Ventilation heterogeneity in obesity

Pellegrino, Riccardo; Gobbi, Alessandro; Antonelli, Andrea; Torchio, Roberto; Gulotta, Carlo; Pellegrino, Giulia Michela; Dellacà, Raffaele L.; Hyatt, Robert E.; Brusasco, Vito

doi:10.1152/japplphysiol.01339.2013

Cited by 42 publications

(41 citation statements)

References 55 publications

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“…Published data consistently show stronger associations between BMI and forced oscillation impedance than between BMI and spirometry. Pellegrino et al 37 reported that obesity was associated with FOT abnormalities while FEV 1 /FVC did not differ between normal, overweight and obese subjects. Mahadev et al 21 showed that abnormalities in FOT associated with obesity were due in part to reduced end-expiratory lung volumes encroaching on closing volumes.…”

Section: Discussionmentioning

confidence: 97%

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Determinants of peripheral airway function in adults with and without asthma

et al. 2017

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Section: Discussionmentioning

confidence: 97%

“…Published data consistently show stronger associations between BMI and forced oscillation impedance than between BMI and spirometry. Pellegrino et al . reported that obesity was associated with FOT abnormalities while FEV 1 /FVC did not differ between normal, overweight and obese subjects.…”

Section: Discussionmentioning

confidence: 97%

Determinants of peripheral airway function in adults with and without asthma

et al. 2017

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“…However, the modest weight loss was sufficient to reduce the Rrs measured in the supine position likely because moving to the supine position augments lung compression associated with obesity (Navajas et al 1988;Yap et al 1995) and that could amplify the changes in mechanics with weight loss. Compression reduces lung volume and lung elastic recoil (Pellegrino et al 2014), resulting in weaker airway-parenchymal tethering and the collapse of dependent airways (Salome et al 2010).…”

Section: Discussionmentioning

confidence: 99%

Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity

Peters

Hernández

Dechman

et al. 2016

Appl. Physiol. Nutr. Metab.

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Obesity is associated with respiratory symptoms that are reported to improve with weight loss, but this is poorly reflected in spirometry, and few studies have measured respiratory mechanics with oscillometry. We investigated whether early changes in lung mechanics following weight loss are detectable with oscillometry. Furthermore, we investigated whether the changes in lung mechanics measured in the supine position following weight loss are associated with changes in sleep quality. Nineteen severely obese female subjects (mean body mass index, 47.2 ± 6.6 kg/m(2)) were evaluated using spirometry, oscillometry, plethysmography, and the Pittsburgh Sleep Quality Index before and 5 weeks after bariatric surgery. These tests were conducted in both the upright and the supine position, and pre- and postbronchodilation with 200 μg of salbutamol. Five weeks after surgery, weight loss of 11.5 ± 2.5 kg was not associated with changes in spirometry and plethysmography, with the exception of functional residual capacity. There were also no changes in upright respiratory system resistance (Rrs) or reactance following weight loss. Importantly, however, in the supine position, weight loss caused a substantial reduction in Rrs. In addition, sleep quality improved significantly and was highly correlated with the reduction in supine Rrs. Prior to weight loss, subjects did not respond to the bronchodilator when assessed in the upright position with either spirometry or oscillometry; however, with modest weight loss, bronchodilator responsiveness returned to the normal range. Improvements in lung mechanics occur very early after weight loss, mostly in the supine position, resulting in improved sleep quality. These improvements are detectable with oscillometry but not with spirometry.

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“…13,14 Expiratory flow limitation worsens the elastic properties of the lung due to heterogeneous ventilation of lung units. 15 Expiratory flow limitation also leads to an increased work of breathing, 16 because every breath requires additional force to overcome the auto-PEEP, open small airways, and generate air flow.…”

Section: Physiological Characteristics Of the Respiratory System Durimentioning

confidence: 99%

Respiratory Management of Perioperative Obese Patients

et al. 2016

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SummaryWith a rising incidence of obesity in the United States, anesthesiologists are faced with a larger volume of obese patients coming to the operating room as well as obese patients with ever-larger body mass indices (BMIs). While there are many cardiovascular and endocrine issues that clinicians must take into account when caring for the obese patient, one of the most prominent concerns of the anesthesiologist in the perioperative setting should be the status of the lung. Because the pathophysiology of reduced lung volumes in the obese patient differs from that of the ARDS patient, the best approach to keeping the obese patient's lung open and adequately ventilated during mechanical ventilation is unique. Although strong evidence and research are lacking regarding how to best ventilate the obese surgical patient, we aim with this review to provide an assessment of the small amount of research that has been conducted and the pathophysiology we believe influences the apparent results. We will provide a basic overview of the anatomy and pathophysiology of the obese respiratory system and review studies concerning pre-, intra-, and postoperative respiratory care. Our focus in this review centers on the best approach to keeping the lung recruited through the prevention of compression atelectasis and the maintaining of physiological lung volumes. We recommend the use of PEEP via noninvasive ventilation (NIV) before induction and endotracheal intubation, the use of both PEEP and periodic recruitment maneuvers during mechanical ventilation, and the use of PEEP via NIV after extubation. It is our hope that by studying the underlying mechanisms that make ventilating obese patients so difficult, future research can be better tailored to address this increasingly important challenge to the field of anesthesia.

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Ventilation heterogeneity in obesity

Cited by 42 publications

References 55 publications

Determinants of peripheral airway function in adults with and without asthma

Determinants of peripheral airway function in adults with and without asthma

Early detection of changes in lung mechanics with oscillometry following bariatric surgery in severe obesity

Respiratory Management of Perioperative Obese Patients

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