Korean J Crit Care Med.  2014 Aug;29(3):183-188. 10.4266/kjccm.2014.29.3.183.

Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents

• Nam SJ
• Park JY
• Lee H
• Lee T
• Lee YJ
• Park JS
• Yoon HI
• Lee JH
• Lee CT
• Cho YJ

• KMID: 1892249
• DOI: http://doi.org/10.4266/kjccm.2014.29.3.183

Abstract

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy.
METHODS
In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not.
RESULTS
PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 +/- 4.8 kg/m2, and mean acute physiology and chronic health evaluation II score was 24.4 +/- 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 +/- 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657).
CONCLUSIONS
PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Keyword

airway management; intensive care units; platelet aggregation inhibitors; tracheostomy

MeSH Terms

Airway Management
APACHE
Body Mass Index
Bronchoscopy
Critical Illness*
Hemorrhage
Humans
Incidence
Intensive Care Units
Platelet Aggregation Inhibitors*
Punctures
Respiration, Artificial
Tracheostomy*
Platelet Aggregation Inhibitors