Risk factors for bleeding complications after percutaneous dilatational tracheostomy: a ten-year institutional...

Area of Science:

• Critical Care Medicine
• Surgical Complications
• Airway Management

Background:

• Bleeding complications following percutaneous dilatational tracheostomy (PDT) can significantly impact patient outcomes.
• Risk stratification is essential for patients undergoing PDT to anticipate and mitigate potential bleeding events.

Purpose of the Study:

• To identify independent predictors of clinically significant bleeding after percutaneous dilatational tracheostomy (PDT).
• To establish risk factors for bleeding during PDT to improve patient safety.

Main Methods:

• Retrospective review of 1001 patients undergoing PDT using the Ciaglia Blue Rhino® technique with bronchoscopic guidance.
• Patients were stratified into groups based on bleeding severity (moderate/severe/major vs. none/mild).
• Logistic regression analysis was used to identify independent predictors of significant bleeding.

Main Results:

• Most patients experienced no or mild bleeding (91.3%). Moderate bleeding occurred in 8.4%, severe in 0.3%, and major in 0.1%.
• Significant bleeding was associated with higher Simplified Acute Physiology Score, renal replacement therapy, coagulopathy, lower platelet counts, lower fibrinogen levels, procedures performed by residents, and higher difficulty grading.
• Independent predictors of significant bleeding included difficult PDT, less experienced operator, Simplified Acute Physiology Score >40, and low fibrinogen levels.

Conclusions:

• Difficult PDT, less experienced operators, high patient acuity (SAPS >40), and low fibrinogen levels are associated with increased bleeding risk.
• These findings support the need for risk stratification and careful procedural planning to minimize bleeding complications during PDT.