Safety of Bedside Percutaneous Dilatational Tracheostomy in Obese Patients in the ICU

Mansharamani, Naresh G.; Koziel, Henry; Garland, Robert; LoCicero, Joseph; Critchlow, Jonathan F.; Ernst, Armin

doi:10.1378/chest.117.5.1426

Cited by 89 publications

(65 citation statements)

References 9 publications

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“…Paratracheal tube insertion occurred in one patient, but was immediately recognised and corrected [10], and no other complications were noted. In contrast, Massick and coworkers studied 100 patients who underwent Ciaglia's percutaneous dilational technique, and found that periand postoperative complications were significantly more likely in patients with poorly identified anatomy, such as obese patients [24].…”

Section: Discussionmentioning

confidence: 88%

“…As a result, intensivists are increasingly confronted with critically ill obese patients who require long-term respiratory support [10]. Although percutaneous tracheostomy can be successfully performed in obese patients [10][11][12]20], obesity is still regarded as a contraindication because of distorted and unidentifiable neck anatomy [21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies report on a total of 17 obese patients with BMIs ranging from 28.1 to 67.0 kg.m )2 [10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Obesity has also become a common problem in intensive care medicine [9]. However, only a few reports assess the safety of percutaneous tracheostomy in obese patients [10][11][12].…”

mentioning

confidence: 99%

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Peri‐operative complications during percutaneous tracheostomy in obese patients

et al. 2004

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SummaryThe safety of percutaneous tracheostomy in 73 obese patients (body mass index ‡ 27.5 kg.m )2 ) in a cohort of 474 adults was studied. Four percutaneous techniques were employed (percutaneous dilational tracheostomy, n = 48; Ciaglia Blue Rhino, n = 157; guide wire dilating forceps, n = 62, translaryngeal tracheostomy, n = 207). The overall complication rate was 43.8% (n = 32) in the obese group compared to 18.2% (n = 73) in the control group (p < 0.001). Seven (9.6%) obese patients suffered life-threatening complications compared to three non-obese patients (0.7%, p < 0.001). Obese patients had a 2.7-fold increased risk for peri-operative complications, and a 4.9-fold increased risk for serious complications. The data suggest that percutaneous tracheostomy in obese patients is associated with a considerably increased risk for peri-operative complications, especially for serious adverse events.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Peri‐operative complications during percutaneous tracheostomy in obese patients

et al. 2004

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“…On the other hand, multiple studies showed the safety of PT in obese patients without a higher complication rate (21,22 ) who required tracheostomy for failure to wean and procedural complications were limited to paratracheal tracheostomy tube placement in one patient, with immediate identification and appropriate correction (22). We believe that PT can be done safely in obese population with additional skills and experience.…”

Section: 4) Of Tracheostomy-related Complications (20)mentioning

confidence: 82%

Percutaneous tracheostomy: a comprehensive review

Rashid

Islam

2017

J. Thorac. Dis.

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Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world.Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications.PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective.Experience with the technique and careful planning is needed to minimize any avoidable potential complication.

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