Implications of Obesity for the Management of Severe Coronavirus Disease 2019 Pneumonia

Abstract

Objectives: To investigate patients’ characteristics, management, and outcomes in the critically ill population admitted to the ICU for severe acute respiratory syndrome coronavirus disease 2019 pneumonia causing an acute respiratory distress syndrome. Design: Retrospective case-control study. Setting: A 34-bed ICU of a tertiary hospital. Patients: The first 44 coronavirus disease 2019 acute respiratory distress syndrome patients were compared with a historical control group of 39 consecutive acute respiratory distress syndrome patients admitted to the ICU just before the coronavirus disease 2019 crisis. Interventions: None. Measurements and Main Results: Obesity was the most frequent comorbidity exhibited by coronavirus disease 2019 patients (n = 32, 73% vs n = 11, 28% in controls; p < 0.001). Despite the same severity of illness and level of hypoxemia at admission, coronavirus disease 2019 patients failed more high flow oxygen via nasal cannula challenges (n = 16, 100% vs n = 5, 45% in controls; p = 0.002), were more often intubated (n = 44, 100% vs n = 22, 56% in controls; p < 0.001) and paralyzed (n = 34, 77% vs n = 3, 14% in controls; p < 0.001), required higher level of positive end-expiratory pressure (15 vs 8 cm H2O in controls; p < 0.001), more prone positioning (n = 33, 75% vs n = 6, 27% in controls; p < 0.001), more dialysis (n = 16, 36% vs n = 3, 8% in controls; p = 0.003), more hemodynamic support by vasopressors (n = 36, 82% vs n = 22, 56% in controls; p = 0.001), and had more often a prolonged weaning from mechanical ventilation (n = 28, 64% vs n = 10, 26% in controls; p < 0.01) resulting in a more frequent resort to tracheostomy (n = 18, 40.9% vs n = 2, 9% in controls; p = 0.01). However, an intensive management requiring more staff per patient for positioning coronavirus disease 2019 subjects (6 [5–7] vs 5 [4–5] in controls; p < 0.001) yielded the same ICU survival rate in the two groups (n = 34, 77% vs n = 29, 74% in controls; p = 0.23). Conclusions: In its most severe form, coronavirus disease 2019 pneumonia striked preferentially the vulnerable obese population, evolved toward a multiple organ failure, required prolonged mechanical ventilatory support, and resulted in a high workload for the caregivers.

Obesity Is Associated with Severe Disease and Mortality in Patients with Coronavirus Disease 2019 (COVID-19)

“…To test the impact of obesity on viral infection, we included 4 studies (16)(17)(18)(19) with subjects. The data indicate that obesity significantly increased the risk of viral infection (OR = 3.19, 95% CI, 1.45, 7.03; I = 98.3%; Fig.…”

Risk Factors for Invasive Pulmonary Aspergillosis in Critically Ill Patients With Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome

“…All the cases of COVID-19-induced ARDS patients admitted to our 34-bed ICU between March 24, 2020, and May 25, 2020 were retrospectively collected. All of them met the Berlin definition of ARDS and the diagnostic criteria for COVID-19 pneumonia ( 4 ). For the diagnosis of IPA, we considered the European Organization for Research and Treatment of Cancer Mycoses Study Group (EORTC-MSG), Aspergillosis in ICU (Asp-ICU), and modified Asp-ICU criteria simultaneously ( 5 , 6 ).…”

Obesity is a strong independent risk factor for short-term mortality and adverse outcomes in Mexican patients with COVID-19: A national observational study

“…As previously mentioned, these conditions increase the risk of difficult ventilation and intubation scenarios during the rapid intubation sequence, as well as alterations in gas exchange, respiratory mechanics, and hemodynamic disturbances in patients under IMV, thereby complicating ventilatory management [38]. Patients with obesity who progress to critical COVID-19 present a higher frequency of treatment failure with high-flow nasal cannulas, higher IMV requirements, higher frequencies of ventilatory therapy in the prone position, and a higher frequency of retarded removal of IMV and tracheostomies [39].…”