Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients

Background. The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial. Methods. We conducted a retrospective chart review of morbidly obese subjects (BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and one or more comorbi...

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Main Authors:	Alhajhusain, Ahmad, Ali, Ailia W., Najmuddin, Asif, Hussain, Kashif, Aqeel, Masooma, El-Solh, Ali A.
Format:	Online
Language:	English
Published:	Hindawi Publishing Corporation 2014
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178908/

id	pubmed-4178908
recordtype	oai_dc
spelling	pubmed-41789082014-10-08 Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients Alhajhusain, Ahmad Ali, Ailia W. Najmuddin, Asif Hussain, Kashif Aqeel, Masooma El-Solh, Ali A. Clinical Study Background. The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial. Methods. We conducted a retrospective chart review of morbidly obese subjects (BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and one or more comorbid conditions) who underwent a tracheotomy between July 2008 and June 2013 at a medical intensive care unit (ICU). Clinical characteristics, rates of nosocomial pneumonia (NP), weaning from mechanical ventilation (MV), and mortality rates were analyzed. Results. A total of 102 subjects (42 men and 60 women) were included; their mean age and BMI were 56.3 ± 15.1 years and 53.3 ± 13.6 kg/m2, respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (P = 0.43). Mortality was significantly higher in those who failed to wean (P = 0.02). A cutoff value of 9 days for the time to tracheotomy provided the best balanced sensitivity (72%) and specificity (59.8%) for predicting NP onset. Rates of NP and total duration of MV were significantly higher in those who had tracheostomy ≥ 9 days (P = 0.004 and P = 0.002, resp.). Conclusions. The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality. Hindawi Publishing Corporation 2014 2014-09-15 /pmc/articles/PMC4178908/ /pubmed/25298891 http://dx.doi.org/10.1155/2014/840638 Text en Copyright © 2014 Ahmad Alhajhusain et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Alhajhusain, Ahmad Ali, Ailia W. Najmuddin, Asif Hussain, Kashif Aqeel, Masooma El-Solh, Ali A.
spellingShingle	Alhajhusain, Ahmad Ali, Ailia W. Najmuddin, Asif Hussain, Kashif Aqeel, Masooma El-Solh, Ali A. Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
author_facet	Alhajhusain, Ahmad Ali, Ailia W. Najmuddin, Asif Hussain, Kashif Aqeel, Masooma El-Solh, Ali A.
author_sort	Alhajhusain, Ahmad
title	Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
title_short	Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
title_full	Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
title_fullStr	Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
title_full_unstemmed	Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
title_sort	timing of tracheotomy in mechanically ventilated critically ill morbidly obese patients
description	Background. The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial. Methods. We conducted a retrospective chart review of morbidly obese subjects (BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and one or more comorbid conditions) who underwent a tracheotomy between July 2008 and June 2013 at a medical intensive care unit (ICU). Clinical characteristics, rates of nosocomial pneumonia (NP), weaning from mechanical ventilation (MV), and mortality rates were analyzed. Results. A total of 102 subjects (42 men and 60 women) were included; their mean age and BMI were 56.3 ± 15.1 years and 53.3 ± 13.6 kg/m2, respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (P = 0.43). Mortality was significantly higher in those who failed to wean (P = 0.02). A cutoff value of 9 days for the time to tracheotomy provided the best balanced sensitivity (72%) and specificity (59.8%) for predicting NP onset. Rates of NP and total duration of MV were significantly higher in those who had tracheostomy ≥ 9 days (P = 0.004 and P = 0.002, resp.). Conclusions. The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality.
publisher	Hindawi Publishing Corporation
publishDate	2014
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178908/
_version_	1613138594517483520

Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients

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