Supportive Care in Cancer

, Volume 3, Issue 5, pp 291–296

Early tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study

  • F. Blot
  • S. Antoun
  • B. Leclercq
  • G. Nitenberg
  • B. Escudier
  • M. Gurguet
Original Article

DOI: 10.1007/BF00335304

Cite this article as:
Blot, F., Antoun, S., Leclercq, B. et al. Support Care Cancer (1995) 3: 291. doi:10.1007/BF00335304

Abstract

Despite substantial advances in the management of such patients, the prognosis of ventilated neutropenic patients remains grim. The objective of our study was to evaluate the benefit of tracheotomy in this category of patients, in terms of mortality while they were in the intensive-care unit and nosocomial pneumonias. The charts of 53 consecutive, ventilated, neutropenic patients, or those destined to be imminently neutropenic, admitted to our intensive-care unit during a 4-year period, have been retrospectively reviewed. Tracheotomy was performed at the bedside or in the operating room: 20 patients underwent tracheotomy within 48 h of mechanical ventilation (ET group), while 33 were tracheotomized later or remained intubated (INT group). The two groups were comparable with regard to the underlying disease, respiratory failure, mechanical ventilation patterns and severity scores, but neutropenia was more profound in the ET group. Mortality while in the intensivecare unit was similar (ET:70%; INT:78.8%). However, the survival curves showed a trend towards longer survival in the ET group, even after adjustment for the degree of neutropenia (log-rank test: P=0.07). The incidence of pneumonias was similar in both groups. No major complications of tracheotomy were reported. These findings suggest that a tracheotomy could be proposed for neutropenic patients requiring mechanical ventilation, in order to prologn their survival beyond the end of the neutropenic period. A prospective study is underway to confirm these preliminary results.

Key words

Tracheotomy Endotracheal intubation Mechanical ventilation Neutropenia Cancer 

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • F. Blot
    • 1
  • S. Antoun
    • 1
  • B. Leclercq
    • 1
  • G. Nitenberg
    • 1
  • B. Escudier
    • 1
  • M. Gurguet
    • 2
  1. 1.Service de RéanimationInstitut Gustave RoussyVillejuifFrance
  2. 2.INSERM U 263Hopital Saint AntoineParisFrance