Percutaneous tracheostomy is safe in patients with severe thrombocytopenia

Study objectives: Severe thrombocytopenia has been described as a contraindication for percutaneous tracheostomy (PT). The objective of this study was to assess the safety of PT in mechanically ventilated patients with severe thrombocytopenia (defined by a platelet count of < 50 X 10(9) cells/L). Design: Retrospective, single-center cohort study. Setting: Medical ICU of the University Hospital Hamburg-Eppendorf, Germany. Patients: Forty-two medical patients with acute respiratory failure and severe thrombocytopenia. Interventions: Bedside PT under bronchoscopic guidance using the Griggs guidewire forceps technique. Measurements and main results: The mean (+/- SD) intubation time prior to undergoing PT was 6.7 +/- 3.9 days (range, 1 to 20 days). The mean platelet count was 26.4 +/- 11.6 X 10(9)) cells/L (range, I X 109 to 47 X 109 cells/L). The median transfusion of platelets before the procedure in 40 of the 42 patients was 6 +/- 2.5 U (range, 3 to 12 U). Twenty-two patients (52%) had an additional coagulopathy (activated partial thromboplastin time [APTT], > 40 s; international normalized ratio, > 1.5). PT was safely performed in all 42 patients. Only two (5%) patients developed major postprocedural bleeding complications that required suturing. Both of these patients had an elevated APTT due to heparin therapy. Conclusions: When performed by experienced personnel, PT with bronchoscopic guidance has a low complication rate in patients with severe thrombocytopenia, provided that platelets are administered beforehand. However, in order to minimize bleeding complications heparin infusions should be temporarily interrupted during the procedure.