Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications

Abstract

Background: Tracheostomy is a common procedure in critically ill patients requiring prolonged mechanical ventilation. While the percutaneous approach has become increasingly popular due to its convenience and reduced risk of wound infections, its safety in patients at high risk of bleeding has remained a subject of concern. Objectives: This study aimed to evaluate the safety, feasibility, and complications of percutaneous tracheostomy (PCT) in patients identified as high risk for bleeding complications. Methods: A retrospective analysis was performed on patients who underwent PCT in a tertiary care hospital over a period of 5 years. Patients with known risk factors for bleeding such as anticoagulation, platelet dysfunction, or liver diseases were included. Outcomes measured included procedure-related complications, particularly bleeding, need for surgical intervention, length of ICU stay, and mortality. Results: Among the 200 patients subjected to PCT, 100 were delineated as high-risk for bleeding. In this high-risk group, 20 patients (20%) encountered minor bleeding, which was conservatively managed, while 10 individuals (10%) necessitated surgical interventions owing to major bleeding episodes. There were no deaths associated with the procedure itself. Subsequent to the PCT, the typical duration for ICU stay stood at 14 days. When analyzed in relation to the outcomes from the low-risk group, the complication rates did not present any significant variance. Conclusion: Percutaneous tracheostomy appears to be a safe procedure in patients at high risk of bleeding, provided meticulous technique and appropriate patient selection are followed. Further prospective studies are recommended to validate these findings and establish clear guidelines for this specific patient population