Ventilator dependency among morbidly obese in the ICU

Introduction

The purpose of this study was to evaluate the dependency for mechanical ventilation among morbidly obese patients (MOP) defined by BMI ≥ 40 kg/m², admitted to our ICU. Because of reduced functional residual capacity, increased risk of atelectasis, increased work of breathing and decreased compliance of the lungs and chest wall [1], MOP are expected to have a high dependency of mechanical ventilation. Early tracheotomy has a beneficial outcome in a medical population of patients admitted to the ICU [2], and one should assume benefits of early tracheotomy in MOP because they are at high risk of pulmonary complication. A subject of debate as a study has shown morbid obesity associated with increased risk of complications [3].

Methods

All MOP admitted for more than 24 hours in a 12-bed mixed ICU at a Danish university hospital in the period of 2007 and 2008 were retrospectively included. The ICU stay was registered as well as airway management, length of mechanical ventilation and time for tracheotomy after intubation.

Results

Twenty-one morbidly obese patients were admitted. Fifteen patients (71.4%) needed mechanical ventilation. Three of these patients had a period of noninvasive ventilation. The median duration of ventilation was 13 days (range 4 to 71 days) and median length of stay was 16 days (range 4 to 71 days). Eleven patients were tracheotomised after a median 7 days (range 1 to 11 days). Six patients had no need for mechanical ventilation. Their median length of stay was 3 days (range 1 to 12 days). There was no difference in age and BMI between the two groups. Female/male ratio was 8/7 in the ventilated group versus 5/1 in the nonventilated group. Surgical/medical ratio was 11/4 in the ventilated group versus 6/0 in the nonventilated group. Only one patient died in the ICU.

Conclusion

A high proportion of MOP admitted to our ICU needed mechanical ventilation (71.4%) and a very high proportion was tracheotomised. Further studies are needed to evaluate the beneficial effects of early tracheotomy in this patient group.

References

1. Marik P, et al.: The obese patient in the ICU.

   Chest 1998, 113:492-498. PubMed Abstract | Publisher Full Text

2. Rumbak MJ, et al.: A prospective, randomised, study comparing early percutaneous dilational trachetomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.

   Crit Care Med 2004, 32:1689-1694. PubMed Abstract | Publisher Full Text

3. Solh A, Jaafar W: A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients.

   Crit Care 2007, 11:R3. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text

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