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Predictors of Complicated Percutaneous Dilatational Tracheostomy Insertion
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A6062 - Predictors of Complicated Percutaneous Dilatational Tracheostomy Insertion
Author Block: J. Hansen1, K. Morris2, S. Thapamagar1, W. Klein3; 1Pulmonary and Critical Care Medicine, Loma Linda University, Loma Linda, CA, United States, 2Anesthesia, Riverside University Health System, Moreno Valley, CA, United States, 3Pulmonary and Critical Care Medicine, Riverside University Health System, Moreno Valley, CA, United States.
Introduction:
Percutaneous dilatational tracheostomy (PDT) is a safe and efficient bedside procedure performed in the intensive care unit. However, no existing studies have investigated factors predicting difficult PDT insertion. We performed a prospective, observational study to investigate patient-related factors that may lead to difficult PDT insertion.
Methods:
This is a single-center, prospective, observational study, which enrolled all medical ICU patients who underwent PDT from May 2016 to September 2017. Patient variables such as age, gender, ethnicity, body mass index (BMI), neck circumference (NC), thyromental distance (TMD) and sterno-mental distance (SMD) were recorded. Procedure-related variables such as duration of the procedure, number of attempts and periprocedural complications were also recorded. The primary outcome was the incidence of a complicated PDT, defined as > 2 needle insertions, procedure duration (skin incision to tracheostomy insertion) > 10 min or airway loss during the procedure. PDT was performed using the Cook Blue Rhino kit with bronchoscopic guidance.
Results:
Sixty-four patients were enrolled in the study. Of those, 59.4% were male and the mean age was 59.0 (±17.6) years. The most common reason for PDT placement was failure to liberate from mechanical ventilation (54.5%). Mean BMI was 32.8 (±15.61) kg/m2. Mean NC was 44.6 (±8.65) cm, mean TMD was 6.45 (±1.80) cm and mean SMD was 11.5 (±2.64) cm. The mean duration of the procedure was 10.1 (±7.43) minutes. In 19 patients (29.69%), the procedure took > 10 minutes. On average, 3.5 (±3.58) needle insertion attempts were made. Three patients (4.69%) had a transient loss of airway during the procedure. Thirty-eight patients (59.4%) had a complicated PDT insertion. Univariate analysis showed BMI to be the only significant variable predicting the primary outcome, with mean BMI in the complicated group of 30.53 vs 25.82 in the uncomplicated group. (p=0.038). In patients with a BMI ≥ 40, more complicated PDTs were encountered (10 vs 3).
Conclusion:
Difficulty performing bedside PDT can be expected more often in patients with obesity, especially those with BMI ≥ 40. We did not encounter any increase in serious adverse outcomes such as death, severe bleeding, false passage, or airway loss in this population. Further study with a larger sample size is needed to adequately examine these risks in obese patients.
Author Block: J. Hansen1, K. Morris2, S. Thapamagar1, W. Klein3; 1Pulmonary and Critical Care Medicine, Loma Linda University, Loma Linda, CA, United States, 2Anesthesia, Riverside University Health System, Moreno Valley, CA, United States, 3Pulmonary and Critical Care Medicine, Riverside University Health System, Moreno Valley, CA, United States.
Introduction:
Percutaneous dilatational tracheostomy (PDT) is a safe and efficient bedside procedure performed in the intensive care unit. However, no existing studies have investigated factors predicting difficult PDT insertion. We performed a prospective, observational study to investigate patient-related factors that may lead to difficult PDT insertion.
Methods:
This is a single-center, prospective, observational study, which enrolled all medical ICU patients who underwent PDT from May 2016 to September 2017. Patient variables such as age, gender, ethnicity, body mass index (BMI), neck circumference (NC), thyromental distance (TMD) and sterno-mental distance (SMD) were recorded. Procedure-related variables such as duration of the procedure, number of attempts and periprocedural complications were also recorded. The primary outcome was the incidence of a complicated PDT, defined as > 2 needle insertions, procedure duration (skin incision to tracheostomy insertion) > 10 min or airway loss during the procedure. PDT was performed using the Cook Blue Rhino kit with bronchoscopic guidance.
Results:
Sixty-four patients were enrolled in the study. Of those, 59.4% were male and the mean age was 59.0 (±17.6) years. The most common reason for PDT placement was failure to liberate from mechanical ventilation (54.5%). Mean BMI was 32.8 (±15.61) kg/m2. Mean NC was 44.6 (±8.65) cm, mean TMD was 6.45 (±1.80) cm and mean SMD was 11.5 (±2.64) cm. The mean duration of the procedure was 10.1 (±7.43) minutes. In 19 patients (29.69%), the procedure took > 10 minutes. On average, 3.5 (±3.58) needle insertion attempts were made. Three patients (4.69%) had a transient loss of airway during the procedure. Thirty-eight patients (59.4%) had a complicated PDT insertion. Univariate analysis showed BMI to be the only significant variable predicting the primary outcome, with mean BMI in the complicated group of 30.53 vs 25.82 in the uncomplicated group. (p=0.038). In patients with a BMI ≥ 40, more complicated PDTs were encountered (10 vs 3).
Conclusion:
Difficulty performing bedside PDT can be expected more often in patients with obesity, especially those with BMI ≥ 40. We did not encounter any increase in serious adverse outcomes such as death, severe bleeding, false passage, or airway loss in this population. Further study with a larger sample size is needed to adequately examine these risks in obese patients.
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