Tracheostomy Case Studies

Obesity has become a major health issue in the United States and Europe [1]. It is estimated that more than one-third of population in the US is obese [2]. Obesity and morbid obesity are defined as body mass index (BMI) ≥30- <40 kg.m-2 and ≥40 kg.m-2, respectively. A broad range of health issues such as cardiac disease, hypertension, stroke, type 2 diabetes mellitus, obstructive sleep apnea and obesity hypoventilation syndrome are associated with obesity. All of the latter consequently increases the risk of hospitalization and a need for higher level of care. A recent study showed obesity was associated with significantly higher all-cause mortality relative to normal weight population [3]. From a pulmonary standpoint, lung physiology is significantly altered in the obese patient; including respiratory muscle insufficiency, reduced functional residual volume (FRC), expiratory reserve volume (ERV) and lung compliance [4]. Ventilation and perfusion (V/Q) matching is altered due to small airway
Tracheostomy is a commonly performed procedure that establishes a long-term secure airway for patients who require extended mechanical ventilation from a variety of disease processes. More than one hundred thousand tracheostomies are performed in the United States annually [7]. The procedure can be performed either in the operating room or at the bedside. Although newer techniques and instruments have evolved over years, some studies suggest morbid obesity is a risk factor for tracheostomy regardless of utilized technique (percutaneous versus surgical) [6, 8]. Technique and optimal timing of tracheostomy in obese patients remains a subject of debate. The current recommendations suggest an individualized approach taking in consideration the reason for prolonged mechanical ventilation, the underlying comorbidities and the potential risk factors that increase the incidence of complications