title: Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units.
abstract: BACKGROUND
  Intubation procedure in obese patients is a challenging issue both in the intensive care unit (ICU) and in the operating theatre (OT). The objectives of the study were (i) to compare the incidence of difficult intubation and (ii) its related complications in obese patients admitted to ICU and OT.
  
  
  METHODS
  We conducted a multicentre prospective observational cohort study in ICU and OT in obese (BMI≥30 kg m(-2)) patients. The primary endpoint was the incidence of difficult intubation. Secondary endpoints were the risk factors for difficult intubation, the use of difficult airway management techniques, and severe life-threatening complications related to intubation (death, cardiac arrest, severe hypoxaemia, severe cardiovascular collapse).
  
  
  RESULTS
  In cohorts of 1400 and 11 035 consecutive patients intubated in ICU and in the OT, 282 (20%) and 2103 (19%) were obese. In obese patients, the incidence of difficult intubation was twice more frequent in ICU than in the OT (16.3% vs 8.2%, P<0.01). In both cohorts, risk factors for difficult intubation were Mallampati score III/IV, obstructive sleep apnoea syndrome, and reduced mobility of cervical spine, while limited mouth opening, severe hypoxaemia, and coma appeared only in ICU. Specific difficult airway management techniques were used in 66 (36%) cases of difficult intubation in obese patients in the OT and in 10 (22%) cases in ICU (P=0.04). Severe life-threatening complications were significantly more frequent in ICU than in the OT (41.1% vs 1.9%, relative risk 21.6, 95% confidence interval 15.4-30.3, P<0.01).
  
  
  CONCLUSIONS
  In obese patients, the incidence of difficult intubation was twice more frequent in ICU than in the OT and severe life-threatening complications related to intubation occurred 20-fold more often in ICU.
  
  
  BACKGROUND
  Current controlled trials. Identifier: NCT01532063.
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France.
authors.forename: A
authors.initials: A
authors.lastname: De Jong
authors.affiliation: Department of Medical Statistics, La Colombière University Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier F-34295, France.
authors.forename: N
authors.initials: N
authors.lastname: Molinari
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Pouzeratte
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France.
authors.forename: D
authors.initials: D
authors.lastname: Verzilli
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France.
authors.forename: G
authors.initials: G
authors.lastname: Chanques
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France Institut National de la Santé et de la Recherche Médicale U1046.
authors.forename: B
authors.initials: B
authors.lastname: Jung
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France.
authors.forename: E
authors.initials: E
authors.lastname: Futier
authors.affiliation: Anesthesiology and Critical Care Department C, Gui de Chauliac Hospital, Montpellier F-34295, France.
authors.forename: P-F
authors.initials: PF
authors.lastname: Perrigault
authors.affiliation: Anesthesiology and Critical Care Department D, Arnaud de Villeneuve Teaching Hospital.
authors.forename: P
authors.initials: P
authors.lastname: Colson
authors.affiliation: Anesthesiology and Critical Care Department A, Lapeyronie Teaching Hospital, and Université Montpellier 1, Centre Hospitalier Universitaire Montpellier, Montpellier F-34295, France.
authors.forename: X
authors.initials: X
authors.lastname: Capdevila
authors.affiliation: Anesthesiology and Critical Care Department B, Saint Eloi Teaching Hospital, Montpellier F-34295, France Institut National de la Santé et de la Recherche Médicale U1046, s-jaber@chu-montpellier.fr.
authors.forename: S
authors.initials: S
authors.lastname: Jaber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000453:epidemiology; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D009873:Operating Rooms / Q000458:organization & administration; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: complications; intensive care unit; intubation; obese; operating theatre