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Safety of Bedside Percutaneous Dilatational Tracheostomy in Obese Patients in the ICU^*

^* From the Division of Pulmonary and Critical Care Medicine, Department of Medicine (Drs. Mansharamani, Koziel, Ernst, and Mr. Garland) and Department of Surgery (Drs. LoCicero and Critchlow), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Correspondence to: Armin Ernst, MD, Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Boston, MA 02115; e-mail: aernst{at}caregroup.harvard.edu

Study objective: To examine the safety of bedside percutaneous dilatational tracheostomy in obese patients.

Design: Case series of consecutive obese patients (body mass index 27 kg/m²) with acute respiratory failure in a medical, cardiac, or surgical ICU unit who required tracheostomy for failure to wean and continued mechanical ventilatory support.

Results: Thirteen obese patients were identified and consented to the procedure. Bedside percutaneous dilatational tracheostomy was successfully performed in the ICU for all 13 patients. Procedural complications were limited to paratracheal tracheostomy tube placement in one patient, with immediate identification and appropriate correction. Postprocedural complications were limited to a cuff leak in one patient.

Conclusion: Bedside percutaneous tracheostomy can be safely performed in obese patients.

Key Words: morbid obesity • percutaneous dilatational tracheostomy • respiratory failure

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