Chest mechanics in morbidly obese non-hypoventilated patients

Ladosky, W.; Botelho, Marcos Alberto Machado; Albuquerque, J. P.

doi:10.1053/rmed.2001.1035

Cited by 111 publications

(92 citation statements)

References 29 publications

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“…Second, obese patients may have been intubated earlier because of their body habitus rather than the severity of their illness. 32,33 Third, the care given to obese patients may be different from normal-or under-weight patients. For example, obese patients may be more carefully observed and treated.…”

Section: Discussionmentioning

confidence: 99%

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

et al. 2015

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BACKGROUND: Obesity has been associated with increased mortality in the general population, whereas a paradoxical relationship between higher body mass index and lower mortality has been referred to as the obesity paradox in critically ill patients. However, it remains unknown whether a particular subgroup is most affected. The aim of the present study is to elucidate whether obesity is associated with lower mortality in the ICU population by comparing subjects with and without mechanical ventilation. METHODS: A total of 334,238 subjects from a nationwide database who were discharged between July 2010 and March 2012 and who were admitted to general ICUs during their hospitalization were included in this study. The primary outcome was in-hospital mortality. RESULTS: Of all subjects evaluated, 23.3% were started on mechanical ventilation within the first 2 d after ICU admission. Compared with the non-ventilated group, the ventilated group was more likely to have sepsis, pneumonia, or coma. The ventilated group underwent more procedures within the first 2 d after ICU admission compared with the non-ventilated group. A restricted cubic spline function showed lower mortality in subjects with a higher body mass index among the ventilated group, whereas mortality was increased with increasing body mass index in the non-ventilated group. CONCLUSIONS: This study shows that a high body mass index is associated with low mortality in the mechanically ventilated group, whereas the non-ventilated group showed a reverse J-shaped association. There was a higher mortality rate in underweight subjects in both groups.

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Section: Discussionmentioning

confidence: 99%

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

et al. 2015

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“…Thus, since the translation of neural drive into inspiratory driving pressure is modulated by lung volume, obese patients (who breath at low lung volumes, that is, with a reduced FRC) improve the effectiveness of the inspiratory muscles as pressure generators. 32 This result Noninvasive assessment of the tension-time index M Chlif et al indicates that, in obese subjects, the load imposed by excessive adipose tissue in the chest wall has to be counterbalanced by an increase in neural drive and, consequently, in occlusion pressure. Hence, the major factor determining inspiratory muscle weakness is the magnitude of the inspiratory pressure demand (P I ) to maximal inspiratory pressure ratio (P Imax ).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive assessment of the tension–time index of inspiratory muscles at rest in obese male subjects

Chlif¹,

Keochkerian²,

Mourlhon³

et al. 2005

Int J Obes

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OBJECTIVE:The aim of this study was to investigate the effect of excessive mechanical load caused by obesity on the inspiratory muscle performance in obese men at rest. METHODS:We therefore measure at rest spirometric flows and the noninvasive tension time index of inspiratory muscle (T Tmus ¼ P I /P Imax Â T I /T TOT ) in eight obese male subjects (body mass index (BMI)430) and 10 controls. RESULTS: Spirometric flow (FEV 1 % pred, FVC% pred) and maximal inspiratory pressure (P Imax ) were significantly lower in obese subjects compared to controls (Po0.001). The mean T Tmus was significantly higher in obese subjects than in controls (0.13670.003 vs 0.04570.01). The increase in T Tmus was primarily due to an increase in the ratio of mean inspiratory pressure to maximal inspiratory pressure (P I /P Imax ) and the duty cycle (T I /T TOT ). We found a significant negative relationship between P Imax and BMI (r ¼ À0.74, Po0.001), a positive correlation between T Tmus and BMI (r ¼ 0.80, Po0.001) and a negative correlation between T Tmus and forced expiratory volume in 1 s (r ¼ À0.85, Po 0.001). CONCLUSION: Excessive mechanical load caused by obesity imposes a great burden on the inspiratory muscle, which may predispose such subjects to respiratory muscle weakness at rest.

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“…(16) The effect of obesity on spirometry and pulmonary volumes is influenced by the degree of obesity, age, and type of fat distribution. (17) Morbid obesity has an evident effect on ventilatory function, (18) and weight loss results in increased FVC (19) in obese individuals, which is why such individuals were excluded. The effect that obesity other than morbid obesity has on spirometry is controversial.…”

Section: Diverse Variablesmentioning

confidence: 99%

Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca

Sato²,

2007

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Objective: To describe spirometric reference equations for healthy Brazilian adults who have never smoked and to compare the predicted values with those derived in 1992. Methods: Reference equations for spirometry were derived in 270 men and 373 women living in eight cities in Brazil. Ages ranged from 20 to 85 years in women and from 26 to 86 years in men. Spirometry examinations followed the recommendations of the Brazilian Thoracic Society. Lower limits were derived by the analysis of the fifth percentiles of the residuals. Results: Forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), FEV 1 /FVC and FEV 1 /forced expiratory volume in six seconds (FEV 6 ) were best fitted by linear regression. Flows were best fitted using log equations. For both genders, greater height resulted in lower values for FEV 1 /FVC, FEV 1 /FEV 6 and flow/FVC ratios. The reference values for FEV 1 and FVC in the present study were higher than those derived for Brazilian adults in 1992. Conclusion: New predicted values for forced spirometry were obtained in a sample of white Brazilians. The values are greater than those obtained in 1992, probably due to technical factors.

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Chest mechanics in morbidly obese non-hypoventilated patients

Cited by 111 publications

References 29 publications

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

The Dose-Response Relationship Between Body Mass Index and Mortality in Subjects Admitted to the ICU With and Without Mechanical Ventilation

Noninvasive assessment of the tension–time index of inspiratory muscles at rest in obese male subjects

Novos valores de referência para espirometria forçada em brasileiros adultos de raça branca

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