Tracheostomy in a Patient Weighing over 200 kg Presenting with Acute Respiratory Failure

Abstract

In general, stable respiratory management after tracheostomy is difficult in patients with a thick short neck. A longer length of the tracheal tube is needed for patients with a thick short neck as compared to patients with a normal size of the neck. The unstable condition associated with the use of a longer tracheal tube in patients with a thick neck results in many complications and difficulty in respiratory management. We report the case of a patient weighing over 200 kg with a very thick neck in whom we performed tracheostomy because of acute respiratory failure. Prior to the tracheostomy, the fatty tissue between the skin and trachea was removed to the minimum extent needed to avoid the production of dead space after the tracheostomy. We discuss the problems related to tracheostomy and management of the tracheal tube in overweight patients. From our experience with this case, we recommend selection of a tracheal tube with a movable neck flange for patients with a thick neck. The BMI based on the body weight after the tracheostomy (such as 14 days later, 21 days later) has been suggested as a novel predictor of the development of postoperative complications in these patients.