+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Physiological and management implications of obesity in critical illness



Physiological and management implications of obesity in critical illness



Annals of the American Thoracic Society 11(8): 1286-1297



Obesity is highly prevalent in the United States and is becoming increasingly common worldwide. The anatomic and physiological changes that occur in obese individuals may have an impact across the spectrum of critical illness. Obese patients may be more susceptible to hypoxemia and hypercapnia. During mechanical ventilation, elevated end-expiratory pressures may be required to improve lung compliance and to prevent ventilation-perfusion mismatch due to distal airway collapse. Several studies have shown an increased risk of organ dysfunction such as the acute respiratory distress syndrome and acute kidney injury in obese patients. Predisposition to ventricular hypertrophy and increases in blood volume should be considered in fluid management decisions. Obese patients have accelerated muscle losses in critical illness, making nutrition essential, although the optimal predictive equation to estimate nutritional needs or formulation for obese patients is not well established. Many common intensive care unit medications are not well studied in obese patients, necessitating understanding of pharmacokinetic concepts and consultation with pharmacists. Obesity is associated with higher risk of deep venous thrombosis and catheter-associated bloodstream infections, likely related to greater average catheter dwell times. Logistical issues such as blood pressure cuff sizing, ultrasound assistance for procedures, diminished quality of some imaging modalities, and capabilities of hospital equipment such as beds and lifts are important considerations. Despite the physiological alterations and logistical challenges involved, it is not clear whether obesity has an effect on mortality or long-term outcomes from critical illness. Effects may vary by type of critical illness, obesity severity, and obesity-associated comorbidities.

(PDF emailed within 0-6 h: $19.90)

Accession: 055001114

Download citation: RISBibTeXText

PMID: 25172506

DOI: 10.1513/AnnalsATS.201404-159FR


Related references

Recognition and management of critical illness by midwives: implications for service provision. Journal of Nursing Management 15(3): 348-356, 2007

Diagnosis and management of critical illness polyneuropathy and critical illness myopathy. Current Treatment Options in Neurology 9(2): 85-92, 2007

Sex-dependent disparities in critical illness: methodological implications for critical care research. Nursing in Critical Care 20(2): 58-62, 2015

Obesity, inflammation, and pharmaconutrition in critical illness. Nutrition 30(4): 492-494, 2014

Obesity, Malnutrition, and the Response to Critical Illness. Critical Care Medicine 43(8): E321-E321, 2015

Obesity And Critical Illness: Insights From Animal Models. Shock 45(4): 349-358, 2015

The obesity factor in critical illness: Between consensus and controversy. Journal of Trauma and Acute Care Surgery 78(4): 866-873, 2015

Obesity, Acute Kidney Injury, and Mortality in Critical Illness. Critical Care Medicine 44(2): 328-334, 2016

Obesity, acute kidney injury and outcome of critical illness. International Urology and Nephrology (): -, 2016

The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Medicine 35(7): 1152-1170, 2009

Strengthen cooperation and updating the concept to improve the standardized management of neurosurgical critical care patients -for the publishing of "The Experts Consensus for Critical Care Management of Neurosurgical Illness (2013)". Zhonghua Yi Xue Za Zhi 93(23): 1763-1764, 2014

Part 1 mania clinical aspects rating scales and incidence of manic depressive illness and part 2 differential diagnostic issues with schizoaffective illness a critical assessment and implications for research and treatment. 1979

Intra-Abdominal Pressure, Acute Kidney Injury, and Obesity in Critical Illness. Critical Care Medicine 44(8): E766-E767, 2016

Electro physiological signs of the poly neuropathy associated with critical illness. Electroencephalography & Clinical Neurophysiology 56(3): S49, 1983

Obesity and mental illness: implications for cognitive functioning. Advances in Therapy 30(6): 577-588, 2014