Safety analysis of percutaneous dilational tracheostomies with bronchoscopy in the obese patient

Since originally described in 1985 by Ciaglia, percutaneous dilational tracheostomy (PDT) has grown in popularity, and today is widely used for critically ill patients requiring long-term mechanical ventilation. Since the inception of PDT, obesity has been considered a relative contraindication to its use. The purpose of this study is to evaluate the risks of PDT in obese patients.

Retrospective review.

A retrospective review was performed of prospectively collected data from 426 patients who underwent PDT at a single teaching institution from July 2003 to October 2009. The groups were separated into those who had a body mass index (BMI) of <30 or ≥30 kg/m(2) . The following variables were collected: blood loss at the time of procedure, difficulty in tracheotomy dilation and/or tracheostomy placement, presence of tracheal ring breaks, any bleeding episodes requiring treatment by surgery or blood transfusion, pre- and postprocedure pneumonia, and stoma infection requiring antibiotics. All tracheostomies were placed using the Ciaglia Blue Rhino Introducer Kit (Cook Medical Inc., Bloomington, IN). Statistical analysis was performed with nonparametric statistics using χ(2) testing with P < .05 as significant.

No statistically significant difference was found between the obese and nonobese groups for any of the variables studied. Similar results were found when BMI of 40 was used for grouping.

PDT can be performed safely in obese patients. There were no statistically significant differences in measured variables found between the two study groups. This study supports the use of intensive care unit bedside PDT in the obese population.