Obesity and the lung: 3 {middle dot} Obesity, respiration and intensive care

Malhotra, Atul; Hillman, David R.

doi:10.1136/thx.2007.086835

Cited by 100 publications

(68 citation statements)

References 97 publications

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“…These issues are complex-for example, measured intrathoracic vascular pressures are higher in patients who are obese, which refl ects both issues of accurate measurement as well as actual physiologic changes-and are reviewed extensively elsewhere in the literature. 16 …”

Section: Chest 2012; 142( 3 ): 785 -790mentioning

confidence: 99%

Obesity and ARDS

Hibbert

Rice

Malhotra

2012

Chest

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The obesity pandemic continues, with rising prevalence reported throughout the world. In the United States, recent data show that more than twothirds of US citizens are either obese or overweight (BMI . 25 kg/m 2 ). Approximately 33% of adults in the United States are obese (BMI . 30 kg/m 2 ), and in some areas of the country the prevalence of obesity reaches . 40%. 1 In Europe, obesity prevalence varies by country but ranges from 9% to 30%, and is steadily increasing. 2 All of these statistics emphasize the importance of obesity and related conditions in patient care. Even in a state of relative health, obesity has major effects on cardiopulmonary physiology. ARDS continues to be both prevalent and very morbid, with an estimated age-adjusted incidence of 86.2 per 100,000 patient years, and reported in-hospital mortality of nearly 40%. 3 Data from the 2009 infl uenza A(H1N1) pandemic suggested that patients who are obese represent a unique patient population in ARDS. Among patients with severe or fatal 2009 infl uenza A(H1N1), rates of severe and morbid obesity (BMI . 35 kg/m 2 and . 40 kg/m 2 , respectively) were fi ve to 15 times higher than the general population. 4 , 5 This fi nding, with other data, suggests a potential link between ARDS and obesity, and at a minimum demonstrates that when critical illness is coincident with obesity, there are additional considerations for dis ease mechanism, management, and prognosis. 6 Such inpatients are often challenging to manage due to issues including line placement, transportation, drug dosing , and imaging ( Table 1 ). Changes in Baseline PhysiologyEven without the additional pathophysiology of ARDS, patients who are obese experience a number of changes in their physiology compared with lean control subjects. Some of the baseline alterations in respiratory mechanics of the patient who is obese include a decrease in total lung capacity (TLC), functional residual capacity (FRC), and vital capacity (VC) as well as increases in pleural pressure and upper and lower airway resistance.The decreased TLC, FRC, and VC are due to an overall decrease in respiratory system compliance, which in turn is secondary to increased weight of the chest wall and increased abdominal pressure from

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Section: Chest 2012; 142( 3 ): 785 -790mentioning

confidence: 99%

Obesity and ARDS

Hibbert

Rice

Malhotra

2012

Chest

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“…84 It is known that classical anatomic airway landmarks are not evident, so management is challenging. 85 The airway is characterized by a small oral cavity with redundant oropharyngeal tissue, hypertrophic tonsils and/or adenoids and a thick, short neck with little mobility; there is also fatty infiltration in the muscles, which causes a direct airway narrowing. All such anatomic factors may complicate visualization during a laryngoscopy.…”

Section: Airwaysmentioning

confidence: 99%

The obese child in the Intensive Care Unit. Update

Fuentes¹,

L²,

et al. 2016

Arch Argent Pediat

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Given that childhood obesity is an epidemic, the frequency of critically-ill patients who are overweight or obese seen at intensive care units has increased rapidly. Adipose tissue is an endocrine organ that secretes a number of protein hormones, including leptin, which stands out because it regulates adipose tissue mass. The presence of arterial hypertension, metabolic syndrome, diabetes mellitus, respiratory disease and chronic kidney disease may become apparent and complicate the course of obese pediatric patients in the Intensive Care Unit. Obesity management is complex and should involve patients, their families and the medical community. It should be coordinated with comprehensive government health policies and implemented in conjunction with a change in cultural context

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“…1,[4][5][6] Function of the diaphragm is hampered in obesity due to increased intraabdominal pressure, which additionally contributes to limited compliance of the respiratory system and decreased static and dynamic lung volumes. 1,[4][5][6] Further, pleural pressure is increased in obese patients, resulting in reduced transpulmonary pressure, and thereby enables collapse of airways and lung parenchyma and generation of atelectasis. 1 Atelectasis diminishes lung volume and subsequently the area for gas exchange.…”

Section: Introductionmentioning

confidence: 99%

“…3 Obese patients often suffer from obstructive sleep apnea, obesity hypoventilation, ARDS, hypertension, ischemic heart disease, hyperlipidemia, and type 2 diabetes mellitus. 1,4,5 Respiratory physiology in obese patients is characterized by reduction of tidal volume, expiratory reserve volume, residual volume, total lung capacity, functional residual capacity, vital capacity, FEV 1 , FVC, lung compliance, chest wall compliance, maximum voluntary ventilation, maximum oxygen consumption, diffusing lung capacity for carbon monoxide, upper and lower airway resistance, and increased pleural pressure and work of breathing with unchanged FEV 1 /FVC. 1,[4][5][6] Function of the diaphragm is hampered in obesity due to increased intraabdominal pressure, which additionally contributes to limited compliance of the respiratory system and decreased static and dynamic lung volumes.…”

Section: Introductionmentioning

confidence: 99%

“…1,4,5 Respiratory physiology in obese patients is characterized by reduction of tidal volume, expiratory reserve volume, residual volume, total lung capacity, functional residual capacity, vital capacity, FEV 1 , FVC, lung compliance, chest wall compliance, maximum voluntary ventilation, maximum oxygen consumption, diffusing lung capacity for carbon monoxide, upper and lower airway resistance, and increased pleural pressure and work of breathing with unchanged FEV 1 /FVC. 1,[4][5][6] Function of the diaphragm is hampered in obesity due to increased intraabdominal pressure, which additionally contributes to limited compliance of the respiratory system and decreased static and dynamic lung volumes. 1,[4][5][6] Further, pleural pressure is increased in obese patients, resulting in reduced transpulmonary pressure, and thereby enables collapse of airways and lung parenchyma and generation of atelectasis.…”

Section: Introductionmentioning

confidence: 99%

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Successful Use of Early Percutaneous Dilatational Tracheotomy and the No Sedation Concept in Respiratory Failure in Critically Ill Obese Subjects

2016

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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.

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Obesity and the lung: 3 {middle dot} Obesity, respiration and intensive care

Abstract: Obesity is a major problem from a public health perspective and a difficult practical matter for intensivists. The obesity pandemic has required treating clinicians to develop an appreciation of the substantial pathophysiological effects of obesity on the various organ systems.

Cited by 100 publications

References 97 publications

Obesity and ARDS

Obesity and ARDS

The obese child in the Intensive Care Unit. Update

Successful Use of Early Percutaneous Dilatational Tracheotomy and the No Sedation Concept in Respiratory Failure in Critically Ill Obese Subjects

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