The Crashing Obese Patient

Parker, Brian K; Manning, Sara L.; Winters, Michael E.

doi:10.5811/westjem.2018.12.41085

Cited by 16 publications

(6 citation statements)

References 84 publications

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“…The interaction between body mass and outcome has been incompletely explored, and the evidence of literature is contradictory. Obesity has been associated with increased mortality after motor vehicle collisions, despite comparable or reduced injury severity among obese patients [ 46 – 50 ]. Some have suggested that this demonstrates a “cushion” effect in automobile accidents, and the increased mortality is secondary to other systemic factors.…”

Section: Complex Emergency Scenarios In Obese Patientsmentioning

confidence: 99%

Emergencies in obese patients: a narrative review

Giacinto¹,

Ida

Guarnera

et al. 2021

J Anesth Analg Crit Care

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Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.

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Section: Complex Emergency Scenarios In Obese Patientsmentioning

confidence: 99%

Emergencies in obese patients: a narrative review

Giacinto¹,

Ida

Guarnera

et al. 2021

J Anesth Analg Crit Care

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“…A study by Parker et al (2019) reported that obese ventilated patients should be positioned in a semi‐recumbent or a reverse Trendelenburg position. Both positions reduce atelectasis and intrathoracic pressure, improve ventilation–perfusion mismatching and reduce hypoxaemia as measured by PaO 2 .…”

Section: Discussionmentioning

confidence: 99%

“…Also, obese patients may be more at risk for increased work of breathing, respiratory muscle inefficiency and decreased respiratory compliance. Breathing at low lung volume promotes airway closure in the dependent lung zones with consequent gas exchange abnormalities which is ventilation to perfusion ratio abnormalities and hypoxaemia (Murphy & Wong, 2013; Parameswaran et al, 2006; Parker et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

The effect of reverse Trendelenburg position versus semi‐recumbent position on respiratory parameters of obese critically ill patients: A randomised controlled trial

Hassan

Baraka

2021

Journal of Clinical Nursing

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Aims and objectives To investigate the effect of reverse Trendelenburg position versus semi‐recumbent position on respiratory parameters of obese critically ill patients. Background Reverse Trendelenburg position is recommended for obese patients; however, the effect among critically ill patients, especially those on mechanical ventilation, has limited study. Design Randomised, controlled pretest, repeated post‐test trial with two parallel groups. Methods The study started from 13 January 2020–12 March 2020. Adult critically ill patients with a body mass index ≥30 were randomly assigned by computer‐generated randomisation to either reverse Trendelenburg position group (intervention) or semi‐recumbent position group (active comparator control). Outcome measures were ventilation parameters (dynamic compliance, partial pressure of arterial carbon dioxide and minute volume) and oxygenation parameters (hypoxaemic index and partial pressure of arterial oxygen). Measures were assessed immediately before positioning and after positioning in 10 minutes, 20 minutes and 30 minutes. CONSORT checklist was used to report the current study. Settings Four general intensive care units. Results One hundred and ten patients (55 patients in each group) completed the study. The reverse Trendelenburg position group had a higher improvement than the semi‐recumbent position group as estimated by mean differences in their dynamic compliance, minute volume, partial pressure of carbon dioxide, partial pressure of oxygen and hypoxaemic index. Conclusion Reverse Trendelenburg position improves obese patients’ respiratory parameters more than semi‐recumbent position. Relevance to clinical practice This study directs nurses to use the reverse Trendelenburg position, which is an important position for enhancing the parameters of ventilation and oxygenation of obese mechanically ventilated patients.

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“…Стратегії дозування вазоактивних лікарських засобів на основі ваги та без ваги, таких, як норадреналін, адреналін та добутамін, продемонстрували подібну ефективність у досягненні клінічно значущих результатів щодо показників гемодинаміки та смертності. Отже, вазоактивні ліки не потребують корекції дози у пацієнтів з ожирінням [25].…”

Section: особливості забезпечення прохідності верхніх дихальних шляхів (вдш) та вентиляціїunclassified

Features of Cardiopulmonary Resuscitation in Patients With Morbid Obesity

YEVSIEIEVA¹,

LISUN²,

ZUB³

2021

Pain Anaesth Int Care

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Resume. Resuscitation of the obese patient presents a challenge for even the most skilled physician. Changes in anatomy, metabolic, cardiopulmonary reserve, ventilation, circulation, and pharmacokinetics require special consideration. This article focuses on critical components in the resuscitation of the obese patient, namely circulatory resuscitation, defibrillation, approach to the obese airway and mechanical ventilation, pharmacotherapy of cardiovascular drugs. Materials and methods: Electronic databases of Scopus and PubMed were searched using keyword searches Conclusions. Obesity causes important anatomical and physiological changes that affect resuscitation measures. Healthcare professionals should take into account the specifics of cardiopulmonary resuscitation in patients with morbid obesity to increase the effectiveness of resuscitation in this group of patients

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The Crashing Obese Patient

Cited by 16 publications

References 84 publications

Emergencies in obese patients: a narrative review

Emergencies in obese patients: a narrative review

The effect of reverse Trendelenburg position versus semi‐recumbent position on respiratory parameters of obese critically ill patients: A randomised controlled trial

Features of Cardiopulmonary Resuscitation in Patients With Morbid Obesity

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