Obesity and Emergency Intubation

Intubation to secure a patent airway for ventilation is one of the most common procedures performed in the emergency care of severely injured trauma patients.  

As anyone, who has performed intubations is well aware, the anatomic and physiological characteristics associated with obesity often makes the intubation of larger patients more challenging. It is therefore reasonable to assume that obese trauma patients requiring emergency intubation are at increased risk for unsuccessful intubation and airway-related complications. 

But is this really the case?

To answer this question, Ziad Sifri and colleagues from the New Jersey Medical School, Newark, New Jersey, USA, performed a retrospective review of prospectively collected data from an airway surveillance database of 9,980 patients seen at an urban Level I trauma center between 2001 and 2004 (Journal of Trauma). The study population included all adult patients admitted to the trauma center, who required urgent airway management. The patients were stratified into four groups according to their BMI.

During the three-year study period, 1,435 (14%) were emergently intubated and made up the study population. About 92% of ED intubations were performed by the anesthesia team. Of all emergently intubated patients, 46% were lean, 37% were overweight, 15% were obese, and 2% were morbidly obese.

Interestingly, BMI was not an independent risk factor for failed intubations in the field or in the ED, postintubation airway complications, or death. Only early respiratory complications demonstrated a statistically significant, but unlikely clinically relevant association with a higher BMI.

The authors conclude that emergency intubation of obese trauma patients can be safely and successfully performed in a high volume Level I trauma center. Whether the same is true at less-experienced centres, of course, remains to be seen. 

Overall, this study is very much in line with previous findings that body weight or size in itself is not a key determinant of patient outcome or survival in critical situations.

Clearly, in experienced hands, there is no reason to shy away from intubating patients with larger BMIs. 

Edmonton, Alberta