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

British Journal of Anaesthesia

Volumn 114, Issue 2, 2015, Pages 297-306

  De Jong, A ^a   Molinari, N ^b   Pouzeratte, Y ^a   Verzilli, D ^a   Chanques, G ^a   Jung, B ^a,c   Futier, E ^a   Perrigault, P F ^f   Colson, P ^d   Capdevila, X ^e   Jaber, S ^a,c  

^a HÔPITAL SAINT ELOI   (France)

^b MONTPELLIER UNIVERSITY HOSPITAL   (France)

^c Institut National de la Santé et de la Recherche Médicale U1046   (France)

^d HÔPITAL ARNAUD DE VILLENEUVE   (France)

^e LAPEYRONIE HOSPITAL   (France)

^f GUI DE CHAULIAC HOSPITAL   (France)

Author keywords

complications; intensive care unit; intubation; obese; operating theatre

Indexed keywords

ADULT; AGED; ARTICLE; COHORT ANALYSIS; CONTROLLED STUDY; DIFFICULT INTUBATION; FEMALE; HEART ARREST; HEART VENTRICLE ARRHYTHMIA; HUMAN; HYPOXEMIA; INCIDENCE; INTENSIVE CARE UNIT; INTUBATION; MAJOR CLINICAL STUDY; MALE; MULTICENTER STUDY; OBESITY; OBSERVATIONAL STUDY; OPERATING ROOM; PRIORITY JOURNAL; PROSPECTIVE STUDY; RESPIRATION CONTROL; RISK FACTOR; SHOCK; SLEEP DISORDERED BREATHING; ADOLESCENT; ARTERIAL PRESSURE; BLOOD; CLINICAL TRIAL; COMPARATIVE STUDY; COMPLICATION; ENDOTRACHEAL INTUBATION; INTRAOPERATIVE COMPLICATIONS; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; PHYSIOLOGY; VERY ELDERLY; YOUNG ADULT;

OXYGEN;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; ARTERIAL PRESSURE; FEMALE; HUMANS; INCIDENCE; INTENSIVE CARE UNITS; INTRAOPERATIVE COMPLICATIONS; INTUBATION, INTRATRACHEAL; MALE; MIDDLE AGED; OBESITY; OPERATING ROOMS; OXYGEN; PROSPECTIVE STUDIES; RISK FACTORS; YOUNG ADULT;

EID: 84922496331     PISSN: 00070912     EISSN: 14716771     Source Type: Journal    
DOI: 10.1093/bja/aeu373     Document Type: Article

References (40)

1. Jaber S, Amraoui J, Lefrant J-Y, et al. Clinical practiceandrisk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med 2006; 34: 2355-61
2. Jaber S, Jung B, Corne P, et al.Anintervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med 2010; 36: 248-55
3. Jung B, Clavieras N, Nougaret S, et al. Effects of etomidate on complications related to intubation and on mortality in septic shock patients treated with hydrocortisone: a propensity score analysis. Crit Care (Lond, England) 2012; 16: R224
4. Baillard C, Fosse J-P, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med 2006; 174: 171-7
5. Cook TM, Woodall N, Harper J, Benger J. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth 2011; 106: 632-42
6. Astin J, King EC, Bradley T, Bellchambers E, Cook TM. Survey of airwaymanagement strategies and experienceofnon-consultant doctors in intensive care units in the UK. Br J Anaesth 2012; 109: 821-5
7. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the difficult airway: a closed claims analysis. Anesthesiology 2005; 103: 33-9
8. Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011;106: 617-31
9. Cook TM, MacDougall-Davis SR. Complications and failure of airway management. Br J Anaesth 2012; 109(Suppl. 1): i68-85
10. De Jong A, Molinari N, Terzi N, et al. Early identification of patients at risk for difficult intubation in ICU: development and validation of the MACOCHA Score in a Multicenter Cohort Study. Am J Respir Crit Care Med 2013; 187: 832-9
11. Langeron O, Cuvillon P, Ibanez-Esteve C, Lenfant F, Riou B, Le Manach Y. Prediction of difficult tracheal intubation: time foraparadigm change. Anesthesiology 2012; 117: 1223-33
12. Combes X, Jabre P, Margenet A, et al. Unanticipated difficult airway management in the prehospital emergency setting: prospective validation of an algorithm. Anesthesiology 2011; 114: 105-10
13. Cattano D, Killoran PV, Iannucci D, et al. Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool. Br J Anaesth 2013; 111: 276-85
14. Collins JS, Lemmens HJM, Brodsky JB. Obesity and difficult intubation: where is the evidence? Anesthesiology 2006; 104: 617, author reply 618-9
15. Frat J-P, Gissot V, Ragot S, et al. Impact of obesity in mechanically ventilated patients: a prospective study. Intensive Care Med 2008; 34: 1991-8
16. LundstrømLH, MøllerAM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91, 332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology 2009; 110: 266-74
17. Kiraly L, Hurt RT, Van Way CW. The outcomes of obese patients in critical care. J Parenter Enteral Nutr 2011; 35: 29-35S
18. Burns EM, Naseem H, Bottle A, et al. Introduction of laparoscopic bariatric surgery in England: observational population cohort study. Br Med J 2010; 341: c4296
19. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia 1987; 42: 487-90
20. Mallampati SR, Gatt SP, Gugino LD, et al.Aclinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32: 429-34
21. Tham EJ, Gildersleve CD, Sanders LD, Mapleson WW, Vaughan RS. Effects of posture, phonation and observer on Mallampati classification. Br J Anaesth 1992; 68: 32-8
22. Calder I, Picard J, Chapman M, OSullivan C, Crockard HA. Mouth opening: a new angle. Anesthesiology 2003; 99: 799-801
23. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2003; 98: 1269-77
24. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J AmMed Assoc 1993; 270: 2957-63
25. Simpson GD, Ross MJ, McKeown DW, Ray DC. Tracheal intubation in the critically ill: a multi-centre national study of practice and complications. Br J Anaesth 2012; 108: 792-9
26. LewisM, Keramati S, BenumofJL, Berry CC.What is thebestway to determine oropharyngeal classification and mandibular space length to predict difficult laryngoscopy? Anesthesiology 1994; 81: 69-75
27. Gonzalez H, Minville V, Delanoue K, Mazerolles M, Concina D, Fourcade O. The importance of increased neck circumference to intubation difficulties in obese patients. Anesth Analg 2008; 106: 1132-6
28. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation- Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166: 1338-44
29. Tangri N, Kitsios GD, Su SH, Kent DM. Accounting for center effects in multicenter trials. Epidemiology 2010; 21: 912-3
30. DevauxM, Sassi F. Social inequalities in obesityandoverweight in11 OECD countries. Eur J Public Health 2013; 23: 464-9
31. Walz JM, Zayaruzny M, Heard SO. Airway management in critical illness. Chest 2007; 131: 608-20
32. Kristensen MS. Airway management and morbid obesity. Eur J Anaesthesiol 2010; 27: 923-7
33. Neligan PJ. Metabolic syndrome: anesthesia for morbid obesity. Curr Opin Anaesthesiol 2010; 23: 375-83
34. Isono S. Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anesthesiology 2009; 110: 908-21
35. Brodsky JB, Lemmens HJM, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94: 732-6
36. Kim WH, Ahn HJ, Lee CJ, et al. Neck circumference to thyromental distance ratio: a new predictor of difficult intubation in obese patients. Br J Anaesth 2011; 106: 743-8
37. Hiremath AS, Hillman DR, James AL, Noffsinger WJ, Platt PR, Singer SL. Relationship between difficult tracheal intubation and obstructive sleep apnoea. Br J Anaesth 1998; 80: 606-11
38. El-OrbanyM, Connolly LA. Rapid sequence induction and intubation: current controversy. Anesth Analg 2010; 110: 1318-25
39. Bindra A, Prabhakar H, Singh GP, Ali Z, Singhal V. Is the modified Mallampati test performed in supine position a reliable predictor of difficult tracheal intubation? J Anesth 2010; 24: 482-5
40. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118: 251-70