title: Timing of tracheotomy in mechanically ventilated critically ill morbidly obese patients.
abstract: Background. The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial. Methods. We conducted a retrospective chart review of morbidly obese subjects (BMI ≥ 40 kg/m(2) or BMI ≥ 35 kg/m(2) and one or more comorbid conditions) who underwent a tracheotomy between July 2008 and June 2013 at a medical intensive care unit (ICU). Clinical characteristics, rates of nosocomial pneumonia (NP), weaning from mechanical ventilation (MV), and mortality rates were analyzed. Results. A total of 102 subjects (42 men and 60 women) were included; their mean age and BMI were 56.3 ± 15.1 years and 53.3 ± 13.6 kg/m(2), respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (P = 0.43). Mortality was significantly higher in those who failed to wean (P = 0.02). A cutoff value of 9 days for the time to tracheotomy provided the best balanced sensitivity (72%) and specificity (59.8%) for predicting NP onset. Rates of NP and total duration of MV were significantly higher in those who had tracheostomy ≥ 9 days (P = 0.004 and P = 0.002, resp.). Conclusions. The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Ahmad
authors.identifier: 0000-0002-7277-7797
authors.initials: A
authors.lastname: Alhajhusain
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Ailia W
authors.identifier: 0000-0002-6222-5737
authors.initials: AW
authors.lastname: Ali
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Asif
authors.identifier: 0000-0001-7737-0788
authors.initials: A
authors.lastname: Najmuddin
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Kashif
authors.initials: K
authors.lastname: Hussain
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors.forename: Masooma
authors.identifier: 0000-0001-5276-7017
authors.initials: M
authors.lastname: Aqeel
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences and the Veterans Affairs Medical Center, Buffalo, NY, USA ; Medical Research, VA Western New York Healthcare System, Building 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY 14215-1199, USA.
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh