Guinot Pierre-Grégoire, Zogheib Elie, Petiot Sandra, Marienne Jean-Pierre, Guerin Anne-Marie, Monet Pauline, Zaatar Rody, Dupont Hervé
Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054 Amiens, France.
Crit Care. 2012 Dec 12;16(2):R40. doi: 10.1186/cc11233.
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.
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).
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.
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.
ClinicalTrials.gov: NCT01502657.
本研究的目的是评估超声（US）引导下经皮气管切开术（PCT）在重症肥胖患者中的可行性及并发症发生率。
在两个外科和重症医学科进行了一项前瞻性研究，纳入了连续的50例患者。肥胖定义为体重指数（BMI）至少为30kg/m²。比较肥胖患者（n = 26）和非肥胖患者（n = 24）中PCT的可行性及并发症发生率。结果以中位数（第25-75百分位数）或数量（百分比）表示。
肥胖患者组的BMI中位数为34kg/m²（32-38），非肥胖组为25kg/m²（24-28）（p < 0.001）。非肥胖患者气管切开术的中位时间为10分钟（8-14），肥胖患者为9分钟（5-10）（p = 0.1）。肥胖和非肥胖患者组的总体并发症发生率相似（35%对33%，p = 0.92）。大多数并发症为轻微并发症（低血压、血氧饱和度下降、气管套囊穿刺和轻微出血），肥胖组和非肥胖组之间无差异。支气管镜检查发现肥胖患者中有2例肉芽肿（8%）。1例非肥胖患者发生造口周围皮肤感染，经静脉使用抗生素治疗。所有纳入患者均可进行超声引导下PCT，无手术中转或死亡病例。
本研究表明，超声引导下PCT在肥胖患者中可行，并发症发生率低。肥胖可能不是超声引导下PCT的禁忌证。超声检查可提供颈部解剖结构信息，从而改变并指导PCT穿刺部位的选择。
ClinicalTrials.gov：NCT01502657。
