Associations of obesity with tracheal intubation success on first attempt and adverse events in the emergency department: An analysis of the multicenter prospective observational study in Japan

Abstract

Obesity is deemed to increase the risk of difficult tracheal intubation. However, there is a dearth of research that examines the relationship of obesity with intubation success and adverse events in the emergency department (ED). We analyzed the data from a prospective, observational, multicenter study—the Japanese Emergency Airway Network (JEAN) 2 study from 2012 through 2016. We included all adults (aged ≥18 years) who underwent tracheal intubation in the ED. Patients were categorized into three groups according to their body mass index (BMI): lean (<25.0 kg/m²), overweight (25.0–29.9 kg/m²), and obesity (≥30.0 kg/m²). Outcomes of interest were intubation success on the first attempt and intubation-related adverse events. Of 6,889 patients who are eligible for the analysis, 5,370 patients (77%) were lean, 1,177 (17%) were overweight, and 342 (4%) were obese. Compared to the lean patients, the intubation success rates were significantly lower in the overweight and obese patients (70.9% in lean, 66.4% in overweight, and 59.3% in obese patients; P<0.001). In the multivariable analysis, compared to the lean patients, overweight (adjusted odds ratio [OR], 0.85; 95%CI, 0.74–0.98) and obese (adjusted OR, 0.62; 95%CI, 0.49–0.79) patients had a significantly lower success rate on the first attempt. Additionally, obesity was significantly associated with a higher risk of adverse events (adjusted OR, 1.62; 95%CI, 1.23–2.13). Based on the data from a multicenter prospectively study, obesity was associated with a lower success rate on the first intubation attempt and a higher risk of adverse event in the ED.

Association of ketamine use with lower risks of post-intubation hypotension in hemodynamically-unstable patients in the emergency department

“…This is an analysis of the data from a multicenter prospective observational study of consecutive ED patients who underwent emergency airway management— JEAN-2 registry from February 2012 through November 2016. The study design, setting, methods of data collection, and measured variables have been reported elsewhere 21–25,27,28 . In brief, the JEAN-2 study is a consortium of 15 academic and community medical centers from different geographic regions across Japan.…”

C-MAC Video Laryngoscope versus Conventional Direct Laryngoscopy for Endotracheal Intubation During Cardiopulmonary Resuscitation

“…One possible explanation for the result is that the proportion of obesity in males was higher than that in females. Obesity has been considered to be a risk factor for difficult laryngoscopy [17]. Another potential explanation might be the anatomical differences between males and females, such as soft tissues in the neck and fat distribution [18].…”

Obesity is a risk factor for developing critical condition in COVID‐19 patients: A systematic review and meta‐analysis

“…33,46,47 Excessive body mass and obstructive sleep apnea might complicate different forms of respiratory support and endotracheal intubation. 48,49 Prolonged endotracheal intubation time, which is more frequently present in patients with obesity, also increases the risk of infection of the medical staff. 50 These are of particular importance considering that we have shown a greater risk for IMV in patients with higher BMI in all comparisons.…”