gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Modified percutaneous tracheotomy is save in high risk patients

Meeting Abstract

  • Antje-Christin Deppe - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Yeong-Hoon Choi - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Oliver Liakopoulos - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Elmar Kuhn - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Maximillian Scherner - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Ingo Slottosch - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Georg Langebartels - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln
  • Thorsten Wahlers - University Hospital of Cologne, Department of Cardiothoracic Surgery, Köln

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch179

DOI: 10.3205/12dgch179, URN: urn:nbn:de:0183-12dgch1798

Published: April 23, 2012

© 2012 Deppe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objectives: Early tracheotomy may shorten time of mechanical ventilation and length of stay at the ICU. Generally coagulopathy and acute respiratory distress syndrome (ARDS) represent a contraindication for tracheotomy. However, in cardiac surgery patients an adequate anticoagulation is mandatory due to mechanical valve replacement or ventricular assist support. Here, we analyzed patients undergoing a modified tracheotomy for coagulopathy related bleeding complications and patients with a Horowitz-Index less than 200mmHg for ventilation related oxygenation complications.

Methods: The percutaneous tracheotomy (PDT) was perfomed under bronchoscopic monitoring. Patients who underwent a PDT (Nov 2007 - July 2011) were stratified into a high risk (HR) and low risk (LR) group based on hemostasis parameters: activated partial thromboplastin time (aPTT>60sec.), partial thromboplastin time (PTT<50%), international normalized ratio (INR>1.4) or a thrombocytopenia (<50,000/µl). Primary endpoint parameters were the onset of bleeding complications and the oxygenation parameters prior, 4 and 24 hours after PDT in patients with or without ARDS.

Results: 213 patients underwent PDT. There was no difference in demographics or intraoperative data. Patients of both groups showed mild bleeding (HR=5/85; LR=8/128) without need for surgical intervention or transfusion (p=0.957). There were no severe bleeding or other procedure related complications.

Ventilator settings were available in 140 patients. ARDS was observed in 39 patients (27.9%). 4 hours after PDT oxygenation was improved (pO2=85.2±15.6 mmHg vs. 103.0±39.4 mmHg; p = 0.016) and fraction of inspired oxygen could be lowered within the first 24 hours (0.62±0.20 vs. 0.47±0.09; p<0.012).

Conclusions: Modified PDT is a save procedure even in patients with coagulopathy and ARDS. Therefore, anticoagulation treatment does not need to be discontinued.