F. Blot et al., EARLY TRACHEOTOMY IN NEUTROPENIC, MECHANICALLY VENTILATED PATIENTS - RATIONALE AND RESULTS OF A PILOT-STUDY, Supportive care in cancer, 3(5), 1995, pp. 291-296
Citations number
35
Categorie Soggetti
Oncology,Rehabilitation,"Medicine, General & Internal
Despite substantial advances in the management of such patients, the p
rognosis of ventilated neutropenic patients remains grim. The objectiv
e of our study was to evaluate the benefit of tracheotomy in this cate
gory of patients, in terms of mortality while they were in the intensi
ve-care unit and nosocomial pneumonias. The charts of 53 consecutive,
ventilated, neutropenic patients, or those destined to be imminently n
eutropenic, 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 wi
thin 48 h of mechanical ventilation (ET group), while 33 were tracheot
omized later or remained intubated (INT group). The two groups were co
mparable with regard to the underlying disease, respiratory failure, m
echanical ventilation patterns and severity scores, but neutropenia wa
s more profound in the ET group. Mortality while in the intensive-care
unit was similar (ET:70%; INT:78.8%). However, the survival curves sh
owed a trend towards longer survival in the ET group, even after adjus
tment for the degree of neutropenia (log-rank test: P=0.07). The incid
ence of pneumonias was similar in both groups. No major complications
of tracheotomy were reported. These findings suggest that a tracheotom
y could be proposed for neutropenic patients requiring mechanical vent
ilation, in order to prolong their survival beyond the end of the neut
ropenic period. A prospective study is underway to confirm these preli
minary results.