Abstract
IntroductionThe purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients.MethodsFifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m2. The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage).ResultsThe median BMIs were 34 kg/m2 (32-38) in the obese patient group and 25 kg/m2 (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths.ConclusionsThis study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site.Trial registrationClinicalTrials.gov: NCT01502657.
Highlights
The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients
The increasing prevalence of obesity worldwide has prompted rapid growth in the proportion of obese patients admitted to intensive care units (ICUs)
The management and care of such patients are complex since obesity is associated with a longer duration of mechanical ventilation and a longer stay in the ICU [1,2]
Summary
The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients. Technical progress and low invasiveness have meant that ultrasound (US) is increasingly used in clinical practice in anesthesia and critical care [12]. This is notably the case for improving procedures (central venous cannulation, arterial cannulation, and peripheral nerve block) in obese patients [13]. Rajajee and colleagues [18] demonstrated the feasibility of USguided PCT in a neurosurgical ICU. They reported the safety of US-guided tracheostomy in three obese patients. To the best of our knowledge, there are no published data on the US-guided PCT procedure in obese patients
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