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DOI: 10.1055/s-0030-1269308
Early percutaneous tracheotomy in cardiac surgery patients is a save procedure even in patients with coagulation disorders
Objectives: An early tracheotomy may shorten time of mechanical ventilation and length of stay at the ICU. In general, coagulopathy is a contraindication for surgical tracheotomy. However, some cardiac surgery patients may require an adequate anticoagulation due to mechanical valve replacement or any kind of assist device. In this study we reviewed our patients who underwent percutaneous tracheotomy (PDT) after cardiac surgery. The primary end point was the coagulopathy related bleeding complication.
Methods: PDT was carried out under bronchoscopy monitoring. All patients who underwent PDT from November 2007 to June 2010 were reviewed and were divided into a high risk (HR) and low risk (LR) group in regard to bleeding complications, respectively. An increased risk for bleeding complications were determined by an increased/activated partial thromboplastin time (aPTT>60s.), a decreased/partial
thromboplastin time (PTT<50%) or international normalized ratio (INR>1.4) or a thrombocytopenia (<50.000/µl), respectively.
Results: 189 patients underwent PDT since November 2007. Both groups did not differ in demographics or intraoperative data, respectively. In all patients there was no severe bleeding complication or other procedure related complications. 6/111 (LR) and 2/78 (HR) patients showed mild bleeding complications without need for surgical intervention or transfusion (p=0.473).
Conclusions: Percutaneous tracheotomy (PDT) is a save procedure even in patients with coagulopathy. Therefore, anticoagulation treatment does not need to be discontinued.