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

Objective: To evaluate the safety of tracheotomy in neutropenic ventil ated cancer patients, in terms of infectious and haemorrhagic complica tions. Design: Retrospective study. Setting: A medical-surgical intens ive care unit in a Cancer-hospital. Patients and participants: 26 cons ecutive 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 patien ts undergoing a tracheotomy, the characteristics and duration of both neutropenia and mechanical ventilation have been recorded. Stomal blee ding 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 obs erved. Neither stomal nor pulmonary infections secondary to tracheotom y were noted. No respiratory worsening was attributable to the tracheo tomy. Nineteen patients (73%) died in ICU, without direct link between tracheotomy and death. Conclusions: These findings suggest that a tra cheotomy can be safely performed in neutropenic patients requiring mec hanical ventilation.