Assessment of Airway Closure and Expiratory Airflow Limitation to Set PEEP in Morbidly Obese ARDS Patients

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

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Correlation of Arterial CO2 and Respiratory Impedance Values among Subjects with COPD

Journal of Clinical Medicine ◽

10.3390/jcm9092819 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2819

Author(s):

Tomoki Uno ◽

Tetsuya Homma ◽

Masahiko Shigemura ◽

Yosuke Fukuda ◽

Tomoyuki Kimura ◽

...

Keyword(s):

Regression Analysis ◽

Linear Regression ◽

Linear Regression Analysis ◽

Small Airway ◽

Airflow Limitation ◽

Chronic Obstructive ◽

Forced Oscillation Technique ◽

Airway Closure ◽

Arterial Blood ◽

Increased Risk

Chronic obstructive pulmonary disease (COPD) is a respiratory illness characterized by airflow limitation and chronic respiratory symptoms with a global prevalence estimated to be more than 10% in 2010 and still on the rise. Furthermore, hypercapnic subject COPD leads to an increased risk of mortality, morbidity, and poor QoL (quality of life) than normocapnic subjects. Series of studies showed the usefulness of the forced oscillation technique (FOT) to measure small airway closure. Traditional findings suggested that hypercapnia may not be the main treating targets, but recent findings suggested that blood stream CO2 may lead to a worse outcome. This study aimed to seek the relationship between CO2 and small airway closure by using FOT. Subjects with COPD (n = 124; hypercapnia 22 and normocapnia 102) were analyzed for all pulmonary function values, FOT values, and arterial blood gas analysis. Student’s t-test, Spearman rank correlation, and multi linear regression analysis were used to analyze the data. COPD subjects with hypercapnia showed a significant increase in R5, R20, Fres, and ALX values, and a greater decrease in X5 value than normocapnic patients. Also, multiple linear regression analysis showed R5 was associated with hypercapnia. Hypercapnia may account for airway closure among subjects with COPD and this result suggests treating hypercapnia may lead to better outcomes for such a subject group.

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Percutaneous tracheostomy in three morbidly obese patients using the ‘Blue RhinoTM ’ technique

Anaesthesia ◽

10.1046/j.1365-2044.2000.01664-13.x ◽

2000 ◽

Vol 55 (9) ◽

pp. 917-919 ◽

Cited By ~ 11

Author(s):

M. J. P. Scott ◽

J. Leigh

Keyword(s):

Percutaneous Tracheostomy ◽

Morbidly Obese ◽

Obese Patients

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Serum Retinol and β-carotene Levels and Risk Factors for Cardiovascular Disease in Morbid Obesity

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000018 ◽

2010 ◽

Vol 80 (3) ◽

pp. 159-167 ◽

Cited By ~ 7

Author(s):

Gabriela Villaça Chaves ◽

Gisele Gonçalves de Souza ◽

Andréa Cardoso de Matos ◽

Dra. Wilza Abrantes Peres ◽

Silvia Elaine Pereira ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Morbid Obesity ◽

Serum Levels ◽

World Health ◽

Morbidly Obese ◽

Serum Retinol ◽

Significant Difference ◽

Β Carotene

Objective: To evaluate retinol and β-carotene serum levels and their relationship with risk factors for cardiovascular disease in individuals with morbid obesity, resident in Rio de Janeiro. Methodology: Blood serum concentrations of retinol and β-carotene of 189 morbidly obese individuals were assessed. The metabolic syndrome was identified according to the criteria of the National Cholesterol Education Program (NCEP) and World Health Organization (WHO). Lipid profile, insulin resistance, basal insulin, glycemia, blood pressure, and anthropometry and their correlation with retinol and β-carotene serum levels were evaluated. Results: Metabolic syndrome diagnosis was observed in 49.0% of the sample. Within this percentage the levels of β-carotene were significantly lower when body mass index increased. Serum retinol didn't show this behavior. Serum retinol inadequacy in patients with metabolic syndrome (61.3%), according to WHO criterion, was higher (15.8%) than when the whole sample was considered (12.7%). When metabolic syndrome was diagnosed by NCEP criterion, β-carotene inadequacy was higher (42.8%) when compared to the total sample (37.5%). There was a significant difference between average β-carotene values of patients with and without metabolic syndrome (p=0.048) according to the classification of the NCEP. Lower values were found in patients with metabolic syndrome. Conclusion: Considering the vitamin A contribution in antioxidant protection, especially when risk factors for cardiovascular disease are present, it is suggested that great attention be given to morbidly obese. This could aid in prevention and treatment of cardiovascular disease, which affects a significant part of the population.

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Supplemental Material for Go/No-Go Training Changes Food Evaluation in Both Morbidly Obese and Normal-Weight Individuals

Journal of Consulting and Clinical Psychology ◽

10.1037/ccp0000320.supp ◽

2018 ◽

Keyword(s):

Normal Weight ◽

Morbidly Obese

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Robot assisted gynaecologic procedures in morbidly obese patients

Geburtshilfe und Frauenheilkunde ◽

10.1055/s-0034-1388284 ◽

2014 ◽

Vol 74 (S 01) ◽

Author(s):

C Kurzeder ◽

J Persson ◽

A du Bois ◽

P Kannisto ◽

T Bossmar ◽

...

Keyword(s):

Morbidly Obese ◽

Obese Patients ◽

Robot Assisted

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Hand-assisted laparoscopic nephrectomy in morbidly obese patients

Perspectives in Surgery ◽

10.33699/pis.2020.99.6.271-276 ◽

2020 ◽

Vol 99 (6) ◽

pp. 271-276

Keyword(s):

Body Weight ◽

Surgical Technique ◽

Blood Loss ◽

Hospital Stay ◽

Kidney Cancer ◽

The Body ◽

Laparoscopic Nephrectomy ◽

Morbidly Obese ◽

Obese Patients ◽

Morbid Obese

Introduction: Prevalence of obesity is 30 % in the Czech Republic and is expected to increase further in the future. This disease complicates surgical procedures but also the postoperative period. The aim of our paper is to present the surgical technique called hand-assisted laparoscopic nephrectomy (HALS), used in surgical management of kidney cancer in morbid obese patients with BMI >40 kg/m2. Methods: The basic cohort of seven patients with BMI >40 undergoing HALS nephrectomy was retrospectively evaluated. Demographic data were analyzed (age, gender, body weight, height, BMI and comorbidities). The perioperative course (surgery time, blood loss, ICU time, hospital stay and early complications), tumor characteristics (histology, TNM classification, tumor size, removed kidney size) and postoperative follow-up were evaluated. Results: The patient age was 38−67 years; the cohort included 2 females and 5 males, the body weight was 117−155 kg and the BMI was 40.3−501 kg/m2. Surgery time was 73−98 minutes, blood loss was 20−450 ml, and hospital stay was 5−7 days; incisional hernia occurred in one patient. Kidney cancer was confirmed in all cases, 48–110 mm in diameter, and the largest removed specimen size was 210×140×130 mm. One patient died just 9 months after the surgery because of metastatic disease; the tumor-free period in the other patients currently varies between 1 and 5 years. Conclusion: HALS nephrectomy seems to be a suitable and safe surgical technique in complicated patients like these morbid obese patients. HALS nephrectomy provides acceptable surgical and oncological results.

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