Obesity in the Intensive Care Unit

Honiden, Shyoko; McArdle, John R.

doi:10.1016/j.ccm.2009.05.007

Cited by 38 publications

(40 citation statements)

References 141 publications

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“…Concerns about altered pharmacokinetics leads to exclusion of obese subjects from thromboprophylaxis clinical trials. Practical difficulties with obtaining adequate compression ultrasonography and computed tomographic angiography in obese patients may lead to reduced diagnosis rates of DVT and pulmonary emboli [13]. In this study we did not find an increased rate of clinically documented DVT in obese patients.…”

Section: Discussioncontrasting

confidence: 54%

“…In this study we did not find an increased rate of clinically documented DVT in obese patients. Obesity has been associated with immunologic changes but the impact of these on CLABSI rates is uncertain [13]. Yaegashi et al [26] found significantly higher CLABSI rates in morbidly obese ICU patients, but their study did not include an appropriate nonobese comparison group.…”

Section: Discussionmentioning

confidence: 99%

“…Obese patients have deranged lung and chest wall mechanics, a decreased functional residual capacity with increased airway closure during tidal breathing [9,10] and an increased risk for asthma [11,12]. Obese patients also have increased circulating blood volume and cardiac output with increased left ventricular (LV) size and mass [13]. They also have an increased right ventricular (RV) mass and RV stroke volume, but a lower RV ejection fraction after adjustment for LV size [14].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Obesity on Outcomes in Mechanically Ventilated Patients in a Medical Intensive Care Unit

2014

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Background: The effect of obesity on outcomes in critically ill patients requiring invasive mechanical ventilation in a medical intensive care unit (ICU) is uncertain. Objectives: This study was intended to further explore the relationship between outcomes and obesity in patients admitted to a medical ICU who required invasive mechanical ventilation. Methods: All adult patients admitted to the medical ICU at Washington Hospital Center requiring intubation and invasive mechanical ventilation for at least 24 h between January 1 and December 31, 2009, were retrospectively studied. Patients were categorized as nonobese (BMI <30) and obese (BMI ≥30). The primary outcome measure was 30-day mortality following intubation. Secondary outcomes included ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. Results: There were 504 eligible patients: 306 nonobese and 198 (39%) obese. Obese patients had significantly higher rates of diabetes (43 vs. 30%, p = 0.004), hyperlipidemia (32 vs. 24%, p = 0.04), asthma (16 vs. 8%, p = 0.004) and obstructive sleep apnea requiring continuous positive airway pressure treatment (12 vs. 1%, p < 0.001). Nonobese patients had a significantly higher rate of HIV infection (10 vs. 5%, p = 0.05) and malignancy (21 vs. 13%, p = 0.03). There were no significant differences in mortality up to 30 days following intubation and secondary outcomes between obese and nonobese patients. Multivariate analysis using logistic regression showed no significant relationship between mortality rate at 30 days following intubation and obesity. Outcomes were similar for the black obese (n = 153) and nonobese (n = 228) patients and the obese (n = 85) and very obese (n = 113) patients. Conclusions: Obesity did not influence outcomes in critically ill patients requiring invasive mechanical ventilation in a medical ICU. Black obese patients had similar outcomes to black nonobese patients, and very obese patients also had similar outcomes to obese patients.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Obesity on Outcomes in Mechanically Ventilated Patients in a Medical Intensive Care Unit

2014

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“…Indirect calorimetry remains the best choice to accurately determine nutritional needs (73). Multiple retrospective and prospective studies (75)(76)(77)(78)(79) suggested that early high-protein hypocaloric enteral feeding may offer some anabolic advantages compared with other feeding strategies, such as eucaloric or hypercaloric feeding. Advantages include maintaining a net positive protein anabolism and lipid-based weight loss.…”

Section: Nutritionmentioning

confidence: 99%

Difficulties in managing the surgical patient who is morbidly obese

King

Velmahos

2010

Critical Care Medicine

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Managing patients who are morbidly obese in the intensive care unit is associated with a variety of problems uncommonly experienced with the those who are not morbidly obese. Clinicians experience a myriad of unique problems and circumstances, from the need for special beds and lifts to unusual and unknown volumes of distribution resulting in unclear drug dosing. This review examines several issues including sedation, invasive monitoring, venous thromboembolism prophylaxis, surgical infections, nutritional support, and other complications that may be of particular importance to the critically ill patient who is morbidly obese. In many cases, care is altered based on the complicating issues surrounding morbid obesity. In other cases, the presence of obesity suggests no alterations in our routine critical care delivery. A comprehensive review of the literature is undertaken, data are critically considered, and overall opinion is rendered based on the available peer-reviewed literature. In many cases, data are not available that address the specific patient population in question, so related papers (like gastric bypass data) are considered. Many issues do not have definitive answers based on randomized controlled trials, and much is left to treating clinician opinion and local practice patterns. Where good data exist, however, one should consider carefully and individually deviation from the evidence-based approach.

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“…Obese patients often have difficult airways, reduced ability to liberate from the ventilator, challenging central venous catheter placement, unreliable hemodynamic measurements, unreliable medication dosing and require labor-intensive nursing care. 4 Given these management issues, one might expect poor ICU outcomes associated with obesity; however, this is still widely debated. Data from the medical literature is inconsistent.…”

mentioning

confidence: 99%

A Paradox Defined?

Shipe

2015

Respir Care

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Obesity in the Intensive Care Unit

Cited by 38 publications

References 141 publications

The Effect of Obesity on Outcomes in Mechanically Ventilated Patients in a Medical Intensive Care Unit

The Effect of Obesity on Outcomes in Mechanically Ventilated Patients in a Medical Intensive Care Unit

Difficulties in managing the surgical patient who is morbidly obese

A Paradox Defined?

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