Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2015 Feb;114(2):297-306.
doi: 10.1093/bja/aeu373. Epub 2014 Nov 27.

Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units

A De Jong  1 , N Molinari  2 , Y Pouzeratte  1 , D Verzilli  1 , G Chanques  1 , B Jung  3 , E Futier  1 , P-F Perrigault  4 , P Colson  5 , X Capdevila  6 , S Jaber  7
Affiliations
Free article
Clinical Trial

Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units

A De Jong et al. Br J Anaesth. 2015 Feb.
Free article

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.

Clinical trial registration: Current controlled trials. Identifier: NCT01532063.

Keywords: complications; intensive care unit; intubation; obese; operating theatre.

PubMed Disclaimer

Comment in

Associated data