Báo cáo y học: Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial...
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Báo cáo y học: "Percutaneous tracheostomy in patients with severe liver disease and a high incidence of refractory coagulopathy: a prospective trial" Available online http://ccforum.com/content/11/5/R110Research Open AccessVol 11 No 5Percutaneous tracheostomy in patients with severe liver diseaseand a high incidence of refractory coagulopathy: a prospectivetrialGeorg Auzinger, Gerry P OCallaghan, William Bernal, Elizabeth Sizer and Julia A WendonInstitute of Liver Studies, Liver Intensive Care Unit, Kings College Hospital, Denmark Hill, London SE5 9RS, UKCorresponding author: Georg Auzinger, georg.auzinger@kingsch.nhs.ukReceived: 12 Apr 2007 Revisions requested: 31 May 2007 Revisions received: 10 Aug 2007 Accepted: 8 Oct 2007 Published: 8 Oct 2007Critical Care 2007, 11:R110 (doi:10.1186/cc6143)This article is online at: http://ccforum.com/content/11/5/R110© 2007 Auzinger et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction The purpose of this study was to assess the safety the number of adverse incidents between groups. Only oneof percutaneous dilational tracheostomy (PDT) performed by patient in the coagulopathy group had a severe bleedingexperienced operators in critically ill patients with liver disease complication, but this did not require open surgical intervention.and coagulopathy. The rate of clinically relevant early complications in all patients was not higher than expected (n = 7, 12%). Resource utilisationMethods We conducted a prospective cohort study in a 10-bed was higher for patients with coagulopathy who receivedspecialist liver intensive care unit of a tertiary university teaching significantly more platelet transfusions over the 3-day period (80hospital. The study consisted of 60 consecutive patients in need versus 49 units; p = 0.009) and who demonstrated a trendof tracheostomy insertion. Patients were categorized as having toward increased fresh frozen plasma requirements (p = 0.059).refractory coagulopathy if their platelet count was less than or The number of patients requiring platelet transfusion was higherequal to 50 × 109 cells/L or their international normalized ratio in the coagulopathy group (21/25 versus 20/35; p = 0.029).(INR) was greater than 1.5 on the day of PDT and for the 72 Hospital survival did not differ between groups.hours afterward despite clotting support.Results Twenty-five patients fulfilled the definition criteria of Conclusion PDT is safe and not contraindicated in patients withrefractory coagulopathy. There was no significant difference in severe liver disease and refractory coagulopathy.Introduction Refractory coagulopathy and thrombocytopenia or impairedSince the introduction of guidewire-assisted percutaneous coagulation is frequently seen in patients with liver diseasedilational tracheostomy (PDT) into routine clinical practice requiring ICU admission. A comprehensive, prospective risksome 20 years ago by Ciaglia and colleagues [1], the tech- assessment of PDT in this patient population has not beennique or modifications thereof have been used increasingly in performed thus far. We report the results of a prospectiveintensive care units (ICUs) worldwide. In fact, the procedure study on the safety of PDT in patients with a wide range of liverhas replaced surgical tracheostomy in many ICUs given the disease, or following liver transplantation for acute liver failure,ease and speed of application, lack of need for transfer to the in which the incidence of refractory coagulopathy is high.operating theatre, and a comparable (if not better) safety pro- Materials and methodsfile [2]. With increasing familiarity with the procedure, indica-tions for PDT have been extended to include patients with Patientspreviously defined contraindications, such as unfavourable Over a consecutive 7-month period, all patients requiring PDTa ...