilating forceps tracheostomy: a metaanalysis of randomised trials. Acta Anaesthesiol Scand 2014;58(2):135–142. DOI: 10.1111/aas.12213.
  7. Sanabria A. Which percutaneous tracheostomy method is better? A systematic review. Resp Care 2014;59(11):1660–1670. DOI: 10.4187/respcare.03050.
  8. Kluge S, Meyer A, Kuhnelt P, Baumann HJ, Kreymann G. Percutaneous tracheostomy is safe in patients with severe thrombocytopenia. Chest 2004;126(2):547–551. DOI: 10.1378/chest.126.2.547.
  9. Beiderlinden M, Groeben H, Peters J. Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP). Intensive Care Med 2003;29(6):944–948. DOI: 10.1007/s00134-003-1656-8.
  10. Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol 2010;27(8):676–682. DOI: 10.1097/EJA.0b013e32833b1ba0.
  11. Guinot PG, Zogheib E, Petiot S, Marienne J-P, Guerin A-M, Monet P, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care 2012;16(2):R40. DOI: 10.1186/cc11233.
  12. Rajajee V, Fletcher J, Sheehan K, Jacobs T. Real time ultrasound reduces complications of percutaneous tracheostomy. Crit Care Med 2013; 41.
  13. Beiderlinden M, Eikermann M, Lehmann N, Adamzik M, Peters J. Risk factors associated with bleeding during and after percutaneous dilational tracheostomy. Anaesthesia 2007;62(4):342–346. DOI: 10.1111/j.1365-2044.2007.04979.x.
  14. Stehling LC, Doherty DC, Faust RJ, Greenburg AG, Harrison CR, Landers DF, et al. Practice guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996;84(3):732–747. DOI: 10.1097/00000542-199603000-00032.
  15. Dempsey GA, Grant CA, Jones TM. Percutaneous tracheostomy: a 6 year prospective evaluation of the single tapered dilator technique. Br J Anaesth 2010;105(6):782–788. DOI: 10.1093/bja/aeq238.
  16. Fikkers BG, Briede IS, Verwiel JMM, van den Hoogen FJA. Percutaneous tracheostomy with the Blue RhinoTM technique: presentation of 100 consecutive patients. Anaesthesia 2002;57(11):1094–1097. DOI: 10.1046/j.1365-2044.2002.02834.x.
  17. Diaz-Reganon G, Minambres E, Ruiz A, Gonzalez-Herrera S, Holanda-Pena M, Lopez-Espadas F. Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients. Anaesthesia 2008;63(11):1198–1203. DOI: 10.1111/j.1365-2044.2008.05606.x.
  18. Kost KM. Endoscopic percutaneous dilatational tracheostomy: a prospective evaluation of 500 consecutive cases. Laryngoscope 2005;115(10 Pt 2):1–30. DOI: 10.1097/01.MLG.0000163744.89688.E8.
  19. Fikkers BG, van Veen JA, Kooloos JG, Pickkers P, van den Hoogen FJA, Hillen B, et al. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study. Chest 2004;125(5):1805–1814. DOI: 10.1378/chest.125.5.1805.
  20. Simon M, Metschke M, Braune SA, Püschel K, Kluge S. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care 2013;17(5):R258. DOI: 10.1186/cc13085.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.