The rising prevalence of morbidly obese patients presents unique challenges to the intensivist, including management of the airway. We present a case where commercially available tracheostomy tubes were of insufficient length due to the patient's body habitus, with potentially disastrous consequences. As a solution, an endotracheal tube was used as the tracheostomy tube to provide sufficient length for correct positioning and to enable weaning from mechanical ventilation. The adjustable flange from a tracheostomy kit was used to secure the tube in position. Our case illustrates one possible solution to the problem of tracheostomy tube positioning in morbidly obese patients.
ColquittJLCleggAJLovemanE. Surgery for morbid obesity. Cochrane Database Syst Rev2005;Oct19:CD003641.
3.
SturmR. Increases in morbid obesity in the USA: 2000–2005. Public Health2007;121: 492–96.
4.
AkinnusiMEPinedaLAEl SolhAA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med2008;36: 151–58.
5.
El-SolhA. Clinical approach to the critically ill, morbidly obese patient. Am J Respir Crit Care Med2004;169: 557–61.
6.
CookTMWoodallNHarperJ. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth2011;106: 632–42.
ToyFJWeinsteinJD. A percutaneous tracheostomy device. Surgery1969;65: 384–89.
10.
DiehlJLEl AtrousSTouchardD. Changes in the work of breathing induced by tracheotomy in ventilator-dependent patients. Am J Respir Crit Care Med1999;159: 383–88.
11.
GrilloHC. Surgical anatomy of the trachea and techniques of resection. In: ShieldsTWLoCiceroJIIIPonnRB, eds. General Thoracic Surgery.5th edition. Philadelphia: Lippincott Williams & Wilkins; 2000. p.1047–60.
12.
El SolhAAJaafarW. A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients. Crit Care2007;11: R3.
13.
HalumSLTingJYPlowmanEK. A multi-institutional analysis of tracheotomy complications. Laryngoscope2012;122: 38–45.
14.
AldawoodASArabiYMHaddadS. Safety of percutaneous tracheostomy in obese critically ill patients: a prospective cohort study. Anaesth Intensive Care2008;36: 69–73.
15.
JonesRLNzekwuMM. The effects of body mass index on lung volumes. Chest2006;130: 827–33.
16.
El SolhA. Clinical approach to the critically ill morbidly obese patient. Am J Respir Crit Care Med2004;169: 557–61.
17.
MallickABodenhamAElliotSOramJ. An investigation into the length of standard tracheostomy tubes in critical care patients. Anaesthesia2008;63: 302–06.
18.
LimPV-HRamanR. Adjustable length tracheostomy tube for the morbidly obese and thick neck patient: A prototype. Otolaryngol Head Neck Surg2001;124: 56–57.
19.
ShimizuTMizutaniTTakahashiS. New use of a laryngectomy tube for management of mechanical ventilation in patients with anatomical abnormalities. Br J Anaesth2008;100: 728–29.
20.
PriceD. Techniques of tracheostomy for intensive care unit patients. Anaesthesia1983;38: 902–04.
21.
GrossNDCohenJIAndersenPEWaxMK. ‘Defatting’ tracheotomy in morbidly obese patients. Laryngoscope2002;112: 1940–44.
22.
CapuanoUFerraraJJ. A modified endotracheal tube for tracheostomy. Crit Care Med1986;14: 521–22.
McGrathBABatesLAtkinsonDMooreJA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia2012;67: 1025–41.
