A38 Percuteneous Dilatation Tracheostomy in Obese Critically Ill Patients with Bronchoscopy Assistance Report of 40 Patients

Introduction: ICU patients, mainly those in need of prolonged mechanical ventilation, may require tracheotomy which once was done in the operating room. Obese critically ill patients are at greater risk for requiring intubation and prolonged mechanical ventilation. Percuteneous dilatational tracheotomy (PDT) was first described in 1985 and now is a well-established procedure that can be performed at the bedside by an intensivist with less surgical equipment required. Goal of Study: To evaluate the safety of performing percuteneous dilatational tracheotomy (PDT) with Fiberoptic bronchoscopy assistance in obese patients requiring prolonged mechanical ventilation. Method: Forty patient 17–79yrs of age, 13 females and 27 males with body mass index 38 ± 8 kg/m2 underwent PDT with bronchoscopy assistance due to prolonged endotracheal intubation between December 2009 and September 2011. The procedures of percuteneous dilatation tracheotomy with guide wire dilator forceps (GWDF) were done bedside with bronchoscopic guidance under general anaesthesia in the intensive care unit. Operative and post operative complications were observed. Results: Overall complication rate was low and occurred in 7 patients, there was no procedure-related mortality. Subcutaneous emphysema without pneumothorax occurred in one patient, one patient had a transitory hypotension related to sedation and five patients had peristomal oozing. The mean time for procedure completion was 15 minutes and no patient required conversion to surgical tracheotomy. The bronchoscopic examination that was performed in 21 of the patients 20 days after tracheotomy tube removal showed no scar formation. Conclusions: PDT with bronchoscopic guidance is safe for obese critically ill patients that can be done by an experienced intensivist at the bedside setting.