Is obesity a risk factor for reintubation?

SESSION TITLE: Critical Care Posters 16 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: The obesity epidemic is a rising public health concern across the United States. Although the current literature on obesity as a risk factor for difficult intubation is mixed, most of the data suggests that obesity is an independent predictor of a difficult intubation. Moreover, obese patients are more likely to have adverse events associated with intubation. We sought to see if obese patients in a large academic center had increased rates of reintubation, length of service (LOS), and mortality. Additionally, we evaluated whether obesity was associated with an increased incidence of tracheostomy and gastrostomy tube placement in our cohort of patients at risk for reintubation. METHODS: This was a retrospective review which included adult patients at the University of Maryland Medical Center who were intubated for greater than 48 hours in the year 2021. Patients were excluded if they were not at risk of reintubation, defined as those who had a tracheostomy placed during initial intubation, had a change in code status to do not intubate within 48 hours of extubation, or deceased with the initial endotracheal tube in place. Obesity was defined as a body mass index (BMI) ≥ 30. Primary endpoints included rate of reintubation, tracheostomy, gastrostomy, and in hospital mortality. RESULTS: There were a total of 237 patients included in our final analysis, of these 142 had a BMI < 30 and 95 had a BMI ≥ 30. There was no significant difference between the rate of reintubation (48.2% vs 53.5%, p=0.44), LOS (16 vs 23 days, p=0.09) or in hospital mortality (25.5% vs 34.5%, p=0.15), in the BMI < 30 and BMI ≥ 30 groups respectively. Similarly, there was no significant difference in tracheostomy (12.8% vs 20.7%, p=0.11) or gastrostomy (14.9% vs 14.0%, p=0.85) for the groups. CONCLUSIONS: In our cohort, although there was a trend towards increased risk of reintubation, LOS, mortality, tracheostomy, and gastrostomy, none of our results were statistically significant. CLINICAL IMPLICATIONS: The primary limitation in our study was the small sample size. Further research is needed to determine the impact of obesity on the clinical course of patients at risk of reintubation. If obese patients are indeed at higher risk of reintubation and mortality, there should be systems in place designed to mitigate these risks. Such systems could include ICU physicians continuing in the management of obese patients for the duration of their hospitalization. DISCLOSURES: No relevant relationships by Kendall Klein No relevant relationships by Omar Mahmoud Consultant relationship with Guidepoint Please note: $1-$1000 by Carl Shanholtz, value=Consulting fee Removed 10/21/2022 by Carl Shanholtz, source=Web Response stock holder relationship with Teva Pharmaceuticals Please note: $1001 - $5000 by Carl Shanholtz, value=stock iinvestor relationship with illumina Please note: $1001 - $5000 by Carl Shanholtz, value=options Removed 10/21/2022 by Carl Shanholtz, source=Web Response No relevant relationships by Hussain Siddiqi No relevant relationships by Cheyenne Snavely No relevant relationships by Adam Starkman No relevant relationships by Samuel Tisherman