Checklists will not fly a plane

Originally posted on my Facebook community page #TBayAirBasedRounds

Definitive airway on BMI 92 hypoxic hypercapnic respiratory failure

Some time ago, in this galaxy, ourabg good friend Jorge Cabrera was faced with managing respiratory failure in a 55’ish year old man with BMI of 92 (ht 6 feet, wt 675 lbs (307kg). This patient was initially admitted with an upper gastrointestinal bleed with congestive heart failure and a history of obstructive sleep apnea. He had required mechanical ventilation but was weaned off recently. His recent intubation involved 2 attempts by anesthesia with the first attempt being  failed Mac 3 direct laryngoscopy and the second attempt being a successful glidescope intubation.

The patient was now in hypercapnic hypoxic respiratory failure despite all treatment including NIPPV. His arterial blood gas was not improving despite CPAP or BiPAP (EPAP of 12).

pH 7.1 PaCO2 90’s PaO2 60’s SaO2<90’s

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