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


Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience

Sweta J Patel, KN Jagadeesh, Mozammil Shafi, Srinivas Monanga, Vipal Chawla

Keywords : Airway, Coagulopathy, Percutaneous tracheostomy, Ultrasound

Citation Information : Patel SJ, Jagadeesh K, Shafi M, Monanga S, Chawla V. Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience. Indian J Crit Care Med 2020; 24 (2):122-127.

DOI: 10.5005/jp-journals-10071-23344

License: CC BY-NC 4.0

Published Online: 20-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objective: To examine the safety and complications associated with percutaneous tracheostomy (PT) in critically ill coagulopathic patients under real-time ultrasound guidance. Materials and methods: Coagulopathy was defined as international normalized ratio (INR) ≥1.5 or thrombocytopenia (platelet count ≤50,000/mm3). Neck anatomy was assessed for all patients before the procedure and was characterized as excellent, good, satisfactory, and unsatisfactory based on the number of vessels in the path of needle. Percutaneous tracheostomy was performed under real-time ultrasound (USG) guidance, with certain modifications to the technique, and patients in both groups were assessed for immediate complications including bleeding. Results: Six hundred and fifty-two patients underwent USG-guided PT. Three hundred and forty-five (52.9%) were coagulopathic before the procedure. Ninety-nine patients (15.2%) had an excellent neck anatomy on USG scan, and 112 patients (62 in coagulopathy group vs 50 in noncoagulopathy group, p value 0.386) had an unsatisfactory neck anatomy for tracheostomy. A total of 42 events of immediate complications were noted in 37 patients (5.7%). No difference was seen in the rate of immediate complications in both groups (5.8% in coagulopathy group vs 5.5% in noncoagulopathy group, p value 0.886). The incidence of minor bleeding in coagulopathic patients was 14 patients (4.1%) and 7 (2.3%) in those without coagulopathy, and this difference was not statistically different (p value—0.199). In the subgroup analysis of patients with significant coagulopathy and unsatisfactory anatomy, no difference was observed in the incidence of immediate complications. Conclusion: This study shows the efficacy and safety of real-time ultrasound-guided PT, even in patients with coagulopathy.

  1. Mallick A, Bodenham AR. Tracheostomy in critically ill patients. Eur J Anaesthesiol 2010;27(8):676–682. DOI: 10.1097/EJA.0b013e32833b1ba0.
  2. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically III patients. Chest 2000;118(5):1412–1418. DOI: 10.1378/chest.118.5.1412.
  3. Dongelmans DA, van der Lely AJ, Tepaske R, Schultz MJ, Fikkers BG, van der Hoeven JG. Complications of percutaneous dilating tracheostomy. Crit Care 2004;8(5):397–398. DOI: 10.1186/cc2941.
  4. Kluge S, Meyer A, Kühnelt 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.
  5. Nun AB, Altman E, Best LA. Extended indications for percutaneous tracheostomy. Ann Thorac Surg 2005;80(4):1276–1279. DOI: 10.1016/j.athoracsur.2005.02.007.
  6. Blankenship DR, Kulbersh BD, Gourin CG, Blanchard AR, Terris DJ. High-risk tracheostomy: exploring the limits of the percutaneous tracheostomy. Laryngoscope 2005;115(6):987–989. DOI: 10.1097/01.MLG.0000163107.80668.12.
  7. 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.
  8. Beiderlinden M, Walz MK, Sander A, Groeben H, Peters J. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med 2002;28(1):59–62. DOI: 10.1007/s00134-001-1151-z.
  9. Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S, et al. Percutaneous vs surgical tracheostomy: a randomized controlled study with long-term follow-up. Crit Care Med 2006;34(8):2145–2152. DOI: 10.1097/01.CCM.0000229882.09677.FD.
  10. Sviri S, van Heerden PV, Samie R. Percutaneous tracheostomy–long-term outlook, a review. Crit Care Resusc 2004;6(4):280–284.
  11. Van Heerden PV, Webb SA, Power BM, Thompson WR. Percutaneous dilational tracheostomy--a clinical study evaluating two systems. Anaesth Intensive Care 1996;24(1):56–59. DOI: 10.1177/0310057X9602400110.
  12. Heuer B, Deller A. Fruh- und spatresultate der perkutanen dilatationstracheostomie (PDT Ciaglia) bei 195 intensivpatienten. Anasthesiol Intensivmed Notfallmed Schmerzther 1998;33(5): 306–312. DOI: 10.1055/s-2007-994254.
  13. Bause H, Prause A, Schulte am Esch J. Indications and technique of percutaneous dilatation tracheotomy for intensive care patients. Anasthesiol Intensivmed Notfallmed Schmerzther 1995;30(8): 492–496. DOI: 10.1055/s-2007-996537.
  14. Disayabutr S, Tscheikuna J, Tangsujaritvijit V, Nana A. Experience of percutaneous dilatational tracheostomy by using Grigg's technique in Siriraj Hospital. J Med Assoc Thai 2013;96(Suppl 2):S22–S28.
  15. Muhammad JK, Major E, Patton DW. Evaluating the neck for percutaneous dilatational tracheostomy. J Craniomaxillofac Surg 2000;28(6):336–342. DOI: 10.1054/jcms.2000.0170.
  16. Al Dawood A, Haddad S, Arabi Y, Dabbagh O, Cook DJ. The safety of percutaneous tracheostomy in patients with coagulopathy or thrombocytopenia. Middle East J Anaesthesiol 2007;19(1): 37–49.
  17. Pandian V, Vaswani RS, Mirski MA, Haut E, Gupta S, Bhatti NI. Safety of percutaneous dilational tracheostomy in coagulopathic patients. Ear Nose Throat J 2010;89(8):387–395.
  18. Takahashi M, Itagaki S, Laskaris J, Filsoufi F, Reddy RC. Percutaneous tracheostomy can be safely performed in patients with uncorrected coagulopathy after cardiothoracic surgery. Innovations (Phila) 2014;9(1):22–26. DOI: 10.1097/imi.0000000000000041.
  19. Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study. Crit Care 2011;15(1):R67. DOI: 10.1186/cc10047.
  20. Guinot PG, Zogheib E, Petiot S, Marienne JP, Guerin AM, Monet P, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care 2012;16(2):R40. DOI: 10.1186/cc11233.
  21. Alansari M, Alotair H, Al Aseri Z, Elhoseny MA. Use of ultrasound guidance to improve the safety of percutaneous dilatational tracheostomy: a literature review. Crit Care 2015;19(1):229. DOI: 10.1186/s13054-015-0942-5.
  22. Ziyaeifard M, Totonchi Z. Real-time ultrasound guided the new standard technique for percutaneous dilatational tracheostomy (PDT). Anesth Pain Med 2015;5(3):e24653. DOI: 10.5812/aapm.24653v2.
  23. Ravi PR, Vijay MN. Real time ultrasound-guided percutaneous tracheostomy: is it a better option than bronchoscopic guided percutaneous tracheostomy? Med J Armed Forces India 2015;71(2):158–164. DOI: 10.1016/j.mjafi.2015.01.013.
  24. Saritas A, Saritas PU, Kurnaz MM, Beyaz SG, Ergonenc T. The role of fiberoptic bronchoscopy monitoring during percutaneous dilatational tracheostomy and its routine use into tracheotomy practice. J Pak Med Assoc 2016;66(1):83–89.
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