PURPOSE: Compare outcomes of bedside percutaneous tracheostomy in non-obese, obese, and morbidly obese patients when performed by medical intensivists.
METHODS: The study protocol was approved by the IRB. We retrospectively studied all patients who underwent bedside percutaneous dilational tracheostomy in the MICU of a tertiary-care, university hospital from 1998 to 2006 by staff physicians in the division of Pulmonary and Critical Care Medicine. Demographic data including age, gender, BMI, primary diagnosis, indication for tracheostomy, and total duration of endotracheal intubation was obtained. PT, PTT, platelet count, baseline FiO2, and PEEP were recorded for each patient. Procedure-related complications of bleeding, malpositioning, perioperative loss of airway, pneumothorax, failure/conversion to surgical approach, observed tracheal ring fracture, and death were also recorded. The patients were grouped into three cohorts: non-obese (BMI <30), obese (BMI 30-39.9), and morbidly obese (BMI ≥40), and the variables and outcomes analyzed for each group.
RESULTS: There were 176 procedures performed. BMI was available in 99 patients (56%). 62 patients (63%) were classified as non-obese (mean BMI 25), 20 (20%) as obese (mean BMI 34), and 17 (17%) as morbidly obese (mean BMI 51). Mean age, gender, duration of endotracheal intubation, PT, PTT, platelets, FiO2, PEEP, and creatinine were comparable between groups. All procedures were performed under bronchoscopic guidance. Bleeding complications were similar between the groups (10.0-12.9%). There was one case each of malpositioning, loss of airway requiring emergent reintubation, and pneumothorax in the non-obese group. There was one case of tracheal ring fracture in both the non-obese and obese groups. There were no failures or procedure-related deaths.
CONCLUSION: Bedside percutaneous tracheostomy is a safe procedure, even in morbidly obese patients, when performed by experienced medical intensivists. There is no difference in early procedure-related complication rates between non-obese, obese, and morbidly obese patients.
CLINICAL IMPLICATIONS: Morbid obesity is not a contraindication to bedside percutaneous tracheostomy performed by medical intensivists.
DISCLOSURE: Christian Butcher, None.