SAFETY OF TRACHEOTOMY IN NEUTROPENIC PATIENTS - A RETROSPECTIVE STUDY OF 26 CONSECUTIVE CASES

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 tracheotomy 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.