Journal of Critical Care
Volume 23, Issue 3 , Pages 394-398, September 2008

Safety of percutaneous dilational tracheostomy in hematopoietic stem cell transplantation recipients requiring long-term mechanical ventilation☆

  • Stefan Kluge, MD

      Affiliations

    • Department of Intensive Care, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
    • Corresponding Author InformationCorresponding author. Medical Intensive Care Unit, Department of Intensive Care, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany. Tel.: +49 40 42803 7010; fax: +49 40 42803 7020.
    • ,
  • Hans Jörg Baumann, MD

      Affiliations

    • Department of Pulmonary Medicine, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
    • ,
  • Axel Nierhaus, MD

      Affiliations

    • Department of Intensive Care, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
    • ,
  • Nicolaus Kröger, MD

      Affiliations

    • Department of Bone Marrow Transplantation, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
    • ,
  • Andreas Meyer, MD

      Affiliations

    • Department of Pulmonary Medicine, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany
    • ,
  • Georg Kreymann, MD

      Affiliations

    • Department of Intensive Care, University Medical Center, Hamburg-Eppendorf, 20246 Hamburg, Germany

published online 06 December 2007.

Abstract 

Purpose

Recent reports have shown that the outcome of mechanically ventilated patients after hematopoietic stem cell transplantation (HSCT) has improved. This study was conducted to clarify if percutaneous dilational tracheostomy is safe in this group of patients and to report the outcome of HSCT recipients requiring long-term mechanical ventilation.

Methods

A retrospective review of our 8-year experience with patients with acute respiratory insufficiency after HSCT, requiring long-term mechanical ventilation and percutaneous dilational tracheostomy and an analysis of patient outcomes were made.

Results

Percutaneous dilational tracheostomy was safely performed in all 51 patients. Although 1 patient (2%) developed a pneumothorax that required drainage, stoma infections or severe bleeding complications were not observed. Of the 51 patients in the study, 14 (27%) survived the intensive care unit stay, and 10 of them were ventilated for more than 20 days. The intensive care unit survival rate for the period from 1998 to 2001 was 11% compared with 38% for the period from 2002 to 2005 (P = .053).

Conclusions

Percutaneous dilational tracheostomy can be safely performed on patients with acute respiratory failure after HSCT. This procedure did not result in postoperative wound infections or significant bleeding complications. Furthermore, the results of our study indicate that today even patients with prolonged mechanical ventilation (>20 days) have a chance of long-term survival.

Keywords: Hematopoietic stem cell transplantation, Percutaneous dilational tracheostomy, Mechanical ventilation

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☆ The first 2 authors contributed equally to this work.

PII: S0883-9441(07)00076-7

doi:10.1016/j.jcrc.2007.05.001

Journal of Critical Care
Volume 23, Issue 3 , Pages 394-398, September 2008

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