EARLY TRACHEOTOMY IN NEUTROPENIC, MECHANICALLY VENTILATED PATIENTS - RATIONALE AND RESULTS OF A PILOT-STUDY

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.