title: The degree of intubation difficulties and the frequency of complications in obese patients at the Hospital Emergency Department and the Intensive Care Unit: Case-control study.
abstract: The intubation difficulties in obese patients are not a new problem. They may result from an accumulation of fat in the oral cavity and cheeks. A thick tongue is also a significant factor. The literature reports that some tests to determine the intubation difficulties in obese people may be unreliable. The observed predictors of difficult intubation were the thyromental and sternomental distance and the intubation difficulty scale: FRONT score.The aim of this study was to assess the degree of difficult intubation in obese patients by the parameters such as the thyromental and sternomental distance. The authors also tried to evaluate the frequency of the guidewire usage and the number of intubation attempts in obese patients in the research sample.The study included the group of 153 patients intubated in prehospital conditions. The research was conducted in 3 clinical centers receiving patients from prehospital care. Among the members of the research sample, obese patients with body mass index >35 were selected and evaluated for various predictors of intubation difficulties. Quantitative analysis of differences in the incidence of the variables was assessed using the chi-squared test for P < 0.05. Analyses were performed in STATISTICA.Complications such as postintubation hematomas were more frequent in obese patients of the research sample. The frequency of the guidewire usage observed in that group was also higher. As anticipated by the adopted predictors, most of the obese patients were classified as difficult to intubate.There is a correlation between the occurrence of injuries and the prevalence of obesity in the research sample and the same dependency has been demonstrated in the issue concerning the use of the guidewire. Although the majority of predictors indicated patients with intubation difficulties, many predictors could show falsely positive results. The greater amount of intubation attempts was observed in obese patients. Further studies devoted to explain those correlations would be needed.
authors.affiliation: Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz University Laboratory of Teaching Medicine in Emergencies, Medical University of Lodz Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Lodz, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Cierniak
authors.forename: Renata
authors.initials: R
authors.lastname: Sobczak
authors.forename: Dariusz
authors.initials: D
authors.lastname: Timler
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wieczorek
authors.forename: Bartosz
authors.initials: B
authors.lastname: Borkowski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gaszyński
mesh_terms: D059925:Anatomic Landmarks; D016022:Case-Control Studies; D002680:Chin / Q000033:anatomy & histology; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D009765:Obesity / Q000150:complications*; D013249:Sternum / Q000033:anatomy & histology; D013961:Thyroid Gland / Q000033:anatomy & histology