Proper positioning is extremely important in morbidly obese patients, to alleviate obstruction and optimize ventilation.
During intubation, proper positioning will improve your chance for success and it will also help bring the trachea into view.
This picture illustrates the “ear-to-sternal notch” positioning ideal for morbidly obese patients. Notice the amount of sheets and blankets used.
Remember, obese patients have the same internal anatomy as lean patients of the same height (ex. Similar lung volumes, the distance from the mouth to the lungs is similar). However, excess tissue causes:
- Impaired laryngoscopy visualization – which means you want to optimize your technique with the ear-to-sternal notch positioning
- Increased oxygen demand and decreased reserve - these patients desaturate quickly!
THEREFORE, make sure to set yourself up for success with optimizing positioning and pre/peri-oxygenation as much as possible.