Evaluation of the Safety of Percutaneous Dilatational Tracheostomies in Patients with Antiplatelet Therapy—A Comparison of Two Single-Step Percutaneous Dilatational Techniques

TL;DR

This study compares two methods of tracheostomy in patients on blood-thinning medication and finds that one method causes more minor bleeding but is still safe.

Contribution

The study evaluates the safety of two single-step percutaneous dilatational tracheostomy techniques in patients on antiplatelet therapy.

Findings

Indirect PDTs caused more periprocedural airway and skin bleedings compared to direct PDTs.

APT patients had higher rates of airway bleeding during indirect PDTs.

No procedure-related deaths were observed, indicating overall safety of PDT in APT patients.

Abstract

Introduction: Antiplatelet therapy (APT) increases bleeding risk and is frequently used in patients who undergo percutaneous dilatational tracheostomy (PDT). However, there are different techniques for single-step PDTs, which can be differently invasive. The aim of the present study was to investigate complications in patients undergoing PDT while being on APT, especially with regard to bleeding and the influence of different PDT techniques. Material and Methods: Between July 2016 and June 2021, 273 intensive care unit (ICU) patients underwent in-house PDT with two different techniques (direct or indirect) and were retrospectively enrolled. Results: A total of 273 patients (mean age: 68 years, 37% female) were included in the study. A total of 51% of patients were on APT on the day of PDT procedure (SAPT: 34%, DAPT: 17%). Direct and indirect PDTs were performed in 33% and 67% of patients. Periprocedural airway or skin bleedings and postprocedural bleedings occurred in 53%, 11%, and 1%. A need for bronchoscopic re-intervention was observed in 2% of APT patients. No death was procedure related. Periprocedural airway bleedings occurred more frequent in “APT patients” (60% vs. 46%, p = 0.03). Periprocedural airway and skin bleedings were more frequent in indirect PDTs (52% and 14%) than direct PDTs (32% and 0%, p = 0.04 and p = 0.02) in “no APT patients”. In “APT patients” this difference was only seen in periprocedural airway bleeding (69% vs. 45%, p = 0.01). Moreover, periprocedural airway bleedings were more frequent in “APT patients” when performing an indirect PDT rather than a direct PDT (69% vs. 52%, p = 0.02). Conclusions: PDTs appear to be safe in patients receiving APT. Indirect PDTs appear to generally increase the risk of clinically irrelevant, minor periprocedural airway and possibly skin bleedings, especially in APT patients.