title: A simple method to predict pretracheal tissue thickness to prevent accidental decannulation in the obese.
abstract: 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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada. Christopher.szeto@mail.mcgill.ca
authors.forename: Christopher
authors.initials: C
authors.lastname: Szeto
authors.forename: Karen
authors.initials: K
authors.lastname: Kost
authors.forename: James A
authors.initials: JA
authors.lastname: Hanley
authors.forename: Ann
authors.initials: A
authors.lastname: Roy
authors.forename: Nicholas
authors.initials: N
authors.lastname: Christou
mesh_terms: 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*