Dear airway enthusiastic friends,
Although there are many articles related to airway management in this time of COVID -19 era, my interested turned to a bit different choice to share with you- of course related to what I know best: Obese Airway management. It refers to not one but to two correspondences in BJA, related to airway trauma in critically ill obese patients due to COVID-19 .
1.Tracheal trauma after difficult airway management in morbidly obese patients with COVID-19
2.Tracheal introducers and airway trauma COVID-19.
As we face the new worldwide pandemic of COVID-19, it was clearly suggested that a serious potential risk factor for infection development with severe disease progression is obesity. Simonnet et al mentioned that approximately 85% of patients with obesity required mechanical ventilation and other preliminary data from New York City showed that obesity (BMI>40 kg/m2) is the second strongest independent predictor of hospitalization, after old age (preprint by Petrilli et al.)
The first paper exemplified that patients with severe obesity with a typical presentation of SARS-CoV-2 infection, requiring invasive ventilationafter failing noninvasive oxygen therapy presented difficult tracheal intubation and the use of a bougie probably induced tracheal trauma thereby worsening the respiratory condition and leading to urgent ECMO.
The second paper has come on behalf of the airway experts as a response to the first paper and give advice about the optimising oxygen delivery before intubation to allow more controlled airway management especially in hypoxaemic obese patients. The likelihood of successful tracheal bougie placement with a Grade IV laryngeal view is quite low, whereas the risk of airway trauma as a result of blind bougie insertion is significant, so that use of a bougie in such a scenario is considered contraindicated.
The appropriate use of this simple device remains a precious adjunct for airway management in conjunction with direct or video-laryngoscopy, especially in difficult airway management patients such as obese patients.