Clinical

Percutaneous tracheostomy seen safe in liver disease with coagulopathy

Last Updated: 2007-11-05 16:23:42 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The first comprehensive, prospective study of percutaneous dilational tracheostomy (PDT) in patients with severe liver diseases indicates that the procedure is safe when performed by an experienced operator, even in patients with refractory coagulopathy.

The researchers note in the October 8 issue of Critical Care that as guide wire-assisted PDT has been increasingly used in ICUs worldwide since its introduction approximately 20 years ago, "indications for PDT have been extended to include patients with previously defined contraindications."

The current study by Dr. Georg Auzinger and colleagues involved 60 consecutive patients (over a 7-month period) in a 10-bed specialized liver intensive care unit at King's College Hospital, London, UK.

Of the 60 patients, 25 were identified as having refractory coagulopathy on the day of PDT and for 72 hours following, despite clotting support. Clotting support included standard doses of fresh frozen plasma and platelets.

The PDTs were performed by personnel who had each performed at least 75 such procedures previously.

Only one patient died during the 72-hour observation period following PDT, from multiple organ failure not related to the PDT. Overall hospital mortality was 50%.

No deaths were related to the PDTs, and there was an overall low rate of clinically significant PDT-related bleeding complications.

In addition, there was no significant difference in the numbers of adverse incidents between the group with refractory coagulopathy and the group with little or no coagulopathy, and hospital survival did not differ between the two groups.

"We conclude that refractory coagulopathy associated with liver disease is not a contraindication for PDT," write Dr. Auzinger and colleagues. "To the contrary, the relative atraumatic nature of the procedure compared to the open surgical approach makes it an attractive alternative in this setting."

Crit Care 2007;11.