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Critical Care
Published in: Critical Care 2/2012

Open Access 01-04-2012 | Research

Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

Authors: Pierre-Grégoire Guinot, Elie Zogheib, Sandra Petiot, Jean-Pierre Marienne, Anne-Marie Guerin, Pauline Monet, Rody Zaatar, Hervé Dupont

Published in: Critical Care | Issue 2/2012

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Abstract

Introduction

The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients.

Methods

Fifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m2. The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage).

Results

The median BMIs were 34 kg/m2 (32-38) in the obese patient group and 25 kg/m2 (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths.

Conclusions

This study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site.

Trial registration

ClinicalTrials.gov: NCT01502657.
Appendix
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Metadata
Title
Ultrasound-guided percutaneous tracheostomy in critically ill obese patients
Authors
Pierre-Grégoire Guinot
Elie Zogheib
Sandra Petiot
Jean-Pierre Marienne
Anne-Marie Guerin
Pauline Monet
Rody Zaatar
Hervé Dupont
Publication date
01-04-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11233

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