Bacteraemia following single-stage percutaneous dilatational tracheostomy

The Feasibility of Percutaneous Dilatational Tracheostomy in Immunosuppressed ICU Patients with or without Thrombocytopenia

Background

Percutaneous dilatational tracheostomy (PDT) has become the preferred method in several intensive care units (ICUs), but data on PDT performed in immunosuppressed and thrombocytopenic patients are scarce. This study aimed to analyze the feasibility of PDT in immunosuppressed and thrombocytopenic patients compared to conventional open surgical tracheostomy (OST).

Methods

We retrospectively analyzed the charts of patients who underwent PDT or OST between May 2017 and November 2020. Our outcomes were stoma site infections and bleeding complications.

Results

63 patients underwent PDT, and 21 patients underwent OST. Distribution of gender ratio, age, SAPS II, time of ventilation before tracheostomy, and preexisting hematooncological diseases was comparable between the two groups. After allogeneic stem cell transplantation (alloSCT), patients were more likely to undergo PDT than OST (p=0.033). The PDT cohort suffered from mucositis more frequently (p=0.043). There were no significant differences in leucocyte or platelet count on the tracheostomy day. Patients with coagulation disorders and patients under immunosuppression were distributed equally among both groups. Stoma site infection was documented in five cases in PDT and eight cases in the OST group. Moderate infections were remarkably increased in the OST group. Smears were positive in six cases in the PDT group; none of these patients had local infection signs. In the OST group, smears were positive in four cases; all had signs of a stroma site infection. Postprocedural bleedings occurred in eight cases (9.5%) and were observed significantly more often in the OST group (p=0.001), leading to emergency surgery in one case of the OST group.

Conclusion

PDT is a feasible and safe procedure in a predominantly immunosuppressed and thrombocytopenic patient cohort without an increased risk for stoma site infections or bleeding complications.

Impact of Antibiotic Therapy during Bedside Percutaneous Tracheotomy procedure in an Intensive Care

INTRODUCTION

Percutaneous bedside tracheostomy (PBT) is a frequently done procedure in the intensive care unit (ICU). The rate of infectious complications and efficacy of perioperative therapy in reducing infections after PBT is currently unknown.

METHODS

All demographic, clinical and microbiologic data was retrospectively collected from 110 cases of PBT performed in our ICU from 2006 to 2012. Of these patients, 82 patients received perioperative antibiotic therapy (Group 1, "antibiotic group") and 28 did not receive antibiotics (Group 2, "Non antibiotic group").

RESULTS

Patients who received antibiotic therapy had a lower incidence of new ventilator associated pneumonia (VAP) episodes [18% vs. 50 %, p = 0.001 (0.23, 0.87-0.13)]. There were no differences in the incidence of bacteremia or line sepsis. Overall Gram negative, Gram positive and fungal flora was similar in both groups before and after PBT.

CONCLUSIONS

Our findings highlight the importance of conducting a prospective randomized control trial to better understand the role of antibiotic prophylaxis in PBT.