Related Experiment Video
Updated: Jun 4, 2025
Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications
Published on: March 15, 2024
Obesity is a risk factor for prolonged mechanical ventilation after tracheotomy
Jacqueline Tucker1, Nicole Ruszkay2, Sara Sandifer1
1College of Medicine Pennsylvania State University Hershey Pennsylvania USA.
Insights
Obese patients undergoing tracheotomy have longer hospital stays and mechanical ventilation durations. Understanding body mass index (BMI) impacts care for tracheotomy patients is crucial for informed decision-making.
Area of Science:
- Medical Research
- Clinical Outcomes
- Patient Care
Background:
- Body Mass Index (BMI) is a critical factor in patient outcomes.
- Tracheotomy is a procedure that requires careful consideration of patient factors.
- Understanding the impact of BMI on tracheotomy patients is essential for optimizing care.
Purpose of the Study:
- To compare patient outcomes across different body mass index (BMI) subgroups following tracheotomy.
- To investigate the relationship between BMI and key clinical outcomes such as length of stay and mechanical ventilation duration.
Main Methods:
- Retrospective chart review of 391 adult patients who underwent tracheotomy.
- Patients categorized into five BMI groups: underweight, normal weight, overweight, obese, and morbidly obese.
- Statistical analyses included Kruskal-Wallis, Chi-square, log-rank tests, and Cox regression.
Main Results:
- Significant differences observed in length of stay (p=.015) and mechanical ventilation duration (p<.001) among BMI groups.
- Obese patients experienced longer hospital stays and ventilation durations compared to normal weight patients.
- Higher BMI correlated with increased likelihood of ventilator dependency at discharge (p<.001) and a decreased rate of tracheotomy change (adjusted HR 0.86).
Conclusions:
- Obese and morbidly obese patients undergoing tracheotomy face longer hospital stays and mechanical ventilation durations.
- Increased BMI is associated with a higher likelihood of ventilator dependency at discharge.
- Informed patient and family counseling regarding BMI's impact on tracheotomy outcomes is recommended.
Objective:
To compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy.
Methods:
This retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal-Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed.
Results:
There were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77-0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011).
Conclusions:
Among patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed.
Level Of Evidence:
Level 3.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:28Tracheostomy: Procedure and Tubes
Tracheostomy tubes can be made of semiflexible plastic (polyurethane or silicone), rigid plastic, or metal, and they come in...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...