Morbid obesity complicates intubation.
Despite attempts at optimal positioning, it's significantly more difficult to intubate patients who are morbidly obese than those of normal weight, according to a poster presentation by Dr. Thomas C. Mort at the annual congress of the Society of Critical Care Medicine.
In a retrospective analysis of more than 1,200 patients, 72% of patients with body mass indexes below 25 kg/[m.sup.2] could be in-rebated on the first try, compared with just 52% of those with BMIs greater than 40. At least three attempts were required for 18% of the morbidly obese (MO) patients, compared with 10.5% of the normal-weight patients.
Accessory airway devices were required far more often in MO patients. Of MO patients, 58% required one of these devices, compared with 22% of normal-weight patients. Bougies were required 21% of the time in MO patients, compared with 10% of normal-weight patients. Similarly significant differences were noted for laryngeal mask airways (28% vs. 4%), but no significant differences were noted in the use of fiberoptic bronchoscopes or Combitubes.
The study involved 1,253 consecutive emergency intubations over a 12-year period from 1994 to 2005. Dr. Mort, of Hartford (Conn.) Hospital, isolated those cases in which emergency airway management took place outside the operating room. Fourteen percent of the cohort (174 patients) had BMIs greater than 40, and they were compared with a cohort of normal-weight patients.
Mild hypoxemia was found in 33% of the MO group, significantly greater than the 17% of the normal-weight patients. Likewise, severe hypoxemia was more common among MO patients (11% vs. 2%).
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|Title Annotation:||Clinical Capsules|
|Publication:||Family Practice News|
|Article Type:||Brief article|
|Date:||Mar 1, 2006|
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