Percutaneous dilatational tracheotomy in high-risk ICU patients
Enzo Lüsebrink, Alexander Krogmann, Franziska Tietz, Matthias Riebisch, Rainer Okrojek, Friedhelm Peltz, Carsten Skurk, Carsten Hullermann, Jan Sackarnd, Dietmar Wassilowsky, Karl Toischer, Clemens Scherer, Michael R. Preusch, Christoph Testori, Ulrike Flierl, Sven Peterß, Sabine Hoffmann, Nikolaus Kneidinger, Christian Hagl, Steffen Maßberg, Sebastian Zimmer, Peter Luedike, Tienush Rassaf, Hölger Thiele, Andreas Schäfer, Martin Orban, Martin Orban, Stefan Kääb, Stefan Brunner, Mathias Orban, Tobias Petzold, Saliha Kehar, Sara Würbel, Hans‐Joachim Stemmler, Leonhard Binzenhöfer, Jan Kleeberger, Antonia Kellnar, Jan Kleeberger, Antonia Kellnar
Abstract
BACKGROUND: Percutaneous dilatational tracheotomy (PDT) has become an established procedure in intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. Therefore, the purpose of this study, including such a high proportion of patients on antithrombotic therapy, was to investigate whether PDT in high-risk ICU patients is associated with elevated procedural complications and to analyse the risk factors for bleeding occurring during and after PDT. METHODS: PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed and the predictors of bleeding occurrence were analysed. RESULTS: receptor inhibitor) with iUFH (prophylactic or therapeutic dosage) except for triple therapy (n = 290) and (4) triple therapy (DAPT with iUFH in therapeutic dosage) (n = 149). Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related. Bleeding occurrence during and after PDT was independently associated with low platelet count (OR 0.73, 95% CI [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02). CONCLUSION: In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Low platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT but not triple therapy.