Morbid Obesity in the Medical ICU

El-Solh, Ali; Sikka, Pawan; Bozkanat, Erkan; Jaafar, Wafaa; Davies, Joan

doi:10.1378/chest.120.6.1989

Cited by 272 publications

(222 citation statements)

References 41 publications

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“…Similarly, dyslipidaemia, often encountered in obesity and an essential part of the metabolic syndrome, is also known to be an independent risk factor for the development of sepsis and increased mortality (12) . Indeed the risk of death from multiorgan failure was shown to be greater in obese patients than in patients with normal weight (13,14) . A study on obese women clearly showed that a reduction in adipose tissue mass, achieved by consuming 2520 kJ/day for 10 weeks, substantially reduced the ability of adipose tissue to produce TNFa, IL-6, IL-8 and leptin (15) .…”

Section: Influence Of Adipose Tissue Mass On Inflammatory Stressmentioning

confidence: 99%

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

Grimble

2010

Proc. Nutr. Soc.

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The objective of the present review is to provide an overview of the metabolic effects of pro-inflammatory cytokine production during infection and injury; to highlight the disadvantages of pro-inflammatory cytokine production and inflammatory stress on morbidity and mortality of patients; to identify the influence of genetics and adiposity on inflammatory stress in patients and to indicate how nutrients may modulate the inflammatory response in patients. Recent research has shown clearly that adipose tissue actively secretes a wide range of pro- and anti-inflammatory cytokines. Paradoxically, although inflammation is an essential part of the response of the body to infection, surgery and trauma, it can adversely affect patient outcome. The metabolic effects of inflammation are mediated by pro-inflammatory cytokines. Metabolic effects include insulin insensitivity, hyperlipidaemia, muscle protein loss and oxidant stress. These effects, as well as being present during infective disease, are also present in diseases with a covert inflammatory basis. These latter diseases include obesity and type 2 diabetes mellitus. Inflammatory stress also increases during aging. The level of cytokine production, within individuals, is influenced by single nucleotide polymorphisms (SNP) in cytokine genes. The combination of SNP controls the relative level of inflammatory stress in both overt and covert inflammatory diseases. The impact of cytokine genotype on the intensity of inflammatory stress derived from an obese state is unknown. While studies remain to be done in the latter context, evidence shows that these genomic characteristics influence morbidity and mortality in infectious disease and diseases with an underlying inflammatory basis and thereby influence the cost of in-patient obesity. Antioxidants andn-3 PUFA alter the intensity of the inflammatory process. Recent studies show that genotypic factors influence the effectiveness of immunonutrients. A better understanding of this aspect of nutrient–gene interactions and of the genomic factors that influence the intensity of inflammation during disease will help in the more effective targeting of nutritional therapy.

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Section: Influence Of Adipose Tissue Mass On Inflammatory Stressmentioning

confidence: 99%

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

Grimble

2010

Proc. Nutr. Soc.

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“…The limited information available concerning pharmacodynamics and pharmacokinetics of perioperatively administered medications in severe obesity poses a challenge to proper drug dosing in these patients (11)(12)(13)(14). In a retrospective study, severe obesity was associated with prolonged mechanical ventilation, prolonged ventilator weaning, and a longer intensive care unit and hospital length of stay (15).…”

Section: Introductionmentioning

confidence: 99%

Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery

et al. 2005

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Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery. Obes Res. 2005;13:254 -266. Objective: To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients. Research Methods and Procedures:This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient. Results: We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research. Discussion: Obesity-related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.

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“…N umerous studies have highlighted the complexity of respiratory management of critically ill obese patients during the period following liberation from mechanical ventilation [1,2]. The development of respiratory instability, episodic desaturation during supine position, and the respiratory depressant effects of sedatives and opioid analgesia predispose these patients to prolonged periods of apnoeas, hypoxia and severe hypercapnia culminating in respiratory failure.…”

mentioning

confidence: 99%

“…FERRER et al [8] have shown not only a reduction in the rate of respiratory failure but also a decrease in the rate of intensive care unit (ICU) mortality. As severely obese patients are considered at high risk of developing respiratory complications [1,9], the current authors instituted a protocol requiring early application of NIV post-extubation. It was hypothesised that the preventive use of NIV would reduce the incidence of respiratory failure and the rate of reintubation.…”

mentioning

confidence: 99%

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

El-Solh

Aquilina²,

Pineda³

et al. 2006

Eur Respir J

176

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Current recommendations for management of obese patients post-extubation are based on clinical experience and expert opinions. It was hypothesised that the application of noninvasive ventilation (NIV) during the first 48 h after extubation in severely obese patients would reduce post-extubation failure and avert the need for reintubation.Following protocol-driven weaning trials, 62 consecutive severely obese patients (body mass index o35 kg?m -2 ) were assigned to NIV via nasal mask immediately post-extubation and compared with 62 historically matched controls who were treated with conventional therapy. The primary end-point was the incidence of respiratory failure in the first 48 h post-extubation.Compared with conventional therapy, the institution of NIV resulted in 16% (95% confidence interval 2.9-29.3%) absolute risk reduction in the rate of respiratory failure. There was a significant difference in the intensive care unit and lengths of hospital stay between the two groups. Subgroup analysis of hypercapnic patients showed reduced hospital mortality in the NIV group compared with the control group.In conclusion, noninvasive ventilation may be effective in averting respiratory failure in severely obese patients when applied during the first 48 h post-extubation. In selected patients with chronic hypercarbia, early application of noninvasive ventilation may confer a survival benefit.

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Morbid Obesity in the Medical ICU

Cited by 272 publications

References 41 publications

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery

Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients

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