By Eleanor McDermid
Anesth Analg 2011; 112: 1132–1138
MedWire News: Only extreme obesity adversely impacts the ease of emergent prehospital intubation, research shows.
But despite the increased difficulty of intubation, nonphysician advanced life support providers achieved a similar intubation success rate in morbidly obese patients as in leaner patients, report Sam Sharar (University of Washington, Seattle, USA) and team.
This argues “against the initiation of complicated or expensive changes to existing training or clinical protocols,” the researchers write in the journal Anesthesia and Analgesia.
However, they add that “our finding that morbidly obese patients have an increased frequency of difficult tracheal intubation in the prehospital setting does suggest that this subset of patients may benefit from such efforts.”
The team’s conclusions are based on data from 823 patients who underwent prehospital intubation over a 4-year period and had a calculable body mass index (BMI).
Overall, 98.5% of intubations were successful, but 6.8% were classed as difficult, requiring four or more attempts or recourse to an alternative airway management approach.
Patients with and without difficult intubations did not differ in terms of age, gender, whether they were trauma or nontrauma patients, or whether they were given succinylcholine.
The degree of obesity was the only independent predictor of difficult intubation. Compared with nonobese patients (BMI <30 kg/m2), morbidly obese patients (BMI >40 kg/m2) were 3.7 times more likely to have a difficult intubation, whereas those with lesser degrees of obesity (BMI 30–39 kg/m2) did not have an increased risk for difficult intubation.
Morbidly obese patients had a difficult intubation rate of 16.7%, compared with 6.3% in nonobese patients. But, despite this, intubation success rates were very similar, at 95.8% and 98.5%, respectively. Also, 79.2% of morbidly obese patients were successfully intubated at the first attempt, as were 74.8% of less obese and nonobese patients.
“Our findings highlight the importance of education and training in the use of alternative airway techniques that may obviate the need for laryngoscopy and tracheal intubation in selected cases,” comment Sharar et al.
