文章基本信息

标题：Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients
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作者：Ahmad Alhajhusain ; Ailia W. Ali ; Asif Najmuddin 等
期刊名称：Critical Care Research and Practice
印刷版ISSN：2090-1305
电子版ISSN：2090-1313
出版年度：2014
卷号：2014
DOI：10.1155/2014/840638
出版社：Hindawi Publishing Corporation
摘要：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/m2 or BMI ≥ 35 kg/m2 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/m2, respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (). Mortality was significantly higher in those who failed to wean (). 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 ( and , 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.