BACKGROUND:The prevalence of obesity in developed countries is rising. Currently, Europe has a prevalence of 9 -30% with significant impact on public health systems. Obese patients in ICUs require special management and treatment. Altered anatomy in obese patients complicates procedures such as mechanical ventilation. Obesity affects cardiopulmonary physiology and requires elevated ventilation pressures. In our retrospective study, we determined the effect of early percutaneous dilatational tracheotomy (PDT) and cessation of sedation on respiratory parameters in severely obese subjects. METHODS: From June 2010 to July 2014, we included all subjects with a body weight of >130 kg (body mass index >35 kg/m 2 ) and respiratory failure who were admitted to the medical ICU of the University Hospital of Mü nster. All subjects were treated with early PDT and immediate cessation of sedative drugs. We compared ventilator parameters and blood gas analysis before and after PDT. Parameters were recorded on days 0, 1, 3, and 5. Day 0 represents values during ventilation via an endotracheal tube, and days 1, 3, 5 represent values during ventilation via a tracheotomy tube. PDT was performed on day 0 after recording values during ventilation via an endotracheal tube. RESULTS: We included 23 subjects with a mean body mass index of 53.1 kg/m 2 and respiratory failure. After PDT and cessation of sedation, the required ventilation pressures and F IO 2 could be rapidly reduced (P < .001), whereas blood gas parameters significantly improved. We observed no severe PDT-associated complications in our cohort. CONCLUSIONS: In severe obesity, respiratory failure might be increased by problems in mechanical ventilation due to required high pressures and obesity-induced pulmonary restriction. Rapid tracheotomy with reduction of dead-space ventilation and airway resistance as well as cessation of sedation to enable spontaneous breathing might be a key factor in the therapy of respiratory failure.
0.0004]. The mean SpO2 was not significantly increased at 0.69% p= 0.92]. Despite the improvement in the PaO2/ FiO2 ratio and the stable saturation on arrival at the tertiary hospitals, 35.8% of patients experienced a desaturation event in transport, and 11.9% had a critical desaturation. Patients with initial saturations of < 80% were the only group to show a decrease in PaO2 on arrival, while all other groups had an increase in PaO2. Conclusions: In this cohort of critically ill patients with severe hypoxemic respiratory failure, PaO2/FiO2 ratios and PaO2 ratios increased after transport by a CCT team, despite 35% of patients having a desaturation episode in transit.
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