Tracheostomy: current practice on timing, correction of coagulation disorders and peri-operative management - a postal survey in the Netherlands

Abstract

Background: Several factors may delay tracheostomy. As many critically ill patients either suffer from coagulation abnormalities or are being treated with anticoagulants, fear of bleeding complications during the procedure may also delay tracheostomy. It is unknown whether such (usually mild) coagulation abnormalities are corrected first and to what extent. The purpose of this study was to ascertain current practice of tracheostomy in the Netherlands with regard to timing, pre-operative correction of coagulation disorders and peri-/intra-operative measures.

Methods: In October 2005, a questionnaire was sent to the medical directors of all non-pediatric ICUs with >/=5 beds suitable for mechanical ventilation in the Netherlands.

Results: A response was obtained from 44 (64%) out of 69 ICUs included in the survey. Seventy-five percent of patients receive tracheostomy within 2 days after the decision to proceed with a tracheostomy. Reasons indicated as frequent causes for delay were most often logistical factors. A heterogeneous attitude exists regarding values of coagulation parameters acceptable to perform tracheostomy. Fifty percent of the respondents have no guideline on correction of coagulation disorders or anticoagulant therapy before tracheostomy. Antimicrobial prophylaxis is almost never administered before tracheostomy. Forty-eight percent mentioned always using endoscopic guidance and 66% of ICUs only perform chest radiography on indication.

Conclusions: There is a high variation in peri- and intra-operative practice of tracheostomy in the Netherlands. Especially on the subject of coagulation and tracheostomy there are different opinions and protocols are often lacking.