ARDS in Obese Patients: Specificities and Management

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

Obesity Doubles Mortality in Patients Hospitalized for Severe Acute Respiratory Syndrome Coronavirus 2 in Paris Hospitals, France: A Cohort Study on 5,795 Patients

“…An important result of the study is the poorer vital prognosis observed in people with obesity and COVID-19. Such a result contrasts with the general findings of a similar or even better prognosis than in the population with ARDS without obesity (19). However, one should keep in mind the worse vital prognosis previously observed in people with obesity and H1N1 infection (6).…”

“…The dysregulated cytokine environment may be the early biological step that mediates multiple organ failure (14). Second, obesity is associated with several respiratory disorders, such as obstructive sleep apnea syndrome, asthma, restrictive respiratory syndrome, and obesity 11 (15) 33 (10) 49 (12) 55 (17) 32 (19) 17 (16) Intensive care 161 (14) 17 (16) 121 (14) 190 (18) 90 (19) Age, mean (SD), y 60 (13) 60 (14) 61 (16) 61 (13) 61 (12) 59 (12) 56 (13) 52. 16 254 551 1118 (14) 17 (24)…”

Obesity: A critical risk factor in the COVID‐19 pandemic

“…It is well recognized that in critically ill ICU patients admitted with any cause, patients with obesity have an increased risk of developing ARDS 49,50 . Unexpectedly, although these patients may have worse morbidity outcomes, their mortality rates are not increased.…”

“…In a single centre ICU study it was shown that prone‐positioning in ARDS patients improved partial arterial oxygen pressure significantly more in patients with obesity than healthy‐weight patients 64 . Additionally upper chest and pelvic supports are usually required in patients with obesity to avoid abdominal compression and the bed is frequently placed in the reverse Trendelenburg position to lessen transdiaphragmatic pressure and atelectasis 50 …”

Fluid Management in Patients with Acute Respiratory Distress Syndrome and Diabetes Mellitus

“…[ 12 , 14 ] The following variables were identified as likely confounders for the interaction of diabetes on ARDS outcomes: age, gender, body mass index (BMI), and ethnicity. [ 15 – 17 ] The additional covariates included in the propensity score model were: the primary cause of ARDS, whether the patient was immediately post-operative, AIDS status, if the patient had leukemia, lymphoma, solid tumor with metastasis, immunosuppression, cirrhosis, underlying chronic pulmonary disease, if the patient needed vasopressors in the last 24 hours, hematocrit, highest white blood cell count, platelets, mean arterial pressure, pulmonary artery carbon dioxide, pulmonary artery pH, albumin levels, bilirubin levels, bicarbonate levels, fluid intake and output over the past 24 hours before randomization, partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, and fluid management strategy. The following covariates, which could mediate the effect pathway of the interaction of diabetes on ARDS, were excluded from the propensity score: diagnosis of hypertension, myocardial infarction, congestive heart disease, peripheral vascular disease, stroke, if the participant was on dialysis at baseline, highest baseline creatinine, lowest baseline creatinine, highest baseline glucose, edema, and lowest baseline glucose.…”