scholarly journals Outcomes of Morbidly Obese Patients Receiving Invasive Mechanical Ventilation

CHEST Journal ◽  
2013 ◽  
Vol 144 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Gagan Kumar ◽  
Tilottama Majumdar ◽  
Elizabeth R. Jacobs ◽  
Valerie Danesh ◽  
Gaurav Dagar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Morbidly Obese ◽  
Obese Patients

scholarly journals Timing of Tracheotomy in Mechanically Ventilated Critically Ill Morbidly Obese Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Ahmad Alhajhusain ◽  
Ailia W. Ali ◽  
Asif Najmuddin ◽  
Kashif Hussain ◽  
Masooma Aqeel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Total Duration ◽  
Retrospective Chart Review ◽  
Optimal Timing ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Weaning From Mechanical Ventilation ◽  
Successful Weaning ◽  
Obese Subjects

Background.The optimal timing of tracheotomy and its impact on weaning from mechanical ventilation in critically ill morbidly obese patients remain controversial.Methods.We conducted a retrospective chart review of morbidly obese subjects (BMI ≥ 40 kg/m2or BMI ≥ 35 kg/m2and one or more comorbid conditions) who underwent a tracheotomy between July 2008 and June 2013 at a medical intensive care unit (ICU). Clinical characteristics, rates of nosocomial pneumonia (NP), weaning from mechanical ventilation (MV), and mortality rates were analyzed.Results.A total of 102 subjects (42 men and 60 women) were included; their mean age and BMI were 56.3 ± 15.1 years and 53.3 ± 13.6 kg/m2, respectively. There was no difference in the rate of NP between groups stratified by successful weaning from MV (P=0.43). Mortality was significantly higher in those who failed to wean (P=0.02). A cutoff value of 9 days for the time to tracheotomy provided the best balanced sensitivity (72%) and specificity (59.8%) for predicting NP onset. Rates of NP and total duration of MV were significantly higher in those who had tracheostomy ≥ 9 days (P=0.004andP=0.002, resp.).Conclusions.The study suggests that tracheotomy in morbidly obese subjects performed within the first 9 days may reduce MV and decrease NP but may not affect hospital mortality.

scholarly journals Noninvasive Ventilation and Alveolar Recruitment Maneuver Improve Respiratory Function during and after Intubation of Morbidly Obese Patients

2011 ◽  
Vol 114 (6) ◽  
pp. 1354-1363 ◽  
Author(s):  
Emmanuel Futier ◽  
Jean-Michel Constantin ◽  
Paolo Pelosi ◽  
Gerald Chanques ◽  
Alexandre Massone ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Gas Exchange ◽  
Respiratory Function ◽  
Recruitment Maneuver ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Arterial Oxygenation ◽  
Alveolar Recruitment Maneuver

Background Morbid obesity predisposes patients to lung collapse and hypoxemia during induction of anesthesia. The aim of this prospective study was to determine whether noninvasive positive pressure ventilation (NPPV) improves arterial oxygenation and end-expiratory lung volume (EELV) compared with conventional preoxygenation, and whether NPPV followed by early recruitment maneuver (RM) after endotracheal intubation (ETI) further improves oxygenation and respiratory function compared with NPPV alone. Methods Sixty-six consecutive patients (body mass index, 46 ± 6 kg/m²) were randomized to receive 5 min of either conventional preoxygenation with spontaneous breathing of 100% O₂ (CON), NPPV (pressure support and positive end-expiratory pressure), or NPPV followed by RM (NPPV+RM). Gas exchange was measured in awake patients, at the end of preoxygenation, immediately after ETI, and 5 min after the onset of mechanical ventilation. EELV was measured immediately after ETI and 5 min after mechanical ventilation. The primary endpoint was arterial oxygenation 5 min after the onset of mechanical ventilation. Results are presented as mean ± SD. Results At the end of preoxygenation, Pao₂ was higher in the NPPV and NPPV+RM groups (382 ± 87 mmHg and 375 ± 82 mmHg, respectively; both P < 0.001) compared with the CON group (306 ± 51 mmHg) and remained higher after ETI (225 ± 104 mmHg and 221 ± 110 mmHg, in the NPPV and NPPV+RM groups, respectively; both P < 0.01 compared with the CON group [150 ± 50 mmHg]). After the onset of mechanical ventilation, Pao₂ was 93 ± 25 mmHg in the CON group, 128 ± 54 mmHg in the NPPV group (P = 0.035 vs. CON group), and 234 ± 73 mmHg in the NPPV+RM group (P < 0.0001 vs. NPPV group). After ETI, EELV was higher in the NPPV group compared with the CON group (P < 0.001). Compared with NPPV alone, RM further improved gas exchange and EELV (all P < 0.05). A significant correlation was found between Pao2 obtained 5 min after mechanical ventilation and EELV (R = 0.41, P < 0.001). Conclusion NPPV improves oxygenation and EELV in morbidly obese patients compared with conventional preoxygenation. NPPV combined with early RM is more effective than NPPV alone at improving respiratory function after ETI.

Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery

2017 ◽  
Vol 11 (6) ◽  
pp. 443-452 ◽  
Author(s):  
Lígia de Albuquerque Maia ◽  
Pedro Leme Silva ◽  
Paolo Pelosi ◽  
Patricia Rieken Macedo Rocco
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Obese Patients ◽  
Ventilation Strategies

scholarly journals Relationship between obesity and the occurrence of negative outcome in patients hospitalized with COVID-19: integrative literature review

2021 ◽  
Vol 10 (13) ◽  
pp. e165101321038
Author(s):  
Eline Fernandes Ribeiro de Castro ◽  
Chriscia Jamilly Pinto de Sousa ◽  
Carolina Heitmann Mares Azevedo Ribeiro ◽  
Carlos Augusto Abreu Alberio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Invasive Mechanical Ventilation ◽  
Severe Form ◽  
National Institutes Of Health ◽  
Obese Patients ◽  
National Library ◽  
The Relationship ◽  
High Bmi

Objective: To verify the relationship between obesity and the occurrence of negative outcomes in hospitalized patients. Methodology: An integrative review was carried out using the National Library of Medicine of the National Institutes of Health (PubMed) and the Virtual Health Library (VLH/BVS) database. Results: It was observed that obese patients are 2 to 5 times more likely to need Invasive Mechanical Ventilation (IMV) when admitted to the Intensive Care Unit. Patients with high BMI (obese) and who needed mechanical ventilation had a mortality rate above 60%. The risk increases as the patient has other pathologies, this fact is shown that mortality by COVID-19 has multifactorial causes. Conclusion: The study showed that obesity is a risk factor associated with the increased development of the severe form of the disease, usually associated with other pathologies (hypertension, diabetes and cardiovascular diseases). That is, obesity increases the likelihood of unfavorable outcomes.

High-Frequency Percussive Ventilation Rescue Therapy in Morbidly Obese Patients Failing Conventional Mechanical Ventilation

2018 ◽  
Vol 35 (6) ◽  
pp. 583-587 ◽  
Author(s):  
Anatoliy Korzhuk ◽  
Ashwad Afzal ◽  
Ivan Wong ◽  
Felix Khusid ◽  
Berhane Worku ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Retrospective Analysis ◽  
High Frequency ◽  
Rescue Therapy ◽  
Conventional Mechanical Ventilation ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background: Morbidly obese patients with respiratory failure who do not improve on conventional mechanical ventilation (CMV) often undergo rescue therapy with extracorporeal membrane oxygenation (ECMO). We describe our experience with high-frequency percussive ventilation (HFPV) as a rescue modality. Methods: In a retrospective analysis from 2009 to 2016, 12 morbidly obese patients underwent HFPV after failing to wean from CMV. Data were collected regarding demographics, cause of respiratory failure, ventilation settings, and hospital course outcomes. Our end point data were pre- and post-HFPV partial pressure of arterial oxygen and PaO2 to fraction of inspired oxygen (PF) ratios measured at initiation, 2, and 24 hours. Results: Twelve morbidly obese patients required HFPV for respiratory failure. Causes of respiratory failure overlapped and included cardiogenic pulmonary edema (n = 8), pneumonia (n = 5), septic shock (n = 5), and asthma (n = 1). After HFPV initiation, mean fraction of inspired oxygen FiO2 was tapered from 98% to 82% and 66% at 2 and 24 hours, respectively. Mean PaO2 increased from 60.9 mm Hg before HFPV to 175.1 mm Hg ( P < .05) at initiation of HFPV, then sustained at 129.5 mm Hg ( P < .05) and 88.1 mm Hg ( P < .005) at 2 and 24 hours, respectively. Mean PF ratio improved from 66.1 before HFPV to 180.3 ( P < .05), 181.0 ( P < .05) and 148.9 ( P < .0005) at initiation, 2, and 24 hours, respectively. The improvement in mean PaO2 and PF ratios was durable at 24 hours whether or not the patient was returned to CMV (n = 10) or remained on HFPV (n = 2). Survival to discharge was 66.7%. Conclusion: In our cohort of morbidly obese patients, HFPV was successfully utilized as a rescue therapy precluding the need for ECMO. Despite our small sample size, HFPV should be considered as a rescue therapy in morbidly obese patients failing CMV prior to the initiation of ECMO. Our retrospective analysis supports consideration for HFPV as another form of rescue therapy for obese patients with refractory hypoxemia and respiratory failure who are not improving with CMV.

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