The obese child in the Intensive Care Unit. Update

Abstract

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

COVID-19 and obesity in childhood and adolescence: a clinical review

“… 145 Also, extensive involvement of the cardiopulmonary system is frequent 146 and respiratory disorders such as Pickwick syndrome, obstructive apnea, and surfactant dysfunctions may be present. 147 There are also technical issues, such as the fact that many pieces of equipment may not adequately adapt to the obese patient 148 and the greater difficulty of intubation of obese patients, which may lead to the occurrence of lesions and longer periods of hypoxia while the procedure is being completed. 148 Nursing care is always more difficult: the possibility of more precarious hygiene and secondary contamination, as well as harder venipuncture and more likelihood to cause injury; control procedures such as blood pressure measurement and cardiac auscultation are more difficult and more error-prone; and the risk of bedsores during intensive care unit stay is always higher the higher the patient’s weight.…”

Clinical Nutrition Approaches to Medical Management of Children with Obesity and Critical Illnesses

“…Obesity-related diseases and complications and obesity-related challenges in common procedures in PI-CUs make it difficult to conduct the medical management of critically ill obese children and obese children are considered to be at a high risk of mortality and morbidity in PICUs (9,13,14). Obesity-related challenges in the management of obese children in PICUs are summarized in Figure 1.…”

“…In addition to the effects of inflammation and metabolic stress on metabolism nutrients, obesity is associated with alterations in the metabolic process of critically ill obese children due to the high risk of nutritional deprivation in PICUs (13)(14)(15). Therefore, it is critical to screen potential nutritional deficiencies and improve the optimal energy and nutrient delivery in obese patients in PICUs (14)(15)(16).…”

“…Particularly, macrophage-related inflammatory activities may lead to insulin resistance and reduced immunity in obese subjects (25). Therefore, the inflammatory response of obese children to acute injury is differently exacerbated compared with non-obese children (13). Leptin, resistin, adiponectin, and inflammatory mediators secreted by adipose tissue, obesity-related dyslipidemia, and hyperglycemia are other factors involved in the progression of renal dysfunction in obese children admitted to ICUs (13).…”

“…Therefore, the inflammatory response of obese children to acute injury is differently exacerbated compared with non-obese children (13). Leptin, resistin, adiponectin, and inflammatory mediators secreted by adipose tissue, obesity-related dyslipidemia, and hyperglycemia are other factors involved in the progression of renal dysfunction in obese children admitted to ICUs (13). Chronic inflammation state and increased inflammatory mediators in obese children predispose them to pro-inflammatory and prothrombotic states and oxidative stress (20).…”