Emergencies in obese patients: a narrative review (original) (raw)
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Obese patients: Respiratory complications in the post
Introduction: Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU). The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs) in obese patients during their stay in the PACU. Methods: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI) <30 (non-obese control group); the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011). The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test were used for comparisons. Associations with AREs were studied using univariate and multivariate logistic regression models. Results: There was a higher frequency of STOP-BANG ≥3 (89% vs. 11%, p < .001) among obese patients and they were less frequently scheduled to undergo high-risk surgery (7% vs. 41%, p = .005) and major surgery (4% vs. 15%, p = .008). Obese patients had more frequent AREs in the PACU (33% vs. 7%, p < .018). Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs. Stay in the PACU was longer for obese patients (120 min vs. 84 min, p < .01). Conclusions: Obesity was considered an independent risk factor for AREs in the PACU. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital.
Peri-operative and critical care management of morbidly obese patients
Sohag Medical Journal, 2019
AIM: The aim of this work is to know the pathophysiological mechanism of critically ill obese patients and to recognize the new requirements for their management in the critical-care-setting. The obese patient's category is still increasing in many westernized countries especially the united states (USA). As a result, the peri-operative management of obese patients became routine care. As obese patients are now liable for all types of procedures, it is essential and very important for all anesthesiologists, surgeons, perioperative-health care providers to understand their different multi-organ physiology so as to safely prepare those obese patients perioperatively. A good assessment of those patients pre-operatively can decrease the risk of postoperative complications later on …, in this manuscript, we mention the major considerations for the preoperative assessment of morbidly obese patients. Obesity now became the main cause of increased morbidity and mortality because of acute and chronic medical diseases, like diabetes mellitus, hypertension, cardiovascular problems, renal disorders, arthritis, and certain types of cancer (Mokdad et al. 2003). Obese patients, particularly morbidly ones, have a higher percentage of resource utilization, intensive care unit entrance, respiratory diseases, and respiratory distress syndrome, than do nonobese patients (Westerly and Dabbagh2011). also, obese patients are at higher danger for postoperative complications
Risks Associated with Obese Patient Handling in Emergency Prehospital Care
Prehospital Emergency Care, 2014
The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries. In this report, we illustrate the fatal consequences of initial problems in patient handling due to a small ambulance crew size in an obese patient who suffered an out-of-hospital cardiac arrest. Following successful resuscitation, this patient presented humeral fractures that may have promoted a disorder of hemostasis. The patient eventually died. This case highlights the requirement for specific instructions for paramedics to manage obese patients in these emergency conditions. This case also highlights the need to take into account body mass index when deciding on appropriate pre-hospital care, especially regarding the number of ambulance crewmembers.
Emergency Department Management of the Airway in Obese Adults
Annals of Emergency Medicine, 2010
Airway management in obese adults can be challenging, and much of the literature on this subject focuses on elective surgical cases, rather than acutely ill patients. In this article, we review the emergency department evaluation of the airway in obesity, discussing anatomy, physiology, and pharmacology. In addition, we describe techniques and devices used to improve intubating conditions in the obese patient. After our review of the relevant literature, we conclude that research in this particular area of acute care remains in its infancy. [Ann Emerg Med. 2010;56:95-104.]
Scandinavian journal of trauma, resuscitation and emergency medicine, 2016
The incidence of overweight and obesity has been steadily on the rise and has reached epidemic proportions in various countries and this represents a well-known major health problem. Nevertheless, current guidelines for resuscitation do not include special sequences of action in this subset of patients. The aim of this letter is to bring this controversy into focus and to suggest alterations of the known standard cardiopulmonary resuscitation in the obese. An obese patient weighing 272 kg fell to the floor, afterwards being unable to get up again. Thus, emergency services were called for assistance. There were no signs or symptoms signifying that the person had been harmed in consequence of the fall. Only when brought into a supine position the patient suffered an immediate cardiac arrest. Cardiopulmonary resuscitation was performed but there was no return of a stable spontaneous circulation until the patient was brought into a full lateral position. In spite of immediate emergency ...
Managing acute respiratory decompensation in the morbidly obese
Respirology, 2012
Morbid obesity adversely affects respiratory physiology, leading to reduced lung volumes, decreased lung compliance, ventilation perfusion mismatch, sleepdisordered breathing and the impairment of ventilatory control, and neurohormonal and neuromodulators of breathing. Therefore, morbidly obese subjects are at increased risk of various pulmonary complications that can present either acutely or chronically. Respiratory failure is one of the most common pulmonary complications related to morbid obesity. Both acute hypoxaemic and hypercapnic respiratory failure are more common among obese patients. The management pathway of respiratory failure depends, to a large extent, on the underlying cause, primarily due to the diversity of the underlying triggering diseases, the pathophysiology and the prognosis associated with each disease. Morbidly obese patients with hypoventilation have an increased risk of acute hypercapnic respiratory failure. Early diagnosis of this disorder and the application of non-invasive ventilation in this group of patients have been shown to improve respiratory parameters, decrease the need for invasive mechanical ventilation and improve survival.
A lung rescue team improves survival in obesity with acute respiratory distress syndrome
Critical Care
Background Limited data exist regarding ventilation in patients with class III obesity [body mass index (BMI) > 40 kg/m2] and acute respiratory distress syndrome (ARDS). The aim of the present study was to determine whether an individualized titration of mechanical ventilation according to cardiopulmonary physiology reduces the mortality in patients with class III obesity and ARDS. Methods In this retrospective study, we enrolled adults admitted to the ICU from 2012 to 2017 who had class III obesity and ARDS and received mechanical ventilation for > 48 h. Enrolled patients were divided in two cohorts: one cohort (2012–2014) had ventilator settings determined by the ARDSnet table for lower positive end-expiratory pressure/higher inspiratory fraction of oxygen (standard protocol-based cohort); the other cohort (2015–2017) had ventilator settings determined by an individualized protocol established by a lung rescue team (lung rescue team cohort). The lung rescue team used lung re...
Is Obesity Protective During Critical Illness? An Analysis of a National ICU Database
2003
Background: Obesity is a major health care problem worldwide. By current estimates 64% of the adult population in the US are overweight. Ex- cess body weight substantially increases the risk of morbidity and death from many chronic diseases. There is, however, limited data on the impact of obesity during critical illness. Objective: To determine the extent to which in- creasing