Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience

Praveen Kumar; Deepak Govil; Sweta J Patel; K N Jagadeesh; Sachin Gupta; Shrikanth Srinivasan; Mozammil Shafi; Rahul Harne; Divya Pal; Srinivas Monanga; Vipal Chawla; Deeksha S Tomar

doi:10.5005/jp-journals-10071-23344

Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience

Indian J Crit Care Med. 2020 Feb;24(2):122-127. doi: 10.5005/jp-journals-10071-23344.

Authors

Affiliations

¹ Department of Critical Care Medicine, Medanta: The Medicity, Gurugram, Haryana, India.
² Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India.
³ Department of Critical Care Medicine, Manipal Hospital, New Delhi, India.
⁴ Department of Critical Care Medicine, Intensive Care Unit, Medway NHS Foundation Trust, Gillingham, Kent, UK.

Abstract

Objective: To examine the safety and complications associated with percutaneous tracheostomy (PT) in critically ill coagulopathic patients under real-time ultrasound guidance.

Materials and methods: Coagulopathy was defined as international normalized ratio (INR) ≥1.5 or thrombocytopenia (platelet count ≤50,000/mm³). Neck anatomy was assessed for all patients before the procedure and was characterized as excellent, good, satisfactory, and unsatisfactory based on the number of vessels in the path of needle. Percutaneous tracheostomy was performed under real-time ultrasound (USG) guidance, with certain modifications to the technique, and patients in both groups were assessed for immediate complications including bleeding.

Results: Six hundred and fifty-two patients underwent USG-guided PT. Three hundred and forty-five (52.9%) were coagulopathic before the procedure. Ninety-nine patients (15.2%) had an excellent neck anatomy on USG scan, and 112 patients (62 in coagulopathy group vs 50 in noncoagulopathy group, p value 0.386) had an unsatisfactory neck anatomy for tracheostomy. A total of 42 events of immediate complications were noted in 37 patients (5.7%). No difference was seen in the rate of immediate complications in both groups (5.8% in coagulopathy group vs 5.5% in noncoagulopathy group, p value 0.886). The incidence of minor bleeding in coagulopathic patients was 14 patients (4.1%) and 7 (2.3%) in those without coagulopathy, and this difference was not statistically different (p value-0.199). In the subgroup analysis of patients with significant coagulopathy and unsatisfactory anatomy, no difference was observed in the incidence of immediate complications.

Conclusion: This study shows the efficacy and safety of real-time ultrasound-guided PT, even in patients with coagulopathy.

How to cite this article: Kumar P, Govil D, Patel SJ, Jagadeesh KN, Gupta S, Srinivasan S, et al. Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience. Indian J Crit Care Med 2020;24(2):122-127.

Keywords: Airway; Coagulopathy; Percutaneous tracheostomy; Ultrasound.