Percutaneous Tracheostomy: A Safe Procedure in the Morbidly Obese

Background

Percutaneous dilational tracheostomy (PDT) is becoming a widely accepted technique that has replaced open tracheostomy (OT) in many hospitals. One of the remaining relative contraindications is morbid obesity. There are no published case series of its use in this patient population. We reviewed our experience with PDT in the morbidly obese and compared it to OT in this patient population. Our hypothesis is that PDT and OT have a similar frequency of adverse events.

Study design

We reviewed charts of all morbidly obese patients (body mass index [BMI] ≥ 35, calculated as kg/m²) undergoing either PDT or OT at our institution during a 58-month period. Variables examined included age, gender, BMI, diagnosis, bedside or operating room, and bronchoscopy-assisted. We recorded all procedural complications and all tracheostomy-related complications that occurred for 30 days postprocedure or death. Primary adverse end points were defined as procedures that started percutaneous and converted to open; any reoperation related to the initial tracheostomy; malpositioning of tracheostomy resulting in patient morbidity, loss of airway control, and bleeding requiring surgical intervention. Secondary adverse end points occurred when a tracheostomy tube was dislodged or malfunctioned, as in the case of a cuff leak, and any bleeding that occurred more than 24 hours after insertion.

Results

From January 1, 2000, until September 30, 2004, our institution performed 1,062 tracheostomies. One hundred forty-three patients had a BMI ≥ 35. Eighty-nine patients underwent PDT and 53 patients underwent OT. Sixty-seven of the PDTs were performed at the bedside and 22 were performed in the operating room. All OTs were performed in the operating room. Five (6.5%) primary end points were recorded for PDTs (4 conversions to open, 1 malpositioning). Three (6.5%) primary end points were reported for OTs (malpositioning resulting in hypoxia, bleeding requiring surgical intervention, aborted attempt at open).

Conclusions

PDT is a safe procedure to perform on morbidly obese patients.

Abbreviations and Acronyms:  BMI, body mass index , OR, operating room , OT, open tracheostomy , PDT, percutaneous dilational tracheostomy