Obesity in Critical Care
Obesity, defined as a body mass index (BMI) greater than or equal to 30 m/kg2, is increasing in incidence, with more than one-third of American adults in the United States classified as obese and numbers projected to increase. Worse outcomes have been noted in both underweight (BMI <18 m/kg2) and obese critically ill patients. Other studies have associated obesity as an independent risk factor for mortality in the ICU. In addition, morbid obesity is an independent risk factor for the development of organ failure after trauma in the critically ill patient. Given the current obesity epidemic, the number of critically ill obese patients will continue to increase, and a greater understanding of the physiologic challenges associated with obesity in this setting will be needed. This chapter will discuss the multiple intersections and interactions between obesity and critical illness, as well as optimal evaluation and management strategies.
KeywordsObesity Morbid obesity Critical illness Body mass index Metabolic syndrome
- 8.De Jong A, Molinari N, Pouzeratte Y, Verzilli D, Chanques G, Jung B, et al. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units. Br J Anaesth. 2015;114:297–306. https://doi.org/10.1093/bja/aeu373.CrossRefPubMedGoogle Scholar
- 11.Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36:151–8. https://doi.org/10.1097/01.CCM.0000297885.60037.6E.CrossRefPubMedGoogle Scholar
- 12.O’Brien JM, Philips GS, Ali NA, Aberegg SK, Marsh CB, Lemeshow S. The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. Crit Care Med. 2012;40:1456–63. https://doi.org/10.1097/CCM.0b013e31823e9a80.CrossRefPubMedGoogle Scholar
- 16.Chang J, Corcelles R, Boules M, Jamal MH, Schauer PR, Kroh MD. Predictive factors of biliary complications after bariatric surgery. Surg Obes Relat Dis. 2015. https://doi.org/10.1016/j.soard.2015.11.004.
- 18.Virani SS, Nambi V, Lee V-V, Elayda MA, Pan W, Petersen LA, et al. Obesity: an independent predictor of in-hospital postoperative renal insufficiency among patients undergoing cardiac surgery? Texas Hear Inst J. 2009;36:540–5.Google Scholar
- 23.Birkmeyer NJO, Finks JF, Carlin AM, Chengelis DL, Krause KR, Hawasli AA, et al. Comparative effectiveness of unfractionated and low-molecular-weight heparin for prevention of venous thromboembolism following bariatric surgery. Arch Surg. 2012;147:994–8. https://doi.org/10.1001/archsurg.2012.2298.CrossRefPubMedGoogle Scholar
- 29.Fezeu L, Julia C, Henegar A, Bitu J, FB H, Grobbee DE, et al. Obesity is associated with higher risk of intensive care unit admission and death in influenza A (H1N1) patients: a systematic review and meta-analysis. Obes Rev. 2011;12:653–9. https://doi.org/10.1111/j.1467-789X.2011.00864.x.CrossRefPubMedGoogle Scholar
- 36.Mitrov-Winkelmolen L, van Buul-Gast M-CW, Swank DJ, Overdiek HWPM, van Schaik RHN, Touw DJ. The effect of roux-en-Y gastric bypass surgery in morbidly obese patients on pharmacokinetics of (acetyl)salicylic acid and omeprazole: the ERY-PAO study. Obes Surg. 2016;26:2051–8. https://doi.org/10.1007/s11695-016-2065-8.CrossRefPubMedGoogle Scholar