Utilidad de la traqueotomía percutánea en el postoperatorio inmediato del trasplante hepático

Abstract

ObjectiveTo determinate the safety of percutaneous dilatational tracheostomy (PDT) on hepatic allograft recipients. Patients and methodsWe reviewed the records of patients who underwent liver transplantation between October 2007 and April 2013, followed by PDT. In this time period, 25 liver recipients underwent PDT in our intensive care unit. We recorded severity index scores such as APACHE II and SAPS II, number of days since intubation, ratios of PaO2/FiO2 (arterial oxygen pressure to fraction of inspired oxygen), coagulation study findings, complications, and procedure-related mortality rates. We compared these records with the general ICU population and literature reports. ResultsThe median age was 58 (IC range 47-65) and 64% were men. The median time since intubation to PDT was 11 days (IC range 6.5-15.5) and from transplant to PDT 12 days. The median ratio of PaO2/FiO2 was 212 (IC range 177-259). The median platelet count was 89 (IC range 37-149), significantly lower than the general ICU population (272 (IC range 186-381) P=.001).Complications were infrequent and included clinically remarkable major bleeding 8% (vs. 0,3% in general ICU population; P=.005), peristomal infection (4%) and ventilator-associated pneumonia 16% (vs. 2,8% in general ICU population; P=.007). There were no deaths associated with the procedures. ConclusionPDT was tolerated well in recipients of liver allografts and had a relatively low risk of major complications and a low procedure-related mortality rate.