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 comorbid...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2014/840638 |
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| author | Ahmad Alhajhusain Ailia W. Ali Asif Najmuddin Kashif Hussain Masooma Aqeel Ali A. El-Solh |
| author_facet | Ahmad Alhajhusain Ailia W. Ali Asif Najmuddin Kashif Hussain Masooma Aqeel Ali A. El-Solh |
| author_sort | Ahmad Alhajhusain |
| collection | DOAJ |
| 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. |
| format | Article |
| id | doaj-art-2f92edf43f0d42cea07d70622c05df05 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-2f92edf43f0d42cea07d70622c05df052025-02-03T01:09:47ZengWileyCritical Care Research and Practice2090-13052090-13132014-01-01201410.1155/2014/840638840638Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese PatientsAhmad Alhajhusain0Ailia W. Ali1Asif Najmuddin2Kashif Hussain3Masooma Aqeel4Ali A. El-Solh5Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USADepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USADepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USADepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USADepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USADepartment of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences and the Veterans Affairs Medical Center, Buffalo, NY, USABackground. 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.http://dx.doi.org/10.1155/2014/840638 |
| spellingShingle | Ahmad Alhajhusain Ailia W. Ali Asif Najmuddin Kashif Hussain Masooma Aqeel Ali A. El-Solh Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients Critical Care Research and Practice |
| title | 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_short | Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients |
| title_sort | timing of tracheotomy in mechanically ventilated critically ill morbidly obese patients |
| url | http://dx.doi.org/10.1155/2014/840638 |
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