{
  "abstract": "Standard airway management in deteriorating super morbidly obese patients can lead to cardiovascular collapse because of their poor physiological reserves. In this report, we describe a case of awake tracheal intubation in a super morbidly obese patient who was rapidly deteriorating in the intensive care unit. The patient was approached as having a physiologically difficult airway, and therefore, we accounted for the four Hs: hypoxia, hypotension (systemic), hydrogen ions (metabolic acidosis) and hypertension (pulmonary). To optimise these patient factors, we administered pre- and apnoeic oxygen through a high-flow nasal cannula to prevent hypoxia. Awake video laryngoscopy was performed to avoid cardiovascular compromise that could arise from using sedation/induction agents. Intravenous metaraminol was run in parallel to fluid support to reduce cardiovascular compromise risks and worsening acidosis. Approaching the patient as an anatomically and physiologically difficult case provided a safe technique for securing an extremely challenging airway.",
  "authors": [
    {
      "affiliations": [
        "Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Davis Kurian"
    },
    {
      "affiliations": [
        "Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Leshanth Uthayanan"
    },
    {
      "affiliations": [
        "Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Prachi Bansal"
    },
    {
      "affiliations": [
        "Physiological Sciences, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Cassia Edwards"
    },
    {
      "affiliations": [
        "Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Sam George"
    },
    {
      "affiliations": [
        "Intensive Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK"
      ],
      "name": "Manoj Ravindran"
    }
  ],
  "title": "Awake video laryngoscopy and tracheal intubation in a super morbidly obese critically ill patient with a physiologically difficult airway",
  "uid": "83f644cc-4d5a-51cf-972b-e525c67862c4"
}