Critical Care and Shock

Bleeding complications of percutaneous dilatation tracheostomy (PDT) in a group of ICU patients with dual antiplatelet therapy




Objective: Percutaneous dilatational tracheostomy (PDT) is one of the most commonly performed intervention in patients requiring long-term mechanical ventilation in ICUs. The ease of performance and the availability of bronchoscopic control contributed to its safety in the hands of experienced operators and to its widespread acceptance. The bleeding complications of PDT in a group of ICU patients with dual antiplatelet therapy with acetylsalicylic acid (ASS) and clopidogrel were studied.

Design: Retrospective analysis of 56 percutaneous tracheostomies during the study period (July 2008-July 2010) were performed.

Patients: Patients were divided into two groups whereas patients receiving dual platelet inhibition (n=15) were defined as Group 1 and all other patients were classified as Group 2 (n=41).

Results: There was no evidence of major bleeding in the study-group. We found 3 patients in Group 1 and 5 patients in Group 2 who were in need of interventions (prolonged pressure dressing/local endobronchial application of epinephrine) due to prolonged bleeding. The PDT was aborted for one patient in Group 2 because of failed tracheal punction. One patient in Group 2 died during the procedure after perforation of the posterior tracheal wall with consecutive bilateral pneumothoraxes and myocardial depression.

Conclusions: Our data suggest the incidence of bleeding is low in patients with dual platelet inhibition. However, occult bleedings leading to atelectasis due to obstruction of bronchial system, should beware of.