Tracheostomy Procedure in Obese Patients
There are no absolute contraindications to tracheostomy procedure. Instead, variation to standard techniques are employed when challenging cases are faced. An obese neck presents with several challenges when a tracheostomy is required in an obese patient. Careful assessment of obese patients’ neck may reveal the low anterior neck may not be obese and a standard tracheostomy may be appropriate. Although, this is not always the case. The increased distance from the skin of the anterior neck to the anterior tracheal wall must be appropriately managed to avoid potential catastrophic complications. Additionally, the risk of accidental decannulation, particularly with type II slow displacement, is increased in obese patients with tracheostomy.
This is a retrospective chart review of obese tracheostomy procedures performed at Legacy Emanuel Hospital, a trauma one tertiary referral center, in the last 3 years. Total of 50 patients were identified. Here we describe different approaches utilized for tracheostomy procedures in obese patients. We will discuss complication rates and techniques utilized to minimize them.
Most common variations to standard tracheostomy procedure utilized were defatting on anterior neck compartment, the construction of tracheal stoma via different flap designs including Bjork flap, superiorly versus inferiorly based skin flaps or both superior and inferior skin flaps. Additionally, special tracheostomy tubes with distal or proximal extensions or an armored endotracheal tube were utilized in some patients. Most common complication was postoperative bleeding, none which were life threatening. In our group of patients, we had no accidental decannulation or tracheostomy related deaths.
With proper treatment planning and utilization of appropriate surgical techniques complication rates in obese tracheostomy procedures can be significantly minimized.
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