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Airway management in the thrombocytopenic cancer patient with acute respiratory failure

Prolonged endotracheal intubation has long been the preferred approach when ventilatory support is required in thrombocytopenic cancer patients, because of concern for the possible hemorrhagic complications of tracheostomy. During the past 3 years, the authors have treated over 100 patients who developed acute respiratory failure while being treated for myeloproliferative or lymphoproliferative malignancies. This experience has suggested a greater incidence of potentially lethal complications among thrombocytopenic patients with prolonged endotracheal intubation than with early tracheostomy, which is now preferred in the critical care facility of this institution. Tracheostomy using electrocautery and careful technique has been performed without complication in 35 patients whose platelet counts were as low as 5,000–20,000/mm3.