Department of Medicine, Division of Pulmonary-Critical Care Medicine, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
Intern Emerg Med. 2013 Feb;8(1):75-82. doi: 10.1007/s11739-012-0874-x. Epub 2012 Nov 25.
We evaluated the effect of body mass index (BMI) on intubation success rates and complications during emergency airway management. We retrospectively analyzed an airway registry at an academic medical center. The primary outcomes were the incidence of difficult intubation and complication rates, stratified by BMI. We captured 1,075 (98 %, 1,075/1,102; 95 % CI 97-99) intubations. Four hundred twenty-six patients (40 %) had a normal BMI, 289 (27 %) were overweight, 261 (25 %) were obese, and 77 (7 %) were morbidly obese. In a multivariate analysis, obesity (OR 1.90; 95 % CI 1.04-3.45; p = 0.04), but not morbid obesity (OR 2.18; 95 % CI 0.95-4.99; p = 0.07), predicted difficult intubation. BMI was not predictive of post-intubation complications. Airway management in the morbidly obese differed when compared with lean patients, with less use of rapid sequence intubation and increased use of fiberoptic bronchoscopy in the former. During emergency airway management, difficult intubation is more common in obese patients, and morbidly obese patients are more commonly treated as potentially difficult airways.
我们评估了体重指数（BMI）对急诊气道管理中插管成功率和并发症的影响。我们回顾性分析了一家学术医疗中心的气道登记处。主要结局是根据 BMI 分层的困难插管发生率和并发症发生率。我们共记录了 1075 次插管（98%，1075/1102；95%CI 97-99）。426 名患者（40%）的 BMI 正常，289 名（27%）超重，261 名（25%）肥胖，77 名（7%）病态肥胖。多变量分析显示，肥胖（OR 1.90；95%CI 1.04-3.45；p=0.04），而不是病态肥胖（OR 2.18；95%CI 0.95-4.99；p=0.07），可预测困难插管。BMI 不能预测插管后并发症。与瘦患者相比，病态肥胖患者的气道管理方式有所不同，前者较少使用快速序贯插管，更多使用纤维支气管镜。在紧急气道管理中，肥胖患者的插管困难更为常见，病态肥胖患者更常被视为潜在困难气道。
