Abstract
Obesity is deemed to increase the risk of difficult tracheal intubation. However, there is a dearth of research that examines the relationship of obesity with intubation success and adverse events in the emergency department (ED). We analyzed the data from a prospective, observational, multicenter study—the Japanese Emergency Airway Network (JEAN) 2 study from 2012 through 2016. We included all adults (aged ≥18 years) who underwent tracheal intubation in the ED. Patients were categorized into three groups according to their body mass index (BMI): lean (<25.0 kg/m²), overweight (25.0–29.9 kg/m²), and obesity (≥30.0 kg/m²). Outcomes of interest were intubation success on the first attempt and intubation-related adverse events. Of 6,889 patients who are eligible for the analysis, 5,370 patients (77%) were lean, 1,177 (17%) were overweight, and 342 (4%) were obese. Compared to the lean patients, the intubation success rates were significantly lower in the overweight and obese patients (70.9% in lean, 66.4% in overweight, and 59.3% in obese patients; P<0.001). In the multivariable analysis, compared to the lean patients, overweight (adjusted odds ratio [OR], 0.85; 95%CI, 0.74–0.98) and obese (adjusted OR, 0.62; 95%CI, 0.49–0.79) patients had a significantly lower success rate on the first attempt. Additionally, obesity was significantly associated with a higher risk of adverse events (adjusted OR, 1.62; 95%CI, 1.23–2.13). Based on the data from a multicenter prospectively study, obesity was associated with a lower success rate on the first intubation attempt and a higher risk of adverse event in the ED.
Highlights
IntroductionEarly recognition of difficult airway with an optimal preparation and use of alternative methods is critical
Emerging evidence indicates that difficult intubation and repeated intubation attempts are related to a higher risk of intubation-related adverse events in the emergency department (ED) [1,2,3,4]
Based on the data from a large, prospective, multicenter study of 6,889 ED intubations, we found that obesity were significantly associated with a lower success rate on the first intubation attempt
Summary
Early recognition of difficult airway with an optimal preparation and use of alternative methods is critical. Despite the differences in patient population and available resources from the anesthesia settings, there is insufficient existing evidence of the association between obesity and intubation outcomes in the ED. The limited emergency medicine literature—which is based on retrospective studies [7,8]—is conflicting with the intubation success rates in obese patients to be no different from [7] or higher than [8] those in non-obese patients in the ED. As obesity is a common comorbid condition in the ED population [9], further clarification of its impact on the intubation outcomes will inform the strategies to guide optimal emergency airway management in the ED
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