Fiberoptic bronchoscopy–assisted percutaneous tracheostomy is safe in obese critically ill patients: A prospective and comparative study

Romero, Carlos M.; Cornejo, Rodrigo A.; Ruiz, Mauricio H.; Gálvez, L. Ricardo; Llanos, Osvaldo P.; Tobar, Eduardo A.; Larrondo, Jorge F.; Castro, José S.

doi:10.1016/j.jcrc.2008.06.001

« Previous Next »Journal of Critical Care
Volume 24, Issue 4 , Pages 494-500, December 2009

Fiberoptic bronchoscopy–assisted percutaneous tracheostomy is safe in obese critically ill patients: A prospective and comparative study☆

Carlos M. Romero
- Critical Care Unit, University of Chile Clinical Hospital
- Corresponding author. Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico Universidad de Chile, Facultad de Medicina Universidad de Chile, Santos Dumont 999, Independencia, Santiago Norte, Chile. Fax: +56 2 9788264.
Rodrigo A. Cornejo
- Critical Care Unit, University of Chile Clinical Hospital
Mauricio H. Ruiz
- Respiratory Disease Section, Department of Internal Medicine, University of Chile Clinical Hospital, 8380430
L. Ricardo Gálvez
- Critical Care Unit, University of Chile Clinical Hospital
Osvaldo P. Llanos
- Critical Care Unit, University of Chile Clinical Hospital
Eduardo A. Tobar
- Critical Care Unit, University of Chile Clinical Hospital
Jorge F. Larrondo
- Medical Student, University of Chile Faculty of Medicine
José S. Castro
- Critical Care Unit, University of Chile Clinical Hospital

published online 16 September 2008.

Abstract

Background

Obesity has reached epidemic proportions worldwide. In Latin America, 10% to 35% of the population is obese. Obese critically ill patients are at greater risk for requiring intubation and prolonged mechanical ventilation; and in some cases, it is necessary to perform a tracheostomy.

Objective

The objective of the study was to compare the incidence of perioperative complications associated with percutaneous tracheostomy (PT) using the fiberoptic bronchoscopy–assisted Ciaglia Blue Rhino technique (Cook Critical Care, Bloomington, IN) in obese vs nonobese critically ill patients.

Patients and Method

A prospective evaluation was made of 120 patients who underwent PT because of prolonged mechanical ventilation. An analysis of the incidence of operative and early postoperative complications was performed comparing an obese patient group (n = 25) with a nonobese patient group (n = 80). Obesity was defined by a body mass index of at least 30 kg/m².

Results

The 2 groups had no significant differences in their demographic characteristics. The average body mass index for the obese patient group was 38 ± 9 kg/m² vs 22 ± 3 kg/m² for the nonobese patient group (P < .001). The obese patients required 18 ± 7 days of mechanical ventilation, on average, before PT vs 16 ± 7 days for the nonobese patients (P = .15). The incidence of operative complications for the obese patients vs nonobese patients was 8% and 7.5%, respectively (P = 1). The incidence of early postoperative complications was 8% for the obese patients vs 2.5% for the nonobese patients (P = .2).

Conclusion

Percutaneous tracheostomy using the fiberoptic bronchoscopy–assisted Ciaglia Blue Rhino technique is safe for obese critically ill patients when performed by an experienced intensivist.

Keywords: Tracheostomy, Percutaneous tracheostomy, Obesity, Prolonged mechanical ventilation, Fiberoptic bronchoscopy