Higher age and obesity limit atelectasis formation during anaesthesia: an analysis of computed tomography data in 243 subjects

Hedenstierna, Göran; Tokics, L.; Reinius, Henrik; Rothen, Hans Ulrich; Östberg, Erland; Öhrvik, John

doi:10.1016/j.bja.2019.11.026

Cited by 22 publications

(35 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Age, residence, ethnicity, education, and household income were considered as fixed effects (level-1), whereas period, cohort and gender were included as random effects (level-2). According to prior research, overweight was assumed to follow a quadratic function of age [28]. Gender, age, residence, education, and household income were centered around their grand means to facilitate the interpretation and reduce collinearity problems between main effects and their interactions.…”

Section: Methodsmentioning

confidence: 99%

Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Yang

Kelifa

et al. 2020

glob health res policy

View full text Add to dashboard Cite

Background As a key health risk, the prevalence of overweight has been strikingly increasing worldwide. This study aimed to disentangle the net age, period, and cohort effects on overweight among Chinese adults by gender. Methods Data came from the Chinese General Social Survey from 2008 to 2015, which was a repeated cross-sectional survey (n = 55,726, aged 18 and older). χ2 or t tests were used to estimate the gender disparities in overweight and socioeconomic status (SES). A series of hierarchical age-period-cohort cross-classified random-effects models were performed using SAS version 9.4 to estimate the overall and gender-specific temporal trends of overweight, as well as the association between SES and overweight. Further, a series of line charts were used to present the age and cohort variations in overweight. Results After controlling for covariates, significant age and cohort effects were observed among adults in China (b = 0.0205, p < 0.001; b = 0.0122, p < 0.05; respectively). Specifically, inverted U-shaped age effects were identified for both genders, with a high probability of overweight occurring in middle age (b = –0.0012, p < 0.001). Overweight was more prevalent among men than women before 60 years old, and this trend reversed thereafter (b = –0.0253, p < 0.001). Moreover, men born during the war (before 1950) and reform cohorts (after the 1975s) demonstrated a substantial decline in overweight, while men born in 1950–1975 showed an increasing trend in overweight prevalence (b = 0.0378, p < 0.05). However, the cohort effect on women was not statistically significant. Additionally, a higher SES was related to an elevated probability of overweight. Conclusion Gender-specific age and cohort effects on the prevalence of overweight were observed among Chinese adults. Both China and other developing countries need to pay attention to the coming obesity challenge and related health inequality. Full life-cycle overweight prevention interventions should focus on middle-aged adults, men born in the war and reform eras, and adults with a higher SES.

show abstract

Section: Methodsmentioning

confidence: 99%

Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Yang

Kelifa

et al. 2020

glob health res policy

View full text Add to dashboard Cite

show abstract

“…Better elastance of the lung in obese ARDS could be explained by the anti-inflammatory and antifibrotic effects reported in animal models with lung injury. 45 The higher prevalence of atelectasis with lower Pao 2 /Fio 2 reported in obese anesthetized patients 46 may also have artificially worsened hypoxemia and radiologic findings, thereby increasing ARDS severity according to the Berlin definition of ARDS. This could explain why high-PEEP strategy reduced mortality of obese patients' mortality whereas it was not the case for nonobese patients.…”

Section: Relationship Between Lung Mechanics and Bmimentioning

confidence: 99%

Prevalence of Complete Airway Closure According to Body Mass Index in Acute Respiratory Distress Syndrome

Coudroy¹,

Vimpère²,

Aïssaoui³

et al. 2020

Anesthesiology

View full text Add to dashboard Cite

Background Complete airway closure during expiration may underestimate alveolar pressure. It has been reported in cases of acute respiratory distress syndrome (ARDS), as well as in morbidly obese patients with healthy lungs. The authors hypothesized that complete airway closure was highly prevalent in obese ARDS and influenced the calculation of respiratory mechanics. Methods In a post hoc pooled analysis of two cohorts, ARDS patients were classified according to body mass index (BMI) terciles. Low-flow inflation pressure–volume curve and partitioned respiratory mechanics using esophageal manometry were recorded. The authors’ primary aim was to compare the prevalence of complete airway closure according to BMI terciles. Secondary aims were to compare (1) respiratory system mechanics considering or not considering complete airway closure in their calculation, and (2) and partitioned respiratory mechanics according to BMI. Results Among the 51 patients analyzed, BMI was less than 30 kg/m2 in 18, from 30 to less than 40 in 16, and greater than or equal to 40 in 17. Prevalence of complete airway closure was 41% overall (95% CI, 28 to 55; 21 of 51 patients), and was lower in the lowest (22% [3 to 41]; 4 of 18 patients) than in the highest BMI tercile (65% [42 to 87]; 11 of 17 patients). Driving pressure and elastances of the respiratory system and of the lung were higher when complete airway closure was not taken into account in their calculation. End-expiratory esophageal pressure (ρ = 0.69 [95% CI, 0.48 to 0.82]; P < 0.001), but not chest wall elastance, was associated with BMI, whereas elastance of the lung was negatively correlated with BMI (ρ = −0.27 [95% CI, −0.56 to −0.10]; P = 0.014). Conclusions Prevalence of complete airway closure was high in ARDS and should be taken into account when calculating respiratory mechanics, especially in the most morbidly obese patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

show abstract

“…Cardiac arrest is the ultimate complication of severe hypoxemia during intubation procedure occurring in 2-3% in ICU, and it is strongly related to hypoxemia, overweight and obesity [7,8]. Lung function disorders, characterized by reduction in lung volumes and greater atelectasis formation, may explain the risk of severe hypoxemia in patients with obesity [4,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial

Rodriguez

Ragot

Coudroy

et al. 2021

Ann. Intensive Care

View full text Add to dashboard Cite

Background Critically ill patients with obesity may have an increased risk of difficult intubation and subsequent severe hypoxemia. We hypothesized that pre-oxygenation with noninvasive ventilation before intubation as compared with high-flow nasal cannula oxygen may decrease the risk of severe hypoxemia in patients with obesity. Methods Post hoc subgroup analysis of critically ill patients with obesity (body mass index ≥ 30 kg·m−2) from a multicenter randomized controlled trial comparing preoxygenation with noninvasive ventilation and high-flow nasal oxygen before intubation of patients with acute hypoxemic respiratory failure (PaO2/FiO2 < 300 mm Hg). The primary outcome was the occurrence of severe hypoxemia (pulse oximetry < 80%) during the intubation procedure. Results Among the 313 patients included in the original trial, 91 (29%) had obesity with a mean body mass index of 35 ± 5 kg·m−2. Patients with obesity were more likely to experience an episode of severe hypoxemia during intubation procedure than patients without obesity: 34% (31/91) vs. 22% (49/222); difference, 12%; 95% CI 1 to 23%; P = 0.03. Among patients with obesity, 40 received preoxygenation with noninvasive ventilation and 51 with high-flow nasal oxygen. Severe hypoxemia occurred in 15 patients (37%) with noninvasive ventilation and 16 patients (31%) with high-flow nasal oxygen (difference, 6%; 95% CI − 13 to 25%; P = 0.54). The lowest pulse oximetry values during intubation procedure were 87% [interquartile range, 77–93] with noninvasive ventilation and 86% [78–92] with high-flow nasal oxygen (P = 0.98). After multivariable analysis, factors independently associated with severe hypoxemia in patients with obesity were intubation difficulty scale > 5 points and respiratory primary failure as reason for admission. Conclusions Patients with obesity and acute hypoxemic respiratory failure had an increased risk of severe hypoxemia during intubation procedure as compared to patients without obesity. However, preoxygenation with noninvasive ventilation may not reduce this risk compared with high-flow nasal oxygen. Trial registration Clinical trial number: NCT02668458 (http://www.clinicaltrials.gov)

show abstract

Higher age and obesity limit atelectasis formation during anaesthesia: an analysis of computed tomography data in 243 subjects

Cited by 22 publications

References 33 publications

Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Prevalence of Complete Airway Closure According to Body Mass Index in Acute Respiratory Distress Syndrome

Noninvasive ventilation vs. high-flow nasal cannula oxygen for preoxygenation before intubation in patients with obesity: a post hoc analysis of a randomized controlled trial

Contact Info

Product

Resources

About