Scholarlink

Background <p>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.</p> Methods <p>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 <InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="13054_2025_5419_Article_IEq1.gif" Format="GIF" Height="15" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">\(\ge\)</EquationSource> <EquationSource Format="MATHML"><math> <mo>≥</mo> </math></EquationSource> </InlineEquation> 30&#xa0;kg/m<sup>2</sup>) and non-obese patients (BMI <InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="13054_2025_5419_Article_IEq2.gif" Format="GIF" Height="11" Rendition="HTML" Resolution="72" Type="Linedraw" Width="17" /> </InlineMediaObject> <EquationSource Format="TEX">\(&lt;\)</EquationSource> <EquationSource Format="MATHML"><math> <mo>&lt;</mo> </math></EquationSource> </InlineEquation> 30&#xa0;kg/m<sup>2</sup>).</p> Results <p>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, <i>p</i> = 0.01). Variables independently associated with a higher risk of peri-intubation hypoxemia were baseline SpO<sub>2</sub>/FiO<sub>2</sub> (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.</p> Conclusions <p>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.</p> <p><b>Trial registration</b>: Clinicaltrials.gov <a href="https://clinicaltrials.gov/study/NCT03616054?term=intube%26rank=1">NCT03616054</a>. Registered 3 August 2018.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

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

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年5月13日

查看全文
  • Vincenzo Russotto,
  • John G. Laffey,
  • Elena Tassistro,
  • Sheila N. Myatra,
  • Emanuele Rezoagli,
  • Giuseppe Foti,
  • Laura Antolini,
  • Maria Grazia Valsecchi,
  • Philippe R. Bauer,
  • Konstanty Szułdrzyński,
  • Luigi Camporota,
  • Robert Greif,
  • Andy Higgs,
  • Matteo Parotto,
  • Roberto Fumagalli,
  • Massimiliano Sorbello,
  • Chiara Robba,
  • Giacomo Grasselli,
  • Giacomo Bellani,
  • Pietro Caironi,
  • Jean Baptiste Lascarrou,
  • Matthew Anstey,
  • Sandra Colica,
  • David Brewster,
  • Shannon Simpson,
  • Adrian Regli,
  • Ross O’Grady,
  • Edward Litton,
  • Janet Ferrier,
  • Roland Bartholdy,
  • Alexis Tabah,
  • David Bowen,
  • Rebecca Rowley,
  • Jonathan Gatward,
  • Julio Alonso,
  • Sneha Varkey,
  • Vijayanand Palaniswamy,
  • Timothy Chimunda,
  • Syed T. Reza,
  • Mozaffer Hossain,
  • Motiul Islam,
  • Tarikul Hamid,
  • Samareh Ajami,
  • Andrew Steel,
  • Lorenzo Sorbo,
  • Alberto Goffi,
  • Ian Randall,
  • Neill K. J. Adhikari,
  • Tasneem H. Mehesry,
  • Maria M. Vera,
  • Guillermo Bugedo,
  • Gonzalo Labarca,
  • Monica Silva,
  • Wuhua Ma,
  • Yongxing Li,
  • Jiayan Wu,
  • Lun Wu,
  • Marijana Matas,
  • Višnja Ivančan,
  • Mario Pavlek,
  • Slobodan Mihaljević,
  • Aleksandra Jumić,
  • Mate Moguš,
  • Iva Tucić,
  • Pavel Michalek,
  • Marek Flaksa,
  • Hernan Aguirre-Bermeo,
  • Hugo Tirape-Castro,
  • Maria F. Aguilera García,
  • Diana Alvarez Montenegro,
  • Diego Morocho Tutillo,
  • Jose A. León Tutillo,
  • Hadrien Winiszewski,
  • Gael Piton,
  • Nadia Aissaoui,
  • Jean-Loup Augy,
  • Benoit Champigneulle,
  • Diane Zlotnik,
  • Grégoire Muller,
  • Sophie Jacquier,
  • Sami Hraiech,
  • Christophe Guervilly,
  • Gaetan Plantefeve,
  • Damien Contou,
  • Jean Damien Ricard,
  • Sebastien Besset,
  • Gwenhael Colin,
  • Caroline Pouplet,
  • Adrien Mirouse,
  • Elie Azoulay,
  • Florence Boissier,
  • Jean-Pierre Frat,
  • Emmanuelle Mercier,
  • Charlotte Salmon-Gandonnière,
  • Maelle Martin,
  • Alexis Ferre,
  • Stephane Legriel,
  • Cedric Bruel,
  • Francois Philippard,
  • Jonathan Zarka,
  • Frank Chemouni,
  • Olfa Hamzaoui,
  • Benjamin Sztrymf,
  • Yannick Brunin,
  • Sébastien Pili-Floury,
  • Jean-Michel Constantin,
  • Thomas Godet,
  • Tommaso Maraffi,
  • Armand Mekontso Dessap,
  • Mathieu Jozwiak,
  • Nathalie Marin,
  • Christophe Guitton,
  • Nicolas Chudeau,
  • Alexandre Gros,
  • Alexandre Boyer,
  • Kristaps Bokums,
  • Detlef Kindgen-Milles,
  • Christian Putensen,
  • Stefan F. Ehrentraut,
  • Marcel Dudda,
  • Oliver Kamp,
  • Roland Francis,
  • Kay Rumschuessel,
  • Melanie Meersch,
  • Mira Kuellmar,
  • Roland Francis,
  • Kay Rumschuessel,
  • Eleni Papandreou,
  • Athanasia Petsiou,
  • Metaxia Papanikolaou,
  • Aikaterini Kyparissi,
  • Maria Tileli,
  • Alexandros Makris,
  • Dimitrios Tsiftsis,
  • Nadia El-Fellah,
  • Ilias Karametos,
  • Evi Nakou,
  • Athanasios Chalkias,
  • Eleni Arnaoutoglou,
  • Panagiotis Katsoulis,
  • Sofia Pouriki,
  • Kyriaki Vagdatli,
  • Aikaterini Dimitropoulou,
  • Amol Kothekar,
  • Nishanth Baliga,
  • Sara V. Korula,
  • Sam Philip,
  • Lalit Singh,
  • Nipun Agrawal,
  • Deepak Jeswani,
  • Deepti Jeswani,
  • Simant Jha,
  • Mahuya Bhattacharyya,
  • Amit Das,
  • Swarna D. Kuragayala,
  • Subba R. Kesavarapu,
  • Bhagyesh Shah,
  • Shuchi Kaushik,
  • Nilu Sunil,
  • Kingsly Gnanadurai,
  • Atul K. Singh,
  • Dinesh K. Singh,
  • Sudhir Khunteta,
  • Kulbhusahn Gupta,
  • Rhik Sanyal,
  • Abhirup Midya,
  • Vijay N. Tyagi,
  • Prashant Bendre,
  • Kumar Prashant,
  • Satish Chaurasia,
  • Prasanna Mishra,
  • Sampat Dash,
  • Omprakash Sundrani,
  • Jaya Lalwani,
  • Nikhilesh Jain,
  • Kehari Agrawal,
  • Banambar Ray,
  • Ranjan Meher,
  • Lakshmikanthcharan Saravanabavan,
  • Satheesh Munusamy,
  • Manish Gupta,
  • Meraj Ahmad,
  • Kadarapura N. Gopalakrishna,
  • Bharadwaj Suparna,
  • Manimala R. Surath,
  • Kartik Munta,
  • Bharat Jagiasi,
  • Anand Srivastava,
  • Samir Sahu,
  • Vijay N. Tyagi,
  • Prashant Bendre,
  • Sircar Mrinal,
  • Singh Sujeet Kumar,
  • Mehul Shah,
  • Mayur Patel,
  • Shrirang Bamane,
  • Amit Narkhede,
  • Rajesh Chawla,
  • Aakanksha Chawla,
  • Harish Mallapura Maheshwarappa,
  • Ramya Ballekatte Manjunath,
  • Lua Rahmani,
  • Roberto Rona,
  • Annalisa Benini,
  • Annalisa Rundo,
  • Annalisa Luzi,
  • Clelia Esposito,
  • Moana R. Nespoli,
  • Andrea Pradella,
  • Ramona Lungu,
  • Laura Baccari,
  • Fernando Chiumiento,
  • Karim Mariano,
  • Antonella Cotoia,
  • Silvia Rosa,
  • Elisa Boni,
  • Salvatore Palmese,
  • Renato Gammaldi,
  • Savino Spadaro,
  • Lida Santoro,
  • Andrea N. Cracchiolo,
  • Daniela M. Palma,
  • Riccardo Pinciroli,
  • Ilaria Giovannini,
  • Italo Calamai,
  • Rosario Spina,
  • Iacopo Cappellini,
  • Lorenzo Tutino,
  • Agrippino Bellissima,
  • Jessica G. Maugeri,
  • Ivano Riva,
  • Fabrizio Fabretti,
  • Luca Brazzi,
  • Gabriele Sales,
  • Giorgia Montrucchio,
  • Alberto Orsello,
  • Andrea Costamagna,
  • Federico G. Canavosio,
  • Lorella Pelagalli,
  • Maria E. Marcelli,
  • Andrea Cortegiani,
  • Jacopo Tramarin,
  • Stefania Musso,
  • Stefano Tarantino,
  • Ida Giacinto,
  • Anna L. Licciardi,
  • Luca Montini,
  • Gennaro Pascale,
  • Angelo Giacomucci,
  • Pierpaolo Russo,
  • Federico Longhini,
  • Eugenio Garofalo,
  • Massimo Ferluga,
  • Valeria Moro,
  • Marco Cascella,
  • Barbara Caprio,
  • Raffaele Fenza,
  • Francesca Nespoli,
  • Stefano Muttini,
  • Angelo Pezzi,
  • Muhammed Elhadi,
  • Mohamed Ghula,
  • Hazem Abdelkarem Ahmed,
  • Soad Imhmed Alkhumsi,
  • Ala Khaled,
  • Ahmed Elhadi,
  • Abdulmueti Alhadi,
  • Mohd Z Mazlan,
  • Mohd N WanHassan,
  • Shahnaz Hasan,
  • Muhamad F. H. Jamaluddin,
  • Noryani Mohd Samat,
  • Muhamad A. Ismail,
  • Anita Alias,
  • Ngu Pei Hwa,
  • Ismail Nahla Irtiza,
  • Hapiz Khalidah,
  • Lee Chew Kiok,
  • Norbaniza Mohd Nordin,
  • Wan N. Wan Ismail,
  • Mohd N. Ali,
  • Luis Sánchez-Hurtado,
  • Otoniel Toledo-Salinas,
  • Antonio Landaverde,
  • Miguel A. Sosa,
  • Mayra Martinez Gonzalez,
  • Claudia L. Lopez Nava,
  • Nandyelly San Juan Roman,
  • Maria Gonzalez,
  • Missael Espinoza,
  • Daira González,
  • Fernando Flores,
  • Jesus N. Leal Pantoja,
  • Gallardo Loza,
  • Paul Young,
  • Ravi Mistry,
  • Alexander Browne,
  • Petra Crone,
  • Juhi Chandwani,
  • Sazzad Hossein,
  • Salman S. Koul,
  • Rubina Aman,
  • Syed M. Ali,
  • Shazia N. Akhtar,
  • Milosz Jankowski,
  • Piotr Bielanski,
  • Wojciech Mudyna,
  • Pawel Franczyk,
  • Piotr Galkin,
  • Lukasz Skowronski,
  • Tomasz Gaszynski,
  • Mariusz Piegat,
  • Nuno Catorze,
  • Marcia Pinto,
  • Tiago Leonor,
  • Marco Fernandes,
  • Patricia Campos,
  • Irene Aragão,
  • Paulo F Costa,
  • Daniela G Franco,
  • Marta Basto,
  • Carla Nogueira,
  • Rui P. Cunha,
  • Vasco Costa,
  • Vladimir Lomivorotov,
  • Artem Nikitenko,
  • Vladislav Belsky,
  • Mikhail Furman,
  • Marat Magomedov,
  • Vera Baturova,
  • Alexey Karelov,
  • Nadezhda Marova,
  • Ghaleb Almekhlafi,
  • Adnan Alghamdi,
  • Emilio Maseda,
  • Alejandro Suarezdela Rica,
  • Jesus Flores Gonzalez,
  • Miryam Pérez Rica,
  • Oriol Roca,
  • Manel Santafe,
  • Gemma Goma Fernandez,
  • Patricia Escudero-Acha,
  • Alejandro González-Castro,
  • Christina Agvald-Öhman,
  • Lina Broman,
  • Martin Spangfors,
  • Katrin Hannesdottir,
  • Elin Persson,
  • Jon Rosell,
  • Jesper Sperber,
  • Annika Ohlsson,
  • Magnus Seth,
  • Niccolò Pedrotti,
  • Carl Wahlstrom,
  • Maria Meirik,
  • Anna Bandert,
  • Ditte Krog,
  • Lu-Cheng Kuo,
  • Ming-Hann Shin,
  • Jung-Yien Chien,
  • Shih-Chi Ku,
  • Sheng-Yuan Ruan,
  • Chun-Kai Huang,
  • Yu-Chang Yeh,
  • Anne Chao,
  • Kuo-Chuan Wang,
  • Ching-Tang Chiu,
  • Chien-Chang Lee,
  • Nai-Kuan Chou,
  • Tamas Szakmany,
  • Benjamin Jones,
  • Laura Jones,
  • Valentina Della Torre,
  • Ayush Sinah,
  • Alice Quayle,
  • Olivia Cheetham,
  • Yadullah Syed,
  • Kwabena Mensah,
  • Christopher Edmunds,
  • Callum T. Kaye,
  • Yewande E. Odeyemi,
  • Joseph Nates,
  • Andres Laserna,
  • Jarrod Mosier,
  • Cameron Hypes,
  • Eric Gottesman,
  • Fiore Mastroianni,
  • Daniel G. Fein,
  • Dawn Zhao,
  • Xavier E. Fuentes Fonseca,
  • Olfa Hamzaoui,
  • Benjamin J. Sandefur,
  • Akram Khan,
  • Dubier Matos,
  • David A. Kaufman,
  • Andrew Lehr,
  • Luca Bigatello,
  • Iwona Bonney

摘要

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 \(\ge\) ≥ 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.