title: Ultrasound-guided percutaneous tracheostomy in critically ill obese patients.
abstract: BACKGROUND
  The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients.
  
  
  METHODS
  Fifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m². The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage).
  
  
  RESULTS
  The median BMIs were 34 kg/m² (32-38) in the obese patient group and 25 kg/m² (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths.
  
  
  CONCLUSIONS
  This study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01502657.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054 Amiens, France. guinot.pierre-gregoire@gmail.com
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.forename: Sandra
authors.initials: S
authors.lastname: Petiot
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marienne
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Guerin
authors.forename: Pauline
authors.initials: P
authors.lastname: Monet
authors.forename: Rody
authors.initials: R
authors.lastname: Zaatar
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000368:Aged; D016638:Critical Illness; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional