A simple method to predict pretracheal tissue thickness to prevent accidental decannulation in the obese.
OBJECTIVE
Accidental decannulation is the most common and serious complication associated with tracheostomy in obese patients. We lack a simple way to choose appropriate-size tracheostomy tubes in this patient subset. Our purpose was to 1) establish the range of trachea-to-skin soft tissue thickness (TTSSTT) in obese patients and 2) determine which easily obtained anthropometric measurements are most predictive of TTSSTT.


METHODS
Case series with planned data collection.


METHODS
Tertiary care center.


METHODS
Forty consenting patients with body mass index ranging from 30 to 70 were evaluated. These patients, from a bariatric clinic, underwent ultrasound (US) of the neck in predetermined sitting, supine, and neck-extended positions (as for tracheostomy). US was performed by a qualified radiologist. Standard anthropometric measurements of weight, height, arm, hip, waist, and neck sizes were performed. Multiple regression analysis was used to determine which anthropometric measurements best correlated with TTSSTT.


RESULTS
The TTSSTT, as measured by US in the supine position, ranged from 0.65 to 3.53 cm. Although the anthropometric measurement most predictive of TTSSTT was waist circumference, a combination of the more practical arm and neck circumferences resulted in an equivalent correlation (r = 0.82). The average root mean squared error was 0.4 cm. From the fitted regression equation, a table predicting TTSSTT from neck and arm circumference was prepared.


CONCLUSIONS
TTSSTT can be closely predicted using simple anthropometric tape measures. The predicted TTSSTT can be used to select appropriate tracheostomy tube size in obese patients. Use of this simple tool is expected to significantly reduce the incidence of accidental decannulation in obese patients.
Szeto
Christopher
C
Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. Christopher.szeto@mail.mcgill.ca
Kost
Karen
K
Hanley
James A
JA
Roy
Ann
A
Christou
Nicholas
N
D000328:Adult; D000886:Anthropometry; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D016683:Supine Position; D014132:Trachea / Q000033:anatomy & histology*; D014139:Tracheostomy / Q000009:adverse effects* / Q000295:instrumentation*