This Belgian study looked at the risks and complications of bedside percutaneous tracheostomy in patients who received anticoagulant therapy. The 231 tracheostomies included in the study were performed over an eight-year period by two otolaryngologists using bronchoscopic guidance. The mean age at the time of the tracheostomy was 66+/-14 years, and the percutaneous technique was used in 87% of cases. The mean endotracheal intubation period prior to the tracheostomy was 15+/-9 days. Of the patients who underwent tracheostomy, 80% were already under anticoagulant therapy (including aspirin and low molecular weight heparin, and one patient on Factor Xa inhibitor), therefore they were classed as high-risk patients. Minor complications were reported in 7.5% of patients, including minor bleeding intraoperatively (1%), minor postoperative bleeding (4.5%), creation of a false passage (1%), and tracheocutaneous fistula (1%). There were no major complications (such as pneumothorax, subcutaneous emphysema, tracheal stenosis, or tracheoesophageal fistula) reported, according to the authors. The main contraindications to use of the percutaneous technique, and need for surgical tracheostomy, were due to obesity, difficult neck/chest anatomy (e.g. goitre), and extended kyphosis with retrosternal position of the cricoid cartilage. The authors conclude that the percutaneous technique is feasible and safe in patients with moderate to severe coagulation problems, but it should be noted that in this study the procedure was performed by two otolaryngologists, which may not be the case in many units across the UK.

Is percutaneous tracheotomy safe in the context of anticoagulant therapy?
Colpaert C, Cox T, Janssens de Varebeke SP, et al.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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