危重症肥胖患者气管插管相关并发症：国际INTUBE队列的二次分析
Peri-intubation complications in critically ill obese patients: a secondary analysis of the international INTUBE cohort.
作者信息
Russotto Vincenzo, Laffey John G, Tassistro Elena, Myatra Sheila N, Rezoagli Emanuele, Foti Giuseppe, Antolini Laura, Valsecchi Maria Grazia, Bauer Philippe R, Szułdrzyński Konstanty, Camporota Luigi, Greif Robert, Higgs Andy, Parotto Matteo, Fumagalli Roberto, Sorbello Massimiliano, Robba Chiara, Grasselli Giacomo, Bellani Giacomo, Caironi Pietro, Lascarrou Jean Baptiste
机构信息
Department of Oncology, University of Turin, Turin, Italy.
Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Orbassano, Turin, Italy.
出版信息
Crit Care. 2025 May 13;29(1):192. doi: 10.1186/s13054-025-05419-2.
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 30 kg/m) and non-obese patients (BMI 30 kg/m).
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 SpO/FiO (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.
背景
由于一系列生理和解剖学挑战，危重症肥胖患者的气道管理可能与更高的不良事件风险相关。缺乏关于肥胖危重症患者围插管期不良事件的国际前瞻性研究数据。
方法
INTUBE（了解危重症患者气道管理的影响和最佳实践的国际观察性研究）是一项国际多中心前瞻性队列研究，于2018年10月1日至2019年7月31日在全球29个国家的197个地点招募接受院内气管插管的成年危重症患者。这项二次分析比较了肥胖（体重指数-BMI≥30kg/m²）和非肥胖患者（BMI<30kg/m²）的气道管理实践和结果。
结果
共有2946例患者符合这项二次分析的纳入标准，其中639例（21.7%）为肥胖患者，2307例（78.3%）为非肥胖患者。与非肥胖患者相比，肥胖患者围插管期严重低氧血症的报告更为频繁（分别为12.1%和8.6%，p=0.01）。与围插管期低氧血症风险较高独立相关的变量为基线SpO₂/FiO₂（比值比[OR]0.996，95%置信区间[CI]0.994-0.997）、头高位30-45°（OR1.53，95%CI1.04-2.26）和首次插管失败（首次插管成功的OR为0.21，95%CI0.15-0.29）。肥胖（OR0.71，95%CI0.56-0.91）和头高位20°（OR0.67，95%CI0.47-0.95）与首次插管失败的可能性较高独立相关。相比之下，由主治医师/会诊医师（OR1.70，95%CI1.30-2.21）或麻醉医师（OR1.98，95%CI1.55-2.53）进行插管与首次插管成功率较高相关。
结论
与非肥胖患者相比，肥胖危重症患者围插管期严重低氧血症的发生率更高。在这一人群中，较差的基线氧合和首次插管失败显著增加了围插管期严重低氧血症的风险。由于肥胖与首次插管失败的可能性较高相关，可能是由更具挑战性的气道特征所致，在这一高风险人群中，应由专家操作人员进行首次尝试，以尽量减少围插管期并发症。
试验注册
Clinicaltrials.gov NCT03616054。于2018年8月3日注册。
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