High Body Mass Index Is a Weak Predictor for Difficult and Failed Tracheal Intubation

Author:

Lundstrøm Lars H.1,Møller Ann M.2,Rosenstock Charlotte3,Astrup Grethe4,Wetterslev Jørn5

Affiliation:

1. Department of Anesthesia and Intensive Care Herlev, and Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

2. Associate Professor, Department of Anesthesia and Intensive Care Herlev, Copenhagen University Hospital.

3. Consultant, Department of Anesthesia, Hillerd Hospital, Hillerd, Denmark.

4. Consultant, Department of Anesthesia Århus Sygehus, Århus University Hospital, Århus, Denmark.

5. Chief Physician, Copenhagen Trial Unit, Centre of Clinical Intervention Research, Rigshospitalet Copenhagen University Hospital.

Abstract

Background Previous studies have failed to detect high body mass index (BMI) as a risk factor for difficult tracheal intubation (DTI). BMI was investigated as a risk factor for DTI in patients planned for direct laryngoscopy. Methods A cohort of 91,332 consecutive patients planned for intubation by direct laryngoscopy was retrieved from the Danish Anesthesia Database. A four-point scale to grade the tracheal intubation was used. Age, sex, American Society of Anesthesiologists physical status classification, priority of surgery, history of previous DTI, modified Mallampati-score, use of neuromuscular blocker, and BMI were retrieved. Logistic regression to assess whether BMI was associated with DTI was performed. Results The frequency of DTI was 5.2% (95% confidence interval [CI] 5.0-5.3). In multivariate analyses adjusted for other significant covariates, BMI of 35 or more was a risk for DTI with an odds ratio of 1.34 (95% CI 1.19-1.51, P < 0.0001). As a stand alone test, BMI of 35 or more predicted DTI with a sensitivity of 7.5% (95% CI 7.3-7.7%) and with a predictive value of a positive test of 6.4% (95% CI 6.3-6.6%). BMI as a continuous covariate was a risk for failed intubation with an odds ratio of 1.031 (95% CI 1.002-1.061, P < 0.04). Conclusions High BMI is a weak but statistically significant predictor of difficult and failed intubation and may be more appropriate than weight in multivariate models of prediction of DTI.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference33 articles.

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