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Evaluation of a new tracheostomy technique for morbidly obese patients on an intensive care unit
Critical Care volume 14, Article number: P219 (2010)
Tracheostomy in morbidly obese patients is generally performed by surgical technique. Although PDT has a low complication rate in nonobese patients, it is not technically possible to use standard PDT kits in morbidly obese patients with thick necks. The skin to trachea distance renders traditional-length tracheostomy tubes or dilators too short. Recently a tracheostomy kit (Uniperc, Smith Medicals, UK), designed for obese patients has become available. This kit consists of an S-shaped dilator and a long adjustable reinforced tracheostomy tube. The objective of this study was to evaluate the safety and complications of this new technique in morbidly obese patients.
The study was approved and patients' relatives were informed of the use of the new device. A total of 32 (male:female 21:11) morbidly obese (BMI mean 36 ± 4.3) patients (aged 27 to 57 years) were enrolled. Patients were anaesthetised and ventilated with 100% oxygen. PDT was carried out under endoscopic control with stomal dilation using the single stage S-shaped dilator and a reinforced adjustable flange tracheostomy tube size 7 to 9 mm ID as required. Measurements were taken including the distance from skin to the trachea using the graduated introducer needle and the initial small dilator, neck circumference, and length of the tracheostomy tube at the skin. Complications including accidental extubation, paratracheal placement, pneumothorax, major or minor bleeding, hypoxia, transient hypotension, subcutaneous emphysema or death were recorded. Patients were followed up with the inner cannula changed every day.
Thirty-two patients underwent PDT using this new kit. Patients were ventilated for a mean of 10 days (range 3 to 37) prior to tracheostomy. The mean neck circumference was 46.3 mm (37 to 55). The depth of the trachea from skin was a mean of 39 mm (15 to 80). The operators had no problem in stomal dilation using the single-stage dilator. The length of the tracheostomy tube adjusted at the skin ranged from 8 to 20 cm with a mean of 12 cm. No major complications were observed except two minor bleeding episodes and transient desaturation in one patient. The tracheostomy tube was decannulated after a mean of 25 days (6 to 82).
Bedside PDT can be performed in morbidly obese ICU patients using this new single-stage dilator and the adjustable flange reinforced tracheostomy tube with a low rate of complications. Further studies with longer-term follow-up are required.
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Mallick, A., Bodenham, A., Waldmann, C. et al. Evaluation of a new tracheostomy technique for morbidly obese patients on an intensive care unit. Crit Care 14, P219 (2010). https://doi.org/10.1186/cc8451
- Obese Patient
- Minor Bleeding
- Subcutaneous Emphysema
- Tracheostomy Tube