The impact of obesity on the outcome of emergency intubation in trauma patients.

OBJECTIVE: Emergency intubation of trauma patients is a complex intervention, which can be safely and successfully performed in most trauma centers. This, however, has never been validated in the obese trauma population. Obese patients have anatomic and physiologic characteristics that make their intubation more challenging. We therefore hypothesize that obese trauma patients requiring emergency intubation are at increased risk for unsuccessful intubation and airway-related complications.

METHODS: Retrospective review of prospectively collected data from an airway surveillance database at an urban Level I trauma center between 2001 and 2004 was analyzed. The study population included all adult patients admitted to the trauma center, who required urgent airway management. The patients were stratified into four groups according to their body mass index (BMI): lean (BMI < 25), overweight (25 < or = BMI < 30), obese (30 < or = BMI < or = 40), and morbid obesity (BMI > 40). Demographic parameters and outcome measures including field intubation success, airway complications, early respiratory complications, and mortality were collected. Logistic regression was performed to determine predictors of these outcome measures.

RESULTS: Of the 9,980 patients evaluated during the three-year study period, 1,435 (14%) were emergently intubated and made up the study population. About 92% of ED intubations were performed by the anesthesia team. Of all emergently intubated patients, 46% were lean, 37% were overweight, 15% were obese, and 2% were morbidly obese. There were no significant differences in demographic parameters between the lean, overweight, and obese groups. The morbidly obese patients were however older, composed of more female patients and more likely to have suffered a blunt injury. Logistic regression analysis revealed that BMI was not an independent risk factor for failed intubations in the field or in the ED, postintubation airway complications, or death. Only early respiratory complications demonstrated a statistically significant (p = 0.02), but unlikely clinically relevant (OR = 1.04; 95% CI, 0.99-1.07) association with a higher BMI.

CONCLUSION: Emergency intubation of obese trauma patients can be safely and successfully performed in a high volume Level I trauma center. Obesity is not a predictor of postintubation airway complications or mortality. Larger studies are needed to validate these finding in the morbidly obese patients.