Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality

Abstract

Worldwide incidence of obesity is increasing and impaired outcome in postoperative patients has been described. Antibiotic prescribing is complicated by different pharmacology in this population. This study evaluates mortality and morbidity of obese postoperative patients and explores possible relation to antibiotic therapy. Therefore, data obtained in a prospective study in 2009-2010 were analysed. Postoperative patients on 5 ICUs were included with >48h of ICU treatment and documented body-mass-index (BMI). Altogether 451 non-obese patients (BMI<30kg/m(2)) were compared with 130 obese patients including propensity score matching. There was significant heterogeneity of baseline characteristics. ICU-mortality was 7.5% in non-obese and 7.7% in obese patients (p>0.999), but 65.4% of obese patients required mechanical ventilation compared with only 53.2% of non-obese patients (p=0.016). These findings were validated in multivariate regression analyses (adjusted OR for ICU-mortality for obese patients 0.53, 95%-CI 0.188-1.321, p=0.197; adjusted OR for mechanical ventilation 1.841, 95%-CI 1.113-3.076, p=0.018). Results were confirmed by propensity score matching. Therapeutic drug monitoring for vancomycin (TDM) showed that underdosing and overdosing occurred more often in obese patients and sufficient TDM levels were less often achieved. In conclusion, obesity is associated with increased morbidity but ICU mortality is equal compared with a non-obese population. Pharmacological differences might explain observed differences in antibiotic therapy and in obese patients TDM might be especially of importance.

Being Underweight Is an Independent Risk Factor for Poor Outcomes Among Acutely Critically Ill Children

“…Malnutrition, obesity, and being overweight have been associated with poor outcomes among critically ill adult patients. 26,27 However, Goh et al reported that obesity and being overweight were not associated with mortality or morbidity among critically ill children, in line with our findings. 28 Therefore, further large-scale studies are needed to clarify the impact of being overweight on clinical outcomes among acutely critically ill children.…”

Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations

“…Vancomycin TDM showed that underdosing and overdosing occur more often and effective levels are less often achieved, in obese patients. TDM might be of special importance, in obese patients . The majority of these patients present subtherapeutic concentrations, which increases the risk of treatment failure and bacterial resistance.…”

“…TDM might be of special importance, in obese patients. 70 The majority of these patients present subtherapeutic concentrations, which increases the risk of treatment failure and bacterial resistance.…”

High‐Fat Diet Increases HMGB1 Expression and Promotes Lung Inflammation in Mice Subjected to Mechanical Ventilation

“…Moreover, adipose tissue accumulation in the thoracic cavity and abdomen alters respiratory physiology causing an increased load on the respiratory musculature, leading to decreased chest wall compliance and increased resistance, altered ventilation perfusion relation, lung volume, and capacity [ 5 – 7 ]. Recent data indicate that in intensive care units, approximately 20% of patients are obese or severely obese [ 8 ]. These patients have more complications and need longer hospitalization and mechanical ventilation [ 5 ].…”