Allergy and Airway |

Percutaneous Tracheostomy in Severe Obesity: Experience at a Tertiary Care Center FREE TO VIEW

David Chambers, MD; Rebecca Cloyes, NP-C; Abdulgadir Adam, MD; Shaheen Islam, MD
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The Ohio State University, Columbus, OH

Chest. 2013;144(4_MeetingAbstracts):66A. doi:10.1378/chest.1703680
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SESSION TITLE: Airway Management Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Bedside percutaneous tracheostomy (PT) is now commonly performed in intensive care units. Obesity has traditionally been considered a relative contraindication to PT with surgical tracheostomy being preferred. While previous studies have suggested the safety of PT in obese patients, they have been limited by low prevalence of obesity. The purpose of this study was to evaluate the safety of PT in obese patients.

METHODS: Retrospective chart review was performed on patients who underwent PT between January 2010 and December 2012. Information on demographics, height, weight, neck or tracheal anatomy, and procedural data were collected and compared with non-obese (NO) patients. Bleeding more than 10 mL was considered significant. Short neck was defined as cricoid-sternal notch distance less than 1.5 cm. Hypoxia was defined as SpO2 less than 90%. Other complications were identified as hypoxia, balloon rupture, or pneumothorax.

RESULTS: 101 records were available for review; 39 (39%) were severely obese. There was no statistically significant difference in demographics and duration of intubation. Obese patients were significantly more likely to have a deep trachea (23.7% versus 3.4%, p=0.002) and short neck (18.4% versus 5.1%, p = 0.035). There was a significantly increased risk of other complications in obese patients (17.9% versus 5%, p=0.037), the most common complication being hypoxia. There was a trend towards increased pressor requirement in non-obese patients (20.3% versus 7.9%, p = 0.098). There was no significant difference in bleeding, loss of airway, incision extension, or need for tracheostomy change.

CONCLUSIONS: PT can be safely performed in severely obese patients.

CLINICAL IMPLICATIONS: Although limited by retrospective nature, this study reports the safety of PT in a patient population with a high obesity prevalence.

DISCLOSURE: The following authors have nothing to disclose: David Chambers, Rebecca Cloyes, Abdulgadir Adam, Shaheen Islam

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