OBESITY IS NOT A RISK FACTOR FOR COMPLICATIONS IN CRITICALLY ILL PATIENTS INTUBATED WITH VIDEO LARYNGOSCOPY

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Obesity is a known risk factor for difficult intubation with direct laryngoscopy. Although video laryngoscopy (VL) may improve visualization, it is not known if VL can improve first pass success when intubation is performed on obese, critically ill patients. We hypothesized that when using VL, obesity would not be a risk factor for complications of endotracheal intubation. METHODS: We performed a retrospective cohort study of all patients intubated with VL by critical care practitioners on medical/surgical wards or ICUs at an academic medical center in Bronx, NY between January 30, 2016 to July 19, 2019. Pediatric patients and those intubated in the operating room or emergency department were excluded. Obesity was defined as BMI > 35. The primary outcome was first pass success. Secondary outcomes were difficult intubation (defined as requiring more than 2 attempts) and mortality within 24 hours. We performed a chi-square analysis to explore the effect of obesity on first pass success, difficult intubation and mortality. A multivariable logistic regression was utilized with correction for factors associated with difficulty during intubation. Sensitivity analysis was performed defining obesity as BMI > 40. RESULTS: There were 2638 patients during the study period and 668 were intubated with VL. Patients with obesity (BMI > 35) did not have a decreased first pass success (OR 1.04 CI 0.70-1.56; P=0.849) or increased risk of difficult intubation (OR 0.87 CI 0.39-1.95; P=0.73) or mortality within 24 hours (OR 0.8 CI 0.46-1.31; P=0.33). After adjusting for covariates, we did not note a significant association between obesity and first pass success (ORa 1.15 CI 0.72-1.83; P=0.55), difficult intubation (ORa 0.94 CI 0.37-2.37; P=0.90) or mortality (ORa 0.83 CI 0.47-1.44; P=0.50). We conducted a sensitivity analysis to examine the effect of more severe obesity and did not note an association between BMI > 40 (ORa 1.20 CI 0.66-2.17; P=0.58) on first pass success. CONCLUSIONS: When VL is used for the intubation of critically ill patients, we did not find obesity to be a risk factor for failed first pass intubation, difficult intubation or mortality 24 hours after the procedure. These findings did not change when different definitions of obesity were used. Based on our results, when VL is being utilized for the intubation of critically ill patients, obesity may not be a risk factor for complications. CLINICAL IMPLICATIONS: Obesity may not be a risk factor for first pass success or difficult intubation when video laparoscopy is utilized for emergent endotracheal intubation. DISCLOSURES: No relevant relationships by Lewis Eisen, source=Web Response No relevant relationships by Daniel Fein, source=Web Response No relevant relationships by Peter Nauka, source=Web Response No relevant relationships by Ariel Shiloh, source=Web Response