title: The effect of body mass index on intubation success rates and complications during emergency airway management.
abstract: We evaluated the effect of body mass index (BMI) on intubation success rates and complications during emergency airway management. We retrospectively analyzed an airway registry at an academic medical center. The primary outcomes were the incidence of difficult intubation and complication rates, stratified by BMI. We captured 1,075 (98 %, 1,075/1,102; 95 % CI 97-99) intubations. Four hundred twenty-six patients (40 %) had a normal BMI, 289 (27 %) were overweight, 261 (25 %) were obese, and 77 (7 %) were morbidly obese. In a multivariate analysis, obesity (OR 1.90; 95 % CI 1.04-3.45; p = 0.04), but not morbid obesity (OR 2.18; 95 % CI 0.95-4.99; p = 0.07), predicted difficult intubation. BMI was not predictive of post-intubation complications. Airway management in the morbidly obese differed when compared with lean patients, with less use of rapid sequence intubation and increased use of fiberoptic bronchoscopy in the former. During emergency airway management, difficult intubation is more common in obese patients, and morbidly obese patients are more commonly treated as potentially difficult airways.
authors.affiliation: Department of Medicine, Division of Pulmonary-Critical Care Medicine, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA. James.M.Dargin@lahey.org
authors.forename: James M
authors.initials: JM
authors.lastname: Dargin
authors.forename: Lillian L
authors.initials: LL
authors.lastname: Emlet
authors.forename: Frank X
authors.initials: FX
authors.lastname: Guyette
mesh_terms: D000368:Aged; D058109:Airway Management / Q000706:statistics & numerical data*; D015992:Body Mass Index; D004363:Drug Utilization / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007817:Laryngeal Cartilages / Q000601:surgery; D007828:Laryngoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use; D009765:Obesity / Q000150:complications*; D012042:Registries; D012189:Retrospective Studies
chemical_list: D009466:Neuromuscular Blocking Agents