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Obese Patient in Intensive Care Unit

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Diet and Nutrition in Critical Care

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Abstract

The increasing prevalence of obesity in the general population, in addition to the high burden of comorbidities, has resulted in an increased number of obese patients requiring admission to the intensive care unit. Obesity is associated with important pathophysiological derangements of the respiratory, cardiac, and metabolic functions. A further multiorgan impairment is expected when these subjects are exposed to stresses of acute illness. The risk of ventilator-induced lung injury, the effect of chest wall in respiratory mechanics and hence in the selection of ventilatory settings, difficulties in hemodynamic monitoring, adequate thromboembolism prophylaxis, and dosing adjustments for specific drugs are the most challenging issues in the effective management of such patients.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

BMI:

Body mass index

BP:

Blood pressure

CO:

Cardiac output

CV:

Closing volume

EFL:

Expiratory flow limitation

ERV:

Expiratory reserve volume

FiO2:

Fraction of inspired oxygen

FRC:

Functional residual capacity

IBW:

Ideal body weight

ICU:

Intensive care unit

MS:

Metabolic syndrome

PAW:

Airway pressure

PEEP:

Positive end-expiratory pressure

PEEPi:

Intrinsic positive end-expiratory pressure

PPL:

Pleural pressure

Pplat:

Plateau pressure

RMs:

Recruitment maneuvers

Rrs:

Respiratory system resistance

SVR:

Systemic vascular resistance

TBW:

Total body weight

TP:

Transpulmonary pressure

VT:

Tidal volume

VTE:

Venous thromboembolism

WAT:

White adipose tissue

References

  • Abernethy DR, Greenblatt DJ. Lidocaine disposition in obesity. Am J Cardiol. 1984;53(8):1183–6.

    Article  CAS  PubMed  Google Scholar 

  • Abernethy DR, Greenblatt DJ, Smith TW. Digoxin disposition in obesity: clinical pharmacokinetic investigation. Am Heart J. 1981;102(4):740–4.

    Article  CAS  PubMed  Google Scholar 

  • Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36(1):151–8.

    Article  PubMed  Google Scholar 

  • Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321(4):225–36.

    Article  CAS  PubMed  Google Scholar 

  • ARDSnet. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–8.

    Article  Google Scholar 

  • Bastard JP, Jardel C, Delattre J, Hainque B, Bruckert E, Oberlin F. Evidence for a link between adipose tissue interleukin-6 content and serum C-reactive protein concentrations in obese subjects. Circulation. 1999;99(16):2221–2.

    CAS  PubMed  Google Scholar 

  • Bauer LA, Black DJ, Lill JS. Vancomycin dosing in morbidly obese patients. Eur J Clin Pharmacol. 1998;54(8):621–5.

    Article  CAS  PubMed  Google Scholar 

  • Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury J-C. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med. 2004;32(4):998–1003.

    Article  PubMed  Google Scholar 

  • Berghöfer A, Pischon T, Reinhold T, Apovian CM, Sharma AM, Willich SN. Obesity prevalence from a European perspective: a systematic review. BMC Public Health. 2008;8:200.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brook RD, Bard RL, Rubenfire M, Ridker PM, Rajagopalan S. Usefulness of visceral obesity (waist/hip ratio) in predicting vascular endothelial function in healthy overweight adults. Am J Cardiol. 2001;88(11):1264–9.

    Article  CAS  PubMed  Google Scholar 

  • Cheymol G, Poirier JM, Carrupt PA, Testa B, Weissenburger J, Levron JC, et al. Pharmacokinetics of beta-adrenoceptor blockers in obese and normal volunteers. Br J Clin Pharmacol. 1997;43(6):563–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Choban PS, Flancbaum L. The impact of obesity on surgical outcomes: a review. J Am Coll Surg. 1997;185(6):593–603.

    Article  CAS  PubMed  Google Scholar 

  • Christoff PB, Conti DR, Naylor C, Jusko WJ. Procainamide disposition in obesity. Drug Intell Clin Pharm. 1983;17(7–8):516–22.

    CAS  PubMed  Google Scholar 

  • D’Angelo E, Pecchiari M, Baraggia P, Saetta M, Balestro E, Milic-Emili J. Low-volume ventilation causes peripheral airway injury and increased airway resistance in normal rabbits. J Appl Physiol (Bethesda, Md : 1985). 2002;92(3):949–56.

    Google Scholar 

  • D’Angelo E, Pecchiari M, Della Valle P, Koutsoukou A, Milic-Emili J. Effects of mechanical ventilation at low lung volume on respiratory mechanics and nitric oxide exhalation in normal rabbits. J Appl Physiol (Bethesda, Md : 1985). 2005;99(2):433–44.

    Google Scholar 

  • Day C. Diagnostic definitions-Metabolic Syndrome. Br J Diabetes Vasc Dis 2005;5:115–8.

    Article  Google Scholar 

  • Darvall KAL, Sam RC, Silverman SH, Bradbury AW, Adam DJ. Obesity and thrombosis. Eur J Vasc Endovasc Surg. 2007;33(2):223–33.

    Article  CAS  PubMed  Google Scholar 

  • Douglas FG, Chong PY. Influence of obesity on peripheral airways patency. J Appl Physiol. 1972;33(5):559–63.

    CAS  PubMed  Google Scholar 

  • Eichenberger A-S, Proietti S, Wicky S, Frascarolo P, Suter M, Spahn DR, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95(6):1788–92.

    Article  PubMed  Google Scholar 

  • El-Solh AA. Clinical approach to the critically ill, morbidly obese patient. Am J Respir Crit Care Med. 2004;169(5):557–61.

    Article  PubMed  Google Scholar 

  • Farebrother MJ, McHardy GJ, Munro JF. Relation between pulmonary gas exchange and closing volume before and after substantial weight loss in obese subjects. Br Med J. 1974;3(5927):391–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ferrannini E, Natali A, Bell P, Cavallo-Perin P, Lalic N, Mingrone G. Insulin resistance and hypersecretion in obesity. European Group for the Study of Insulin Resistance (EGIR). J Clin Invest. 1997;100(5):1166–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ferretti A, Giampiccolo P, Cavalli A, Milic-Emili J, Tantucci C. Expiratory flow limitation and orthopnea in massively obese subjects. Chest. 2001;119(5):1401–8.

    Article  CAS  PubMed  Google Scholar 

  • Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  PubMed  Google Scholar 

  • Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.

    Article  CAS  PubMed  Google Scholar 

  • Goldhaber SZ, Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Speizer FE, et al. A prospective study of risk factors for pulmonary embolism in women. JAMA. 1997;277(8):642–5.

    Article  CAS  PubMed  Google Scholar 

  • Gong MN, Bajwa EK, Thompson BT, Christiani DC. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax. 2010;65(1):44–50.

    Article  CAS  PubMed  Google Scholar 

  • Guerin C, Koutsoukou A, Milic Emili J, D’Angelo E. Lung mechanics in disease. In: Papadakos P, Lachman B, editors. Mechanical ventilation: clinical applications and pathophysiology. Philadelphia: Saunders; 2008. p. 100–10.

    Chapter  Google Scholar 

  • Habbu A, Lakkis NM, Dokainish H. The obesity paradox: fact or fiction? Am J Cardiol. 2006;98(7):944–8.

    Article  PubMed  Google Scholar 

  • Hedenstierna G, Santesson J, Norlander O. Airway closure and distribution of inspired gas in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand. 1976;20(4):334–42.

    Article  CAS  PubMed  Google Scholar 

  • Hedenstierna G, Strandberg A, Brismar B, Lundquist H, Svensson L, Tokics L. Functional residual capacity, thoracoabdominal dimensions, and central blood volume during general anesthesia with muscle paralysis and mechanical ventilation. Anesthesiology. 1985;62(3):247–54.

    Article  CAS  PubMed  Google Scholar 

  • Hogue CW, Stearns JD, Colantuoni E, Robinson KA, Stierer T, Mitter N, et al. The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med. 2009;35(7):1152–70.

    Article  PubMed  Google Scholar 

  • Holley HS, Milic-Emili J, Becklake MR, Bates DV. Regional distribution of pulmonary ventilation and perfusion in obesity. J Clin Invest. 1967;46(4):475–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jonk AM, Houben AJHM, De Jongh RT, Serné EH, Schaper NC, Stehouwer CDA. Microvascular dysfunction in obesity: a potential mechanism in the pathogenesis of obesity-associated insulin resistance and hypertension. Physiology (Bethesda). 2007;22:252–60.

    Article  CAS  Google Scholar 

  • Kasper EK, Hruban RH, Baughman KL. Cardiomyopathy of obesity: a clinicopathologic evaluation of 43 obese patients with heart failure. Am J Cardiol. 1992;70(9):921–4.

    Article  CAS  PubMed  Google Scholar 

  • Katsiari M, Koulouris NG, Orfanos SE, Maguina N, Sotiropoulou C, Koutsoukou A. Intercomparison of three recruitment maneuvers in acute respiratory distress syndrome: the role of body mass index. Minerva Anestesiol. 2012;78(6):675–83.

    CAS  PubMed  Google Scholar 

  • Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89(6):2548–56.

    Article  CAS  PubMed  Google Scholar 

  • Koutsoukou A, Koulouris N, Bekos B, Sotiropoulou C, Kosmas E, Papadima K, et al. Expiratory flow limitation in morbidly obese postoperative mechanically ventilated patients. Acta Anaesthesiol Scand. 2004;48(9):1080–8.

    Article  CAS  PubMed  Google Scholar 

  • Ku CS, Lin SL, Wang DJ, Chang SK, Lee WJ. Left ventricular filling in young normotensive obese adults. Am J Cardiol. 1994;73(8):613–5.

    Article  CAS  PubMed  Google Scholar 

  • Lapinsky SE, Mehta S. Bench-to-bedside review: recruitment and recruiting maneuvers. Crit Care (London, England). 2005;9(1):60–5.

    Article  Google Scholar 

  • Lewandowski K, Lewandowski M. Intensive care in the obese. Best Pract Res Clin Anaesthesiol. 2011;25(1):95–108.

    Article  PubMed  Google Scholar 

  • Leykin Y, Miotto L, Pellis T. Pharmacokinetic considerations in the obese. Best Pract Res Clin Anaesthesiol. 2011;25(1):27–36.

    Article  CAS  PubMed  Google Scholar 

  • Marini JJ, Amato M. Lung recruitment during ARDS. In: Marini JJ, Evans T, editors. Acute lung injury. Berlin: Springer; 1998. p. 236–57.

    Chapter  Google Scholar 

  • Martell N, Rodriguez-Cerrillo M, Grobbee DE, López-Eady MD, Fernández-Pinilla C, Avila M, et al. High prevalence of secondary hypertension and insulin resistance in patients with refractory hypertension. Blood Press. 2003;12(3):149–54.

    Article  CAS  PubMed  Google Scholar 

  • Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008;52(15):1201–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McCool F, Rochester D. Non muscular diseases of the chest wall. In: Fishman A, Elias J, Fishman J, Crippi M, Kaiser L, Senior R, editors. Fishman’s pulmonary diseases and disorders. 3rd ed. New York: McGrow-Hill; 1998. p. 1555–60.

    Google Scholar 

  • Messerli FH, Ventura HO, Reisin E, Dreslinski GR, Dunn FG, MacPhee AA, et al. Borderline hypertension and obesity: two prehypertensive states with elevated cardiac output. Circulation. 1982;66(1):55–60.

    Article  CAS  PubMed  Google Scholar 

  • Messerli FH, Nunez BD, Ventura HO, Snyder DW. Overweight and sudden death. Increased ventricular ectopy in cardiopathy of obesity. Arch Intern Med. 1987;147(10):1725–8.

    Article  CAS  PubMed  Google Scholar 

  • Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.

    Article  PubMed  Google Scholar 

  • Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol. 1960;15:377–82.

    CAS  PubMed  Google Scholar 

  • O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004;140(5):338–45.

    Article  PubMed  Google Scholar 

  • 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(5):1456–63.

    Article  PubMed  Google Scholar 

  • Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obes (Silver Spring). 2008;16(3):515–21.

    Article  Google Scholar 

  • Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51.

    Article  CAS  PubMed  Google Scholar 

  • Pieracci FM, Barie PS, Pomp A. Critical care of the bariatric patient. Crit Care Med. 2006;34(6):1796–804.

    Article  PubMed  Google Scholar 

  • Poirier P, Lemieux I, Mauriège P, Dewailly E, Blanchet C, Bergeron J, et al. Impact of waist circumference on the relationship between blood pressure and insulin: the Quebec Health Survey. Hypertension. 2005;45(3):363–7.

    Article  CAS  PubMed  Google Scholar 

  • Rice TW. Obesity in acute lung injury: the “weight” is over. Chest. 2007;131(2):333–4.

    Article  PubMed  Google Scholar 

  • Rochester D. Obesity and abdominal distension. In: Roussos C, editor. The thorax part C. New York: Marcel Dekker; 1994. p. 1951–73.

    Google Scholar 

  • Ryo M, Nakamura T, Kihara S, Kumada M, Shibazaki S, Takahashi M, et al. Adiponectin as a biomarker of the metabolic syndrome. Circ J. 2004;68(11):975–81.

    Article  CAS  PubMed  Google Scholar 

  • Scholten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12(1):19–24.

    Article  PubMed  Google Scholar 

  • Serné EH, De Jongh RT, Eringa EC, IJzerman RG, Stehouwer CDA. Microvascular dysfunction: a potential pathophysiological role in the metabolic syndrome. Hypertension. 2007;50(1):204–11.

    Article  PubMed  Google Scholar 

  • Sierra-Honigmann MR, Nath AK, Murakami C, García-Cardeña G, Papapetropoulos A, Sessa WC, et al. Biological action of leptin as an angiogenic factor. Sci (New York, NY). 1998;281(5383):1683–6.

    Article  CAS  Google Scholar 

  • Söderberg S, Olsson T, Eliasson M, Johnson O, Ahrén B. Plasma leptin levels are associated with abnormal fibrinolysis in men and postmenopausal women. J Intern Med. 1999;245(5):533–43.

    Article  PubMed  Google Scholar 

  • Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359(20):2095–104.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Trayhurn P, Beattie JH. Physiological role of adipose tissue: white adipose tissue as an endocrine and secretory organ. Proc Nutr Soc. 2001;60(3):329–39.

    Article  CAS  PubMed  Google Scholar 

  • Traynor AM, Nafziger AN, Bertino JS. Aminoglycoside dosing weight correction factors for patients of various body sizes. Antimicrob Agents Chemother. 1995;39(2):545–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tremblay LN, Slutsky AS. Ventilator-induced injury: from barotrauma to biotrauma. Proc Assoc Am Physicians. 1998;110(6):482–8.

    CAS  PubMed  Google Scholar 

  • Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.

    Article  PubMed  Google Scholar 

  • Wang TJ, Parise H, Levy D, D’Agostino RB, Wolf PA, Vasan RS, et al. Obesity and the risk of new-onset atrial fibrillation. JAMA. 2004;292(20):2471–7.

    Article  CAS  PubMed  Google Scholar 

  • Whitlock G, Lewington S, Sherliker P, Clarke R, Emberson J, Halsey J, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083–96.

    Article  PubMed  Google Scholar 

  • WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. World Health Organization, Geneva Switzerland, 2000;894:i–xii, 1–253.

    Google Scholar 

  • Yaegashi M, Jean R, Zuriqat M, Noack S, Homel P. Outcome of morbid obesity in the intensive care unit. J Intensive Care Med. 2005;20(3):147–54.

    Article  PubMed  Google Scholar 

  • Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G. Effects of obesity on respiratory resistance. Chest. 1993;103(5):1470–6.

    Article  CAS  PubMed  Google Scholar 

  • Ziccardi P, Nappo F, Giugliano G, Esposito K, Marfella R, Cioffi M, et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation. 2002;105(7):804–9.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. ICU, 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria Hospital, 152 Mesogion Avenue, GR-11527, Athens, Greece

    Antonia Koutsoukou & Magdalini Kyriakopoulou

  2. First Critical Care Department, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece

    Anastasia Kotanidou

  3. First Critical Care Department, Medical School, National and Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece

    Foteini Economidou

Authors
  1. Antonia Koutsoukou
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  2. Magdalini Kyriakopoulou
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  3. Anastasia Kotanidou
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  4. Foteini Economidou
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Corresponding author

Correspondence to Antonia Koutsoukou .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

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Koutsoukou, A., Kyriakopoulou, M., Kotanidou, A., Economidou, F. (2015). Obese Patient in Intensive Care Unit. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_19

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