Percutaneous Tracheostomy Can be Safely Performed in Patients with Uncorrected Coagulopathy after Cardiothoracic Surgery
| Autor: | Ramachandra C. Reddy, Farzan Filsoufi, Shinobu Itagaki, Jessica Laskaris, Mitsuko Takahashi |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Heart Diseases Tracheostomy Internal medicine Bronchoscopy Coagulopathy Humans Medicine In patient Prospective Studies Cardiac Surgical Procedures Aged Postoperative Care Platelet Count business.industry General Medicine Blood Coagulation Disorders medicine.disease Surgery Treatment Outcome Cardiothoracic surgery Prothrombin Time Percutaneous tracheostomy Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 9:22-26 |
| ISSN: | 1559-0879 1556-9845 |
| DOI: | 10.1097/imi.0000000000000041 |
| Popis: | Objective It is a common situation after cardiothoracic surgery that a tracheostomy is required for patients who are coagulopathic or on therapeutic anticoagulation. We present our results of percutaneous tracheostomy with uncorrected coagulopathy. Methods Between 2007 and 2012, a total of 149 patients in our Cardiothoracic Surgical Intensive Care Unit underwent percutaneous tracheostomy using the Ciaglia Blue Rhino system (Cook Medical, Bloomington, IN USA). The patients were divided into coagulopathic (platelets, ≤50,000; international normalized ratio of prothrombin time, ≥1.5; and/or partial thromboplastin time, ≥50) and noncoagulopathic groups. Coagulopathy, if present before percutaneous tracheostomy, was not routinely corrected. Results A total of 75 patients (49%) were coagulopathic. Twenty-one patients (14%) had two or more criteria. The coagulopathic patients had a lower platelet count [108 (106) vs 193 (111) (thousands), P < 0.001], with the lowest of 10; higher international normalized ratio of prothrombin time [1.7 (0.6) vs 1.2 (0.1), P < 0.001], with the highest of 5.3; longer partial thromboplastin time [40 (13) vs 33 (7) seconds, P < 0.001], with the longest of 85; and higher total bilirubin [4.6 (7.3) vs 1.9 (3.3) mg/dL, P = 0.005]. Patient demographics and comorbidities were comparable between the groups. No patients had overt bleeding. One coagulopathic patient (1.3%) had clinical oozing treated with packing, as opposed to zero in the noncoagulopathic patients ( P = 1.00). There were no patients with posttracheostomy mediastinitis or late tracheal stenosis. Conclusions Uncorrected coagulopathy and therapeutic anticoagulation did not increase bleeding risk for percutaneous tracheostomy in our cardiothoracic surgical patients. |
| Databáze: | OpenAIRE |
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