Outcome of Morbid Obesity in the Intensive Care Unit

Yaegashi, Makito; Jean, Raymonde; Zuriqat, Muqdad; Noack, Sigrid; Homel, Peter

doi:10.1177/0885066605275314

Cited by 113 publications

(73 citation statements)

References 47 publications

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“…The literature to date with patients with BMI Ն 40 kg/m 2 examined as a cohort is quite variable, with some studies showing no difference in ICU outcomes and mortality, 4,5 others reporting improved mortality, [6][7][8] and others fi nding longer ICU LOS, increased DMV, and increased mortality. [14][15][16] One metaanalysis from 2009 aggregating 23 studies found extremely obese patients as a group had similar hospital mortality (relative risk, 0.83; 95% CI, 0.66-1.04), a trend toward longer ICU and hospital stays, and no difference in DMV compared with patients of normal weight. 17 A recent study found that patients who had 2009 infl uenza A(H1N1) who were obese had a longer DMV, ICU LOS, and hospital LOS without a difference in mortality.…”

Section: Acknowledgmentsmentioning

confidence: 99%

“…[6][7][8] Other studies found that obese and extremely obese patients may have longer ICU and hospital LOS, duration of mechanical ventilation (DMV), and increased mortality. [9][10][11][12][13][14][15][16] A recent meta-analysis reported that extremely obese patients with a BMI Ն 40 kg/m 2 had decreased hospital mortality compared with normal-weight patients, but this did not reach statistical signifi cance (relative risk, 0.83; 95% CI, 0.66-1.04). 17 Additionally, a recent study reported that mortality in critically ill patients who have a BMI Ն 35 kg/m 2 was improved among those who received adequate nutrition (energy and protein).…”

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confidence: 99%

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Extreme Obesity And Outcomes In Critically Ill Patients

Martino¹,

Stapleton²,

Cahill³

et al. 2010

A45. Icu Management and Outcomes: Prediction, Procedures and Pot Pourri

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O besity, defi ned as a BMI between 30 and 39.9 kg/m 2 , and extreme or severe obesity, defi ned as a BMI Ն 40 kg/m 2 , are increasingly prevalent in the United States. 1 During the same time period, 4.2% of men and 7.2% of women were extremely obese. Overweight, obesity, and extreme obesity are associated with increased all-cause mortality among the general population, in both genders. 1 However, in critically ill patients, recent evidence suggests that obese and extremely obese patients do not have increased ICU or hospital lengths of stay

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Section: Acknowledgmentsmentioning

confidence: 99%

mentioning

confidence: 99%

Extreme Obesity And Outcomes In Critically Ill Patients

Martino¹,

Stapleton²,

Cahill³

et al. 2010

A45. Icu Management and Outcomes: Prediction, Procedures and Pot Pourri

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“…Patients with morbid obesity may be at higher risk for these infections 33 than are nonobese patients, and the higher risk may be partly due to the immune dysfunction associated with morbid obesity. 34 However, the results of a recent study 35 did not indicate any difference in the rates of central catheter-associated bloodstream infections between obese and nonobese patients.…”

Section: C: Circulationmentioning

confidence: 99%

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Berrios

2016

Critical Care Nurse

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More than one-third of the US adult population and 17% of the youth are now obese, and obesity is associated with more than $147 billion a year in health care costs. Critical care nurses should understand the physiological differences and practice guidelines for patients with a body mass index greater than 30. The ABCD approach encompasses key clinical concepts in the management of critically ill obese and morbidly obese patients, including management of airways and breathing, minimizing nurses' back and other injuries, increasing awareness of bias, circulation problems, risks of decubitus ulcers and other skin breakdown, differences in drug calculations and metabolism, limitations in diagnostic equipment and imaging, diet and nutritional recommendations, and concerns with durable medical equipment. (Critical Care Nurse. 2016;36[5]:17-26) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Using the ABCD approach, list the key clinical concepts highlighted in this article for managing morbidly obese patients in intensive care units 2. Identify key physiologic differences in airway, breathing, and circulation in morbidly obese patients 3. Identify important considerations in diagnostic and general medical equipment in the management of morbidly obese patients To complete evaluation for CE contact hour(s) for test #C1653, visit www.ccnonline.org and click the "CE Articles" button. No CE test fee for AACN members.

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“…11,12 The results from previous studies and three meta-analyses addressing this topic [13][14][15] have mostly been from mixed medical-surgical ICU populations [13][14][15][16][17][18] and did not include a subgroup analysis by race or the type of ICU (trauma, surgical vs medical) to which patients were admitted. In studies including only patients admitted to medical ICUs (MICU), some lacked appropriate non-obese comparison, 19,20 others used a different definition of obesity 21 or included only limited BMI groups. 24 Laboratory values used were those obtained within 24 hours of admission.…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Intensive Care Unit Outcomes in African American Patients

et al. 2017

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Obesity IntroductIonObesity defined by BMI ≥ 30 kg/ m 2 has increased in the United States in the last three decades. More than one-third of US adults were obese in 2012 1,2 and obesity is projected to rise to more than 50% by the year 2030. 3 While the overall prevalence of obesity has increased, significant racial/ ethnic disparities continue to exist; with highest prevalence found among non-Hispanic Black (47.8%) vs nonHispanic White (32.6%) adults. 1,4 As the prevalence of obesity increases, the numbers of critically ill obese patients will continue to increase making this situation important to examine.Obesity is associated with derangement of cardiovascular and metabolic function 5 leading to increase in comorbid illnesses 6 that can complicate ICU care. Obesity affects respiratory physiology 7,8 leading to decreased chest wall and lung compliance making mechanical ventilator management difficult. In addition to metabolism and clearance of medications, physical factors of obesity, such as a poor anatomical land marks, makes intubation and vascular access placement difficult, 9 adding challenges to ICU management.Despite these challenges of obesity in the ICU and obesity's association with increased all-cause mortality, 10 the effect of obesity on critical illness is less understood. Few prior studies have assessed the effect of BMI on medical ICU outcomes in African American (AA) patients. 11,12The results from previous studies and three meta-analyses addressing this topic [13][14][15] have mostly been from mixed medical-surgical ICU populations 13-18 and did not include a subgroup analysis by race or the type of ICU (trauma, surgical vs medical) to which patients were admitted. In studies including only patients admitted to medical ICUs (MICU), some lacked appropriate non-obese comparison, 19,20 others used a different definition of obesity 21 or included only limited BMI groups. 11Our study aimed to describe the relationship between a wide range of Purpose: We sought to determine whether body mass index (BMI) is associated with worse intensive care unit (ICU) outcomes among Black patients. Methods:Patients admitted to the medical ICU during 2012 were categorized into six BMI groups based on the World Health Organization criteria. ICU mortality, ICU and hospital length of stay (LOS), need for and duration of mechanical ventilation and organ failure rate were assessed.Results: A total of 605 patients with mean age 58.9 ± 16.0 years were studied. Compared with those with normal BMI, obese patients had significant higher rates of hypertension, diabetes mellitus and obstructive sleep apnea diagnoses (P<.001 for all). A total of 100 (16.5%) patients died during their ICU stay. Obesity was not associated with increased odds of ICU mortality (OR=.58; 95% CI, .16-2.20). Moreover, improved survival was observed for class II obese patients (OR, .031; 95% CI, .001-.863). There were no differences in the need for and duration of mechanical ventilation between the BMI groups. However, ICU and hospital LOS were signifi...

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Outcome of Morbid Obesity in the Intensive Care Unit

Cited by 113 publications

References 47 publications

Extreme Obesity And Outcomes In Critically Ill Patients

Extreme Obesity And Outcomes In Critically Ill Patients

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Body Mass Index and Intensive Care Unit Outcomes in African American Patients

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