Tracheostomy in obese patients: the best tube choice issue

L, Marullo; Izzo, Giuseppe; Torino, Annarita; D’Elia, A; Vessicchio, Luana; Ferraro, Fausto

doi:10.1186/cc13510

Cited by 1 publication

(10 citation statements)

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“…Twelve studies included a comparison group without obesity, 4,10,[23][24][25][26][27][28][29][30][31][32] 1 study compared PDTs with OSTs in patients with obesity, 33 and the remaining 5 studies reported solely on PDT outcomes in patients with obesity. [34][35][36][37][38] Table 1 summarizes the study design, included patients, and surgical technique, while Table 2 presents the PDT-associated complication rates.…”

Section: Resultsmentioning

confidence: 99%

“…The mortality rate in the 15 included studies reporting mortality directly associated with the procedure in individuals with obesity was 0.3% (2 of 727 patients). 4,10,[23][24][25][26]28,29,31,[33][34][35][36][37][38] One patient had a cardiac arrest during a Griggs PDT after having recurrent episodes of ventricular fibrillation in the context of a coronary artery bypass graft requiring intraaortic balloon counterpulsation, while another died the day after PDT from massive hemorrhage secondary to an unidentified subcutaneous vessel. 24…”

Section: Mortality Directly Associated With the Proceduresmentioning

confidence: 99%

“…The rate of serious intraoperative or direct postoperative (ie, within 48 hours of the procedure) life-threatening AEs in 16 studies reporting this outcome measure was 4.0% (30 of 750 patients). 4,10,[23][24][25][26][28][29][30][31][33][34][35][36][37][38] These consisted mainly of intraoperative hypoxemia, 24,30 accidental loss of airway, 4,24,25,33 bleeding requiring an additional surgical procedure, 24,33 and aerodigestive tract injury. 24,29 All reported life-threatening complications, including intraoperative, direct postoperative, or late AEs, are detailed in Table 3.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…Intraoperative or direct postoperative non-life-threatening events were reported in 74 of 750 patients (9.9%) in 16 studies reporting this outcome. 4,10,[23][24][25][26][28][29][30][31][33][34][35][36][37][38] Late, life-threatening AEs were reported in 4 of 112 patients with obesity who underwent PDT (3.6%) from 2 studies reporting this outcome. 4,28 All 4 cases represented accidental decannulations (Table 3).…”

Section: Adverse Eventsmentioning

confidence: 99%

“…The reported rate of conversion to an OST or aborted procedure was 0.6% (8 of 1314 patients) including data from 17 studies. 4,10,[23][24][25][26][28][29][30][31][32][33][34][35][36][37][38] Four of the 8 reported events (50.0%) were in cases of attempted PDT guided by anatomical landmarks only (with bronchoscopy available if needed). 33 One patient required conversion to an OST due to bleeding obscuring the field, 2 patients due to failure to pass the tracheostomy tube and guidewire, and 1 patient due to loss of airway control.…”

Section: Conversion To Ostmentioning

confidence: 99%

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Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity

Roy

Silver

Turkdogan

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceObesity has traditionally been described as a relative contraindication to percutaneous dilatational tracheostomy (PDT). Increased familiarity with the technique and use of bronchoscopy or real-time ultrasonography to enhance visualization have led many practitioners to expand the indication for PDT to patients historically deemed to have high risk of perioperative complications.ObjectiveTo assess the reported complication rate of PDT in critically ill adults with obesity and compare it with that of open surgical tracheostomies (OSTs) in this patient population and with that of PDT in their counterparts without obesity.Data SourcesIn this systematic review and meta-analysis, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy and obesity were included.Study SelectionOriginal investigations of critically ill adult patients (age ≥18 years) with obesity who underwent PDT that reported at least 1 complication of interest were included. Case reports or series with fewer than 5 patients were excluded, as were studies in a language other than English or French.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were used, with independent extraction by multiple observers. Frequencies were reported for all dichotomous variables. Relative risks for complications were calculated using both fixed-effects and random-effects models in the meta-analysis.Main Outcomes and MeasuresMain outcomes included mortality directly associated with the procedure, conversion to OST, and complications associated with the procedure (subclassified into life-threatening or non–life-threatening adverse events).ResultsEighteen studies were included in the systematic review, comprising 1355 patients with obesity who underwent PDT. The PDT-related complication rate was 16.6% among patients with obesity overall (791 patients, 17 studies), most of which were non–life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies) were aborted or converted to an OST. A meta-analysis of 12 studies (N = 4212; 1078 with obesity and 3134 without obesity) showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity (risk ratio, 1.78; 95% CI, 1.38-2.28). A single study compared PDT with OST directly for critically ill adults with obesity; thus, the intended meta-analysis could not be performed in this subgroup.Conclusions and RelevanceThe findings suggest that the rate of complications of PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.

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