Tracheotomy Outcomes in Super Obese Patients

Marshall, Ryan; Haas, Patrick J.; Schweinfurth, John M.; Replogle, William H.

doi:10.1001/jamaoto.2016.1089

Cited by 21 publications

(21 citation statements)

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“…Data from our cohort suggests that performing tracheotomies late (>10 days after intubation) does not affect 30‐day mortality, complications, or decannulation. Additionally, we did not find BMI to be predictive of complications or 30‐day mortality, which is consistent with research supporting the safety of tracheotomy in obese or even “superobese” patients with BMI ≥40 …”

Section: Discussionsupporting

confidence: 90%

The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

et al. 2019

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Objectives: To evaluate the safety/efficacy of performing open bedside tracheotomy (OBT) in intensive care unit (ICU) patients and identify predictive factors for outcomes.Methods: This is a retrospective cohort study. We identified 1000 consecutive patients undergoing OBT at a single university hospital starting from August 1, 2007. Complication rate, 30-day mortality, decannulation rate, time to surgery (TTS) from initial consult, and ICU length of stay were analyzed. Multivariate analysis was performed to identify predictors of complication rate, 30-day mortality, and decannulation rate.Results: Mean TTS was 1.80 days. Major complication rate was 1%. No intraoperative deaths were caused by tracheotomy although two deaths resulted from late tracheotomy-related complications. Thirty-day mortality was 26.6%. The only significant predictor for overall complications was mild chronic hepatitis (OR = 2.355). Predictors for 30-day mortality included platelet count <50,000 (OR = 2.125) and vasopressor use (OR = 3.51). Each additional year of age was associated with decreased decannulation rate (OR = 0.972).Conclusions: This study demonstrates the safety and efficacy of starting an OBT program in a highly comorbid population without strict selection criteria. Safety of OBT was supported by minimal major complication rates and no intraoperative tracheotomy-related deaths in our cohort. These complication rates were comparable to, or lower than, published studies of open and percutaneous techniques. Predictive factors for decannulation, complication, and mortality were identified to help determine which patients would benefit from OBT.

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Section: Discussionsupporting

confidence: 90%

The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

et al. 2019

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“…They found that 44% of obese patients (BMI, 30 to 50 kg/m 2 ; n = 34) had undergone successful decannulation, a similar finding to the 50% of patients within this BMI range in the present study (n = 78) with successful decannulation. Only 6 patients in the present study had a BMI greater than 50 kg/m 2 compared with 31 patients in the study by Marshall et al 26 However, despite the small sample size, we found similar rates of long-term tracheostomy dependence, with 7% of the super morbidly obese patients progressing to decannulation in their study and 17% of these subjects progressing to decannulation in our study. A similar weakness of both studies was that the analysis was confined to the information available from each patient's medical records exclusively from the institution conducting the study; thus, the postdischarge clinical course of the patients discharged to health facilities was largely unknown.…”

Section: Discussionsupporting

confidence: 47%

“…Most reported obese tracheostomy studies did not evaluate the postoperative course of these patients, and, of the available studies, none discussed the downsizing process in any detail. A study by Marshall et al 26 assessed obese and super morbidly obese (BMI >50 kg/m 2 ) patients who had undergone tracheostomy. They found that 44% of obese patients (BMI, 30 to 50 kg/m 2 ; n = 34) had undergone successful decannulation, a similar finding to the 50% of patients within this BMI range in the present study (n = 78) with successful decannulation.…”

Section: Discussionmentioning

confidence: 99%

Obese Tracheostomy: A Challenging Path From Surgery to Decannulation

Weyh

Davis

Dolan

et al. 2020

Journal of Oral and Maxillofacial Surgery

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“…En esta serie de casos, el IMC resultó significativo para la presentación de complicaciones, lo cual coincide con lo reportado por otros autores, quienes han referido un riesgo significativamente mayor en los pacientes obesos (23)(24)(25) , sobre todo en el período intraoperatorio y postoperatorio temprano, especialmente en los que cuentan con un IMC igual o superior a 35 (26,27) . Además de los mencionados, los pacientes con intubación orotraqueal prolongada tuvieron mayor riesgo de resultados adversos, lo cual ha sido señalado por otros autores, quienes reportaron 1.42 veces más probabilidad de tener una complicación postoperatoria tardía en individuos intubados por más de una semana; por su parte, la relación que se distinguió en este estudio entre resultados adversos y el tipo de anestesia empleado, difiere de los hallazgos en otras investigaciones, donde no se identificaron diferencias (13) .…”

Section: Discussionunclassified

Secuelas del neurodesarrollo de recién nacidos prematuros de extremadamente bajo peso y de muy bajo peso a los dos años de edad, egresados de la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Edgardo Rebagliati Martins 2009-2014

Lugo-Machado¹,

Delgado

Corral

2017

HorizMed

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RESUMENObjetivo: Describir las condiciones y características del procedimiento de traqueotomía en una unidad de tercer nivel de atención y analizar su asociación con el desenlace registrado. Materiales y métodos: Estudio retrospectivo, observacional y descriptivo, que incluyó a los pacientes intervenidos por el Servicio de Otorrinolaringología del Centro Médico Nacional del Noroeste, Sonora, durante el período de un año agosto de 2014 al 2015. Revisión de expedientes clínicos de casos, incluyéndose 52 por considerarse completos. 57% hombres; edad promedio: 56.2 años. Se empleó estadística descriptiva para caracterizar la distribución y las diferencias se evaluaron mediante prueba de ji cuadrado y T de Student. Resultados: 71% se intervino en quirófano y 29% en la UCI, siendo esta unidad quien indicó la operación en más de la mitad de los casos (51.92%). La intubación prolongada fue la primera causa de traqueotomía (51%). En 34,61% se presentaron complicaciones y fueron en orden descendente: oclusión de cánula, enfisema periestomal, hemorragia, neumotórax bilateral, decanulación y fístula traqueoinnominada. Estas se hallaron significativamente asociadas con obesidad, intubación orotraqueal prolongada y uso de anestesia general. La mortalidad se presentó en 7,69%. Conclusiones: No se encontró diferencia significativa entre las complicaciones entre los pacientes de sala quirúrgica y cama de UCI. La ventilación mecánica prolongada fue la principal indicación para traqueotomía. La decanulación fue la principal causa de complicación; asimismo el IMC es un factor de riesgo de complicaciones. La tasa de mortalidad fue elevada con 7.69% respecto a otros estudios.Palabras clave: Traqueotomía; complicaciones; mortalidad. Tracheotomy in a tertiary health care unit in Northwestern Mexico: description and analysis of a series of cases ABSTRACTObjective: To describe the conditions and characteristics of the tracheostomy procedure in a tertiary health care unit and analyze its association with the recorded outcome. Materials and methods: A retrospective, observational and descriptive study that included patients operated in the Otorhinolaryngology Unit of the Northwest National Medical Center, Sonora, from August 2014 to August 2015. Fifty-two (52) complete clinical records of consecutive series of cases were reviewed, out of which 57% were men with an average age of 56.2 years old. Descriptive statistics was used to characterize the distribution, and the differences were evaluated by chi-square test and Student's t-test. Results: Seventy-one percent (71%) of the patients underwent surgery in an operating room and 29% in the ICU. In the latter, more than half of the cases had a tracheostomy (51.92%). Prolonged intubation was the main cause of 51% of the tracheostomy procedures. Complications reached 34.61% of the cases and included the following disorders in descending order: cannula occlusion, peristomal emphysema, hemorrhage, bilateral pneumothorax, decanulation and innominate fistula. These complications were significantly a...

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Tracheotomy Outcomes in Super Obese Patients

Abstract: Tracheotomy in super obese patients is a safe and effective strategy for airway management. Critically ill, super obese patients have a high likelihood of remaining dependent on a tracheotomy or ventilator at the time of discharge.

Cited by 21 publications

References 19 publications

The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

Obese Tracheostomy: A Challenging Path From Surgery to Decannulation

Secuelas del neurodesarrollo de recién nacidos prematuros de extremadamente bajo peso y de muy bajo peso a los dos años de edad, egresados de la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Edgardo Rebagliati Martins 2009-2014

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