Intensive Care Medicine

, Volume 21, Issue 8, pp 687–690 | Cite as

Safety of tracheotomy in neutropenic patients: A retrospective study of 26 consecutive cases

  • F. Blot
  • G. Nitenberg
  • M. Guiguet
  • M. Casetta
  • S. Antoun
  • J. L. Pico
  • B. Leclercq
  • B. Escudier
Brief Report

Abstract

Objective

To evaluate the safety of tracheotomy in neutropenic ventilated cancer patients, in terms of infectious and haemorrhagic complications.

Design

Retrospective study.

Setting

A medical-surgical intensive care unit in a Cancer-hospital.Patients and participants: 26 consecutive patients undergoing a tracheotomy in neutropenic period, from 1987 to 1990.

Interventions

Tracheotomy, performed at the bedside or in operating, room.

Measurements and results

In all neutropenic patients undergoing a tracheotomy, the characteristics and duration of both neutropenia and mechanical ventilation have been recorded. Stomal bleeding and infection, and infectious pneumonias and alveolar haemorrhage have been carefully reviewed. Platelets were transfused in 23 of the 26 patients at the time of the procedure; no local haemorrhage was observed. Neither stomal nor pulmonary infections secondary to traceotomy were noted. No respiratory worsening was attributable to the tracheotomy. Nineteen patients (73%) died in ICU, without direct link between tracheotomy and death.

Conclusions

These findings suggest that a tracheotomy can be safely performed in neutropenic patients requiring mechanical ventilation.

Key words

Tracheotomy Edotracheal intubation Mechanical ventilation Neutropenia Cancer 

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References

  1. 1.
    Schuster DP, Marion JM (1983) Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy. Am J Med 75: 402–408Google Scholar
  2. 2.
    Denardo SJ, Oye RK, Bellamy PE (1989) Efficacy of intensive care for bone marrow transplant patients with respiratory failure. Crit Care Med 17:4–6Google Scholar
  3. 3.
    Ognibene FP, Martin SE, Parker MM et al (1986) Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551Google Scholar
  4. 4.
    Estopa R, Torres-Marti A, Kastanos N et al (1984) Acute respiratory failure in severe hematologic disorders. Crit Care Med 12:26–28Google Scholar
  5. 5.
    Rodriguez JL, Steinberg SM, Luchetti FA et al (1990) Early tracheostomy for primary airway management in the surgical critical care setting. Surgery 108:655–659Google Scholar
  6. 6.
    Stock MC, Woodward CG, Shapiro BA et al (1986) Perioperative complications of elective tracheostomy in critically ill patients. Crit Care Med 14:861–863Google Scholar
  7. 7.
    Crawford J, Ozer H, Stoller et al (1991) Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small cell lung cancer. N Engl J Med 325:164–170Google Scholar
  8. 8.
    Gastinne H, Wolff M, Delatour F et al (the French Study Group of Selective Decontamination of the Digestive Tract) (1992) A controlled trial in intensive care units of selective decontamination of the digestive tract with non-absorbable antibiotics. N Engl J Med 326:594–599Google Scholar
  9. 9.
    Plummer AL, Gracey DR (1989) Consensus conference on artifical airways in patients receiving mechanical ventilation. Chest 96:178–180Google Scholar
  10. 10.
    Berlauk JF (1986) Prolonged endotracheal intubation vs. tracheostomy. Crit Care Med 18:742–745Google Scholar
  11. 11.
    Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy: a prospective study of 150 critically ill adult patients. Am J Med 70:65–76Google Scholar
  12. 12.
    El-Naggar M, Sadagopan S, Levine H et al (1976) Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: a prospective study. Anesth Analg 55:195–201Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • F. Blot
    • 1
  • G. Nitenberg
    • 1
  • M. Guiguet
    • 3
  • M. Casetta
    • 1
  • S. Antoun
    • 1
  • J. L. Pico
    • 2
  • B. Leclercq
    • 1
  • B. Escudier
    • 1
  1. 1.Intensive Care UnitInstitut Gustave RoussyVillejuifFrance
  2. 2.Bone Marrow Transplant UnitInstitut Gustave RoussyVillefuifFrance
  3. 3.INSERM U263ParisFrance

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