Low complications encountered during percutaneous dilatational tracheostomy among obese people: JAMA

A recent study published in the Journal of American Medical Association found that the rate of complications was low in critically ill individuals undergoing percutaneous dilatational tracheostomy (PDT) with obesity, but still higher than the rate in individuals without obesity.

Obesity has traditionally been considered a relative contraindication to PDT due to concerns about increased risk of perioperative complications. However, as practitioners have become more familiar with the technique and have started to use bronchoscopy or real-time ultrasonography for visualization, the indication for PDT has expanded to include patients who were historically deemed high risk.

The systematic review and meta-analysis of 18 studies by Catherine Roy and team, included 1,355 critically ill adult patients with obesity who underwent PDT, found a complication rate of 16.6%. The majority of these complications were non-life-threatening, and only 0.6% of cases were aborted or converted to open surgical tracheostomy (OST). In addition, a meta-analysis of 12 studies showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity.

The key findings of the study were:

The rate of complications associated with PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.

While the study supports the expanded indication for PDT in patients with obesity, the results highlight the need for caution and careful patient selection.

It is important to note that the study has some limitations, including heterogeneity in the definition of obesity, small sample sizes, and potential publication bias. Nonetheless, the results provide useful insights into the safety and feasibility of PDT in critically ill patients with obesity. Future studies should aim to provide more standardized definitions of obesity and better data on long-term outcomes in this patient population.

Reference:

Roy, C. F., Silver, J. A., Turkdogan, S., Siafa, L., Correa, J. A., & Kost, K. (2023). Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity. In JAMA Otolaryngology–Head & Neck Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamaoto.2022.4824