Is percutaneous tracheotomy safe in the context of anticoagulant therapy?

Abstract

Objectives: Tracheotomy is one of the most frequent procedures performed in intensive care unit patients. The percutaneous procedure presents many advantages, such as cost-effectiveness and feasibility as a bedside technique which is time-saving in skilled hands. Material and methods: All tracheotomies that were accomplished between January 2008 and December 2015 at Jessa Hospital, Hasselt, Belgium, were retrospectively reviewed. In our department, this percutaneous technique is always executed by two otolaryngologists using bronchoscopic guidance. Results: We identified 231 patients who underwent tracheotomy in our hospital between January 2008 and December 2015. Sixty-five percent were male patients, the mean age at time of tracheotomy was 66 +/- 14 years, and the percutaneous technique was used in 87% of these cases. Tracheotomy was required at a mean endotracheal intubation period of 15 +/- 9 days. Results show that 80% of patients were already under anticoagulant therapy at the time of intervention, making them high-risk patients. Minor complications were observed in 7.5% of patients: minor bleeding during tracheotomy (1%), minor postoperative bleeding (4.5%), creation of false passage (1%), and tracheocutaneous fistula (1%). No major complications were noted. Conclusions: Percutaneous tracheotomy is a safe technique in skilled hands and when performed on well-selected patients. The result shows that this technique is feasible and safe in patients with moderate to severe coagulation problems. The main contraindications in our center are obesity and difficult neck/chest anatomy.