Airway management in critically ill patients with obesity - PubMed
3 days ago
- #airway management
- #obesity
- #critically ill
- Airway management in critically ill obese patients is challenging due to anatomical changes like increased adipose tissue narrowing the upper airway and making tissues more collapsible.
- Physiological alterations, including reduced functional residual capacity, shorten safe apnea time and increase hypoxemia risk during intubation; non-invasive ventilation from pre-induction to laryngoscopy helps mitigate this.
- Peri-intubation optimization requires assessment of preload and cardiac contractility, careful monitoring of intrathoracic pressure changes, and cautious titration of positive end-expiratory pressure.
- Awake intubation should be considered in selected patients; for rapid sequence induction, ketamine or etomidate can be used based on clinical context, patient factors, and availability.
- Videolaryngoscopy increases first-attempt success and should be routinely used in obese patients; unanswered questions include pre-emptive vasopressor safety and optimal hypnotic dosing.