肥胖危重症成人经皮扩张气管切开术的安全性：一项回顾性队列研究。

Safety of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity: A Retrospective Cohort Study.

机构信息

Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Canada.

Department of Otolaryngology - Head and Neck Surgery, University of Manitoba, Winnipeg, Canada.

出版信息

Laryngoscope. 2024 Dec;134(12):5015-5020. doi: 10.1002/lary.31664. Epub 2024 Aug 3.

DOI:10.1002/lary.31664

PMID:39096084

Abstract

OBJECTIVE

This study aimed to assess the safety and efficacy of endoscopic percutaneous dilatational tracheostomy (PDT) in obese and nonobese critically ill adults.

METHODS

A retrospective study of all cases of PDT performed at two academic health centers between 2016 and 2023 was conducted. Primary outcomes included peri- and postoperative complications stratified by both timing and severity. body mass index (BMI) data were stratified according to the World Health Organization classification (class I obesity defined as BMI ≥ 30, class II obesity ≥35 and <40, class 3 obesity ≥40).

RESULTS

Totally 336 patients underwent a PDT, 279 of whom had available BMI data: 193 (69.2%) patients had a normal BMI, 56 (20.1%) had class I obesity, 15 (5.4%) class II obesity, and 15 (5.4%) class III obesity. The overall complication rates for the class I, II, and III obesity were 8.9%, 13.3%, and 13.3%, respectively. All procedures were successfully completed at the bedside (no conversions to an open approach), and there was no procedure-related mortality. The only accidental decannulation event was in a patient with class III obesity. There was no difference in overall complication rates between patients without obesity and patients with obesity (7.3% vs. 10.5%, respectively, p = 0.370).

CONCLUSION

This study significantly expands the current literature and represents one of the largest studies to date reporting on PDT in patients with obesity.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:5015-5020, 2024.

摘要

目的

本研究旨在评估内镜经皮扩张气管切开术（PDT）在肥胖和非肥胖危重症成人中的安全性和有效性。

方法

对 2016 年至 2023 年在两个学术医疗中心进行的所有 PDT 病例进行回顾性研究。主要结局包括按时间和严重程度分层的围手术期并发症。体重指数（BMI）数据按世界卫生组织分类（定义为 BMI≥30 的 I 类肥胖、≥35 且<40 的 II 类肥胖、≥40 的 III 类肥胖）进行分层。

结果

共 336 例患者接受了 PDT，其中 279 例有可用的 BMI 数据：193 例（69.2%）患者 BMI 正常，56 例（20.1%）患者为 I 类肥胖，15 例（5.4%）患者为 II 类肥胖，15 例（5.4%）患者为 III 类肥胖。I 类、II 类和 III 类肥胖的总体并发症发生率分别为 8.9%、13.3%和 13.3%。所有手术均在床边成功完成（无转为开放手术），无手术相关死亡。唯一的意外拔管事件发生在一名 III 类肥胖患者中。无肥胖患者与肥胖患者的总体并发症发生率无差异（分别为 7.3%和 10.5%，p=0.370）。