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Observational Study
. 2025 May 13;29(1):192.
doi: 10.1186/s13054-025-05419-2.

Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort

Vincenzo Russotto  1   2 , John G Laffey  3   4 , Elena Tassistro  5   6 , Sheila N Myatra  7 , Emanuele Rezoagli  8   9 , Giuseppe Foti  8   9 , Laura Antolini  6 , Maria Grazia Valsecchi  5   6 , Philippe R Bauer  10 , Konstanty Szułdrzyński  11 , Luigi Camporota  12 , Robert Greif  13 , Andy Higgs  14 , Matteo Parotto  15   16 , Roberto Fumagalli  9   17 , Massimiliano Sorbello  18   19 , Chiara Robba  20   21 , Giacomo Grasselli  22   23 , Giacomo Bellani  24   25 , Pietro Caironi  26   27 , Jean Baptiste Lascarrou  28 ; INTUBE Study Investigators
Collaborators, Affiliations
Observational Study

Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort

Vincenzo Russotto et al. Crit Care. .

Erratum in

Abstract

Background: Airway management in critically ill obese patients is potentially associated with a higher risk of adverse events due to a constellation of physiological and anatomical challenges. Data from international prospective studies on peri-intubation adverse events in obese critically ill patients are lacking.

Methods: INTUBE (International Observational Study to Understand the Impact and Best Practices of Airway Management In Critically Ill Patients) was an international multicentre prospective cohort study enrolling critically ill adult patients undergoing in-hospital tracheal intubation in 197 sites from 29 countries worldwide from October 1, 2018, to July 31, 2019. This secondary analysis compares airway management practices and outcomes between obese (body mass index-BMI ≥ 30 kg/m2) and non-obese patients (BMI < 30 kg/m2).

Results: A total of 2946 patients met inclusion criteria for this secondary analysis, 639 (21.7%) obese and 2307 (78.3%) non-obese. Severe peri-intubation hypoxemia was more frequently reported in obese compared to non-obese patients (12.1% vs 8.6% respectively, p = 0.01). Variables independently associated with a higher risk of peri-intubation hypoxemia were baseline SpO2/FiO2 (OR 0.996, 95% CI 0.994-0.997), 30-45° head-up position (OR 1.53, 95% CI 1.04-2.26) and first-pass intubation failure (OR for first-pass success 0.21, 95% CI 0.15-0.29). Obesity (OR 0.71, 95% CI 0.56-0.91) and 20° head-up position (OR 0.67, 95% CI 0.47-0.95) were independently associated with higher likelihood of first-pass intubation failure. In contrast, intubation by staff physician/consultant (OR 1.70, 95% CI 1.30-2.21) or anesthesiologists (OR 1.98, 95% CI 1.55-2.53) were associated with higher first-pass success.

Conclusions: Compared to non-obese patients, obese critically ill exhibit a higher incidence of peri-intubation severe hypoxemia. In this population, worse baseline oxygenation and first-pass intubation failure significantly increase the risk of peri-intubation severe hypoxemia. As obesity is linked to a higher likelihood of first-pass intubation failure, likely driven by more challenging airway features, in this high-risk population first attempt should be performed by an expert operator to minimize peri-intubation complications.

Trial registration: Clinicaltrials.gov NCT03616054 . Registered 3 August 2018.

Keywords: Airway management; Critical care; Intubation; Obesity.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the coordinating center (Comitato Etico Brianza, No 1420 of July 31, 2018) and then by each local ethics committee according to local regulations, with either the patient’s written consent or waiver of consent for participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Incidence of peri-intubation severe hypoxemia (SpO2 < 80%) in critically ill patients stratified according to the different weight classes according to World Health Organization
See this image and copyright information in PMC

Comment in

References

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