We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Complication Rate of Percutaneous Dilatational Tracheostomy in Critically Ill Adults With Obesity: A Systematic Review and Meta-analysis.
- Authors
Roy, Catherine F.; Silver, Jennifer A.; Turkdogan, Sena; Siafa, Lyna; Correa, José A.; Kost, Karen
- Abstract
This systematic review and meta-analysis assesses the complication rate of percutaneous dilatational tracheostomy in critically ill adults with obesity and compares it with that in patients without obesity and with that of open surgical tracheostomies in adults with obesity. Key Points: Question: What is the reported complication rate of percutaneous dilatational tracheostomy (PDT) in critically ill adults with obesity, and how does it compare (1) with that in patients without obesity and (2) with that of open surgical tracheostomies in adults with obesity? Findings: In the systematic review of 18 studies including 1355 patients with obesity who underwent PDT, tracheostomy-related complications occurred in 16.6% of patients with obesity (791 patients, 17 studies), most of which were non–life-threatening. Patients with obesity had a higher rate of complications with PDT compared with patients without obesity, while analysis was not possible for comparison with the open approach owing to lack of data. Meaning: These findings suggest that the rate of complications of PDT in critically ill individuals with obesity is low but higher than in individuals without obesity. Importance: Obesity has traditionally been described as a relative contraindication to percutaneous dilatational tracheostomy (PDT). Increased familiarity with the technique and use of bronchoscopy or real-time ultrasonography to enhance visualization have led many practitioners to expand the indication for PDT to patients historically deemed to have high risk of perioperative complications. Objective: To assess the reported complication rate of PDT in critically ill adults with obesity and compare it with that of open surgical tracheostomies (OSTs) in this patient population and with that of PDT in their counterparts without obesity. Data Sources: In this systematic review and meta-analysis, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1, 2000, to March 1, 2022. Key terms related to percutaneous tracheostomy and obesity were included. Study Selection: Original investigations of critically ill adult patients (age ≥18 years) with obesity who underwent PDT that reported at least 1 complication of interest were included. Case reports or series with fewer than 5 patients were excluded, as were studies in a language other than English or French. Data Extraction and Synthesis: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were used, with independent extraction by multiple observers. Frequencies were reported for all dichotomous variables. Relative risks for complications were calculated using both fixed-effects and random-effects models in the meta-analysis. Main Outcomes and Measures: Main outcomes included mortality directly associated with the procedure, conversion to OST, and complications associated with the procedure (subclassified into life-threatening or non–life-threatening adverse events). Results: Eighteen studies were included in the systematic review, comprising 1355 patients with obesity who underwent PDT. The PDT-related complication rate was 16.6% among patients with obesity overall (791 patients, 17 studies), most of which were non–life-threatening. Only 0.6% of cases (8 of 1314 patients, 17 studies) were aborted or converted to an OST. A meta-analysis of 12 studies (N = 4212; 1078 with obesity and 3134 without obesity) showed that patients with obesity had a higher rate of complications associated with PDT compared with their counterparts without obesity (risk ratio, 1.78; 95% CI, 1.38-2.28). A single study compared PDT with OST directly for critically ill adults with obesity; thus, the intended meta-analysis could not be performed in this subgroup. Conclusions and Relevance: The findings suggest that the rate of complications of PDT is low in critically ill individuals with obesity, although the risk of complications may be higher than in individuals without obesity.
- Publication
JAMA Otolaryngology-Head & Neck Surgery, 2023, Vol 149, Issue 4, p334
- ISSN
2168-6181
- Publication type
Article
- DOI
10.1001/jamaoto.2022.4824