Subscribe to RSS
DOI: 10.1055/s-0039-1685179
Pathophysiology and Management of Acute Respiratory Distress Syndrome in Obese Patients
Publication History
Publication Date:
06 May 2019 (online)
![](https://www.thieme-connect.de/media/srccm/201901/lookinside/thumbnails/10-1055-s-0039-1685179_01438-1.jpg)
Abstract
A rising prevalence of obesity is reported over time and throughout the world. At the same time, the acute respiratory distress syndrome (ARDS) remains an important public health problem, accounting for approximately 10% of intensive care unit admissions and leading to significant hospital mortality. Even in the absence of acute illnesses, obesity affects respiratory mechanics and gas exchange in the setting of a restrictive disease. In the presence of ARDS, obesity adds various challenges to a safe and effective management of respiratory support. Difficult airway management, altered lung and chest wall physiology, and positional gas trapping are routinely encountered. The management of such difficult cases is generally empiric, as it is based on small-sized, physiologic studies or on suggestions from the general anesthesia literature. The present review focuses on those cases in which ARDS is coincident with obesity, with the aim of presenting treatment options based on the current evidence. The first part summarizes the epidemiology of obesity and ARDS. Then the diagnostic challenges due to obesity-related artifacts of the different imaging techniques will be presented. A subsequent, detailed description of the altered respiratory anatomy and physiology of obesity will provide help in selecting an optimal, individually tailored strategy of support. Furthermore, we will discuss how esophageal manometry should be used to adjust the settings of positive end-expiratory pressure and tidal volume; the challenges of prone positioning and extracorporeal support; and the optimal strategies for weaning from mechanical ventilation, including when and how to perform a tracheostomy.
-
References
- 1 WHO. Obesity. Available at: http://www.who.int/topics/obesity/en/ . Accessed December 30, 2018
- 2 Lewandowski K, Lewandowski M. Intensive care in the obese. Best Pract Res Clin Anaesthesiol 2011; 25 (01) 95-108
- 3 Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am 2010; 39 (01) 1-7
- 4 Duren DL, Sherwood RJ, Czerwinski SA. , et al. Body composition methods: comparisons and interpretation. J Diabetes Sci Technol 2008; 2 (06) 1139-1146
- 5 Bellamy MC, Margarson MP. Designing intelligent anesthesia for a changing patient demographic: a consensus statement to provide guidance for specialist and non-specialist anesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA). Perioper Med (Lond) 2013; 2 (01) 12
- 6 Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol 2006; 35 (01) 93-99
- 7 Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, 2005 to 2014. JAMA 2016; 315 (21) 2284-2291
- 8 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
- 9 Holsten JE. Obesity and the community food environment: a systematic review. Public Health Nutr 2009; 12 (03) 397-405
- 10 Frayling TM, Timpson NJ, Weedon MN. , et al. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science 2007; 316 (5826): 889-894
- 11 Adams KF, Schatzkin A, Harris TB. , et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 2006; 355 (08) 763-778
- 12 Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004; 291 (10) 1238-1245
- 13 Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. ; NEDCOM, the Netherlands Epidemiology and Demography Compression of Morbidity Research Group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med 2003; 138 (01) 24-32
- 14 Field AE, Coakley EH, Must A. , et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161 (13) 1581-1586
- 15 Han E, Truesdale KP, Taber DR, Cai J, Juhaeri J, Stevens J. Impact of overweight and obesity on hospitalization: race and gender differences. Int J Obes 2009; 33 (02) 249-256
- 16 Morgan OW, Bramley A, Fowlkes A. , et al. Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One 2010; 5 (03) e9694
- 17 Neto AS, Barbas CSV, Simonis FD. , et al; PRoVENT; PROVE Network investigators. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med 2016; 4 (11) 882-893
- 18 Gajic O, Dabbagh O, Park PK. , et al; U.S. Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS). Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med 2011; 183 (04) 462-470
- 19 Anzueto A, Frutos-Vivar F, Esteban A. , et al; Ventila group. Influence of body mass index on outcome of the mechanically ventilated patients. Thorax 2011; 66 (01) 66-73
- 20 Gong MN, Bajwa EK, Thompson BT, Christiani DC. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax 2010; 65 (01) 44-50
- 21 Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. ; Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342 (18) 1301-1308
- 22 Mercat A, Richard JC, Vielle B. , et al; Expiratory Pressure (Express) Study Group. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008; 299 (06) 646-655
- 23 Meade MO, Cook DJ, Guyatt GH. , et al; Lung Open Ventilation Study Investigators. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2008; 299 (06) 637-645
- 24 Cavalcanti AB, Suzumura ÉA, Laranjeira LN. , et al; Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017; 318 (14) 1335-1345
- 25 El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest 2001; 120 (06) 1989-1997
- 26 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 (03) 147-154
- 27 Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004; 32 (04) 998-1003
- 28 Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A. Influence of overweight on ICU mortality: a prospective study. Chest 2004; 125 (04) 1441-1445
- 29 Garrouste-Orgeas M, Troché G, Azoulay E. , et al. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med 2004; 30 (03) 437-443
- 30 Frat JP, Gissot V, Ragot S. , et al; Association des Réanimateurs du Centre-Ouest (ARCO) study group. Impact of obesity in mechanically ventilated patients: a prospective study. Intensive Care Med 2008; 34 (11) 1991-1998
- 31 Lee CK, Tefera E, Colice G. The effect of obesity on outcomes in mechanically ventilated patients in a medical intensive care unit. Respiration 2014; 87 (03) 219-226
- 32 Fonarow GC, Srikanthan P, Costanzo MR, Cintron GB, Lopatin M. ; ADHERE Scientific Advisory Committee and Investigators. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J 2007; 153 (01) 74-81
- 33 Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005; 81 (03) 543-554
- 34 Arabi YM, Dara SI, Tamim HM. , et al; Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care 2013; 17 (02) R72
- 35 Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obesity (Silver Spring) 2008; 16 (03) 515-521
- 36 Hogue Jr CW, Stearns JD, Colantuoni E. , et al. The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med 2009; 35 (07) 1152-1170
- 37 Zhao Y, Li Z, Yang T, Wang M, Xi X. Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS One 2018; 13 (06) e0198669
- 38 Soto GJ, Frank AJ, Christiani DC, Gong MN. Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med 2012; 40 (09) 2601-2608
- 39 Soubani AO, Chen W, Jang H. The outcome of acute respiratory distress syndrome in relation to body mass index and diabetes mellitus. Heart Lung 2015; 44 (05) 441-447
- 40 Morris AE, Stapleton RD, Rubenfeld GD, Hudson LD, Caldwell E, Steinberg KP. The association between body mass index and clinical outcomes in acute lung injury. Chest 2007; 131 (02) 342-348
- 41 O'Brien Jr JM, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S. Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med 2006; 34 (03) 738-744
- 42 Stapleton RD, Dixon AE, Parsons PE, Ware LB, Suratt BT. ; NHLBI Acute Respiratory Distress Syndrome Network. The association between BMI and plasma cytokine levels in patients with acute lung injury. Chest 2010; 138 (03) 568-577
- 43 Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante Jr AW. Obesity is associated with macrophage accumulation in adipose tissue. J Clin Invest 2003; 112 (12) 1796-1808
- 44 Porcheray F, Viaud S, Rimaniol AC. , et al. Macrophage activation switching: an asset for the resolution of inflammation. Clin Exp Immunol 2005; 142 (03) 481-489
- 45 Fernandez-Bustamante A, Repine JE. Adipose-lung cell crosstalk in the obesity-ARDS paradox. J Pulm Respir Med 2013; 3: 144 ; doi:10.4172/2161-105X.1000144
- 46 Wiedemann HP, Wheeler AP, Bernard GR. , et al; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354 (24) 2564-2575
- 47 Juvin P, Lavaut E, Dupont H. , et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003; 97 (02) 595-600 table of contents.
- 48 Chiumello D, Colombo A, Algieri I. , et al. Effect of body mass index in acute respiratory distress syndrome. Br J Anaesth 2016; 116 (01) 113-121
- 49 Pelosi P, Croci M, Ravagnan I. , et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87 (03) 654-660
- 50 Jones RL, Nzekwu MM. The effects of body mass index on lung volumes. Chest 2006; 130 (03) 827-833
- 51 Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ. Effects of mass loading the respiratory system in man. J Appl Physiol 1964; 19: 959-966
- 52 Behazin N, Jones SB, Cohen RI, Loring SH. Respiratory restriction and elevated pleural and esophageal pressures in morbid obesity. J Appl Physiol (1985) 2010; 108 (01) 212-218
- 53 Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN. The effect of body fat distribution on pulmonary function tests. Chest 1995; 107 (05) 1298-1302
- 54 Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci 1999; 318 (05) 293-297
- 55 Sampson MG, Grassino AE. Load compensation in obese patients during quiet tidal breathing. J Appl Physiol 1983; 55 (04) 1269-1276
- 56 Pelosi P, Goldner M, McKibben A. , et al. Recruitment and derecruitment during acute respiratory failure: an experimental study. Am J Respir Crit Care Med 2001; 164 (01) 122-130
- 57 Pelosi P, Croci M, Calappi E. , et al. Prone positioning improves pulmonary function in obese patients during general anesthesia. Anesth Analg 1996; 83 (03) 578-583
- 58 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 (01) 144-151
- 59 Hedenstierna G, Santesson J. Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation. Acta Anaesthesiol Scand 1976; 20 (03) 248-254
- 60 Suratt PM, Wilhoit SC, Hsiao HS, Atkinson RL, Rochester DF. Compliance of chest wall in obese subjects. J Appl Physiol 1984; 57 (02) 403-407
- 61 Naimark A, Cherniack RM. Compliance of the respiratory system and its components in health and obesity. J Appl Physiol 1960; 15: 377-382
- 62 Pelosi P, Ravagnan I, Giurati G. , et al. Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 1999; 91 (05) 1221-1231
- 63 Owens RL, Campana LM, Hess L, Eckert DJ, Loring SH, Malhotra A. Sitting and supine esophageal pressures in overweight and obese subjects. Obesity (Silver Spring) 2012; 20 (12) 2354-2360
- 64 Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J Appl Physiol (1985) 2005; 98 (02) 512-517
- 65 Yap JC, Watson RA, Gilbey S, Pride NB. Effects of posture on respiratory mechanics in obesity. J Appl Physiol (1985) 1995; 79 (04) 1199-1205
- 66 Zerah F, Harf A, Perlemuter L, Lorino H, Lorino AM, Atlan G. Effects of obesity on respiratory resistance. Chest 1993; 103 (05) 1470-1476
- 67 Chen L, Del Sorbo L, Grieco DL. , et al. Airway closure in acute respiratory distress syndrome: an underestimated and misinterpreted phenomenon. Am J Respir Crit Care Med 2018; 197 (01) 132-136
- 68 Bellani G, Laffey JG, Pham T. , et al; LUNG SAFE Investigators; ESICM Trials Group. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315 (08) 788-800
- 69 Buckley O, Ward E, Ryan A, Colin W, Snow A, Torreggiani WC. European obesity and the radiology department. What can we do to help?. Eur Radiol 2009; 19 (02) 298-309
- 70 Ginde AA, Foianini A, Renner DM, Valley M, Camargo Jr CA. The challenge of CT and MRI imaging of obese individuals who present to the emergency department: a national survey. Obesity (Silver Spring) 2008; 16 (11) 2549-2551
- 71 Uppot RN. Impact of obesity on radiology. Radiol Clin North Am 2007; 45 (02) 231-246
- 72 Fetterly KA, Schueler BA. Experimental evaluation of fiber-interspaced antiscatter grids for large patient imaging with digital x-ray systems. Phys Med Biol 2007; 52 (16) 4863-4880
- 73 Shah S, Shah V, Ahmed AR, Blunt DM. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications. Br J Radiol 2011; 84 (998) 101-111
- 74 Yanch JC, Behrman RH, Hendricks MJ, McCall JH. Increased radiation dose to overweight and obese patients from radiographic examinations. Radiology 2009; 252 (01) 128-139
- 75 Uppot RN, Sahani DV, Hahn PF, Kalra MK, Saini SS, Mueller PR. Effect of obesity on image quality: fifteen-year longitudinal study for evaluation of dictated radiology reports. Radiology 2006; 240 (02) 435-439
- 76 Barrett JF, Keat N. Artifacts in CT: recognition and avoidance. Radiographics 2004; 24 (06) 1679-1691
- 77 Modica MJ, Kanal KM, Gunn ML. The obese emergency patient: imaging challenges and solutions. Radiographics 2011; 31 (03) 811-823
- 78 De Jong A, Chanques G, Jaber S. Mechanical ventilation in obese ICU patients: from intubation to extubation. Crit Care 2017; 21 (01) 63
- 79 De Jong A, Molinari N, Pouzeratte Y. , 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 (02) 297-306
- 80 Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94 (03) 732-736 table of contents.
- 81 Nair A. Difficult intubation in obese patients. Br J Anaesth 2016; 116 (01) 146
- 82 Sforza E, Petiau C, Weiss T, Thibault A, Krieger J. Pharyngeal critical pressure in patients with obstructive sleep apnea syndrome. Clinical implications. Am J Respir Crit Care Med 1999; 159 (01) 149-157
- 83 Isono S, Remmers JE, Tanaka A, Sho Y, Sato J, Nishino T. Anatomy of pharynx in patients with obstructive sleep apnea and in normal subjects. J Appl Physiol (1985) 1997; 82 (04) 1319-1326
- 84 Glossop AJ, Esquinas AM. Difficult intubation and life-threatening complications in obese patients: understanding the ‘environment effect’. Br J Anaesth 2016; 116 (01) 146-147
- 85 Antonelli M, Conti G, Esquinas A. , et al. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med 2007; 35 (01) 18-25
- 86 Nava S, Hill N. Non-invasive ventilation in acute respiratory failure. Lancet 2009; 374 (9685): 250-259
- 87 Beitler JR, Owens RL, Malhotra A. Unmasking a role for noninvasive ventilation in early acute respiratory distress syndrome. JAMA 2016; 315 (22) 2401-2403
- 88 Bellani G, Laffey JG, Pham T. , et al; LUNG SAFE Investigators; ESICM Trials Group. Noninvasive ventilation of patients with acute respiratory distress syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017; 195 (01) 67-77
- 89 Lemyze M, Taufour P, Duhamel A. , et al. Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure. PLoS One 2014; 9 (05) e97563
- 90 Nicolini A, Lemyze M, Esquinas A, Barlascini C, Cavalleri MA. Predictors of noninvasive ventilation failure in critically ill obese patients: a brief narrative review. Adv Respir Med 2017; 85 (05) 264-270
- 91 Papazian L, Corley A, Hess D. , et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Med 2016; 42 (09) 1336-1349
- 92 Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth 2009; 103 (06) 886-890
- 93 Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth 2011; 107 (06) 998-1004
- 94 Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med 2013; 39 (02) 247-257
- 95 Corley A, Bull T, Spooner AJ, Barnett AG, Fraser JF. Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI ≥30: a randomised controlled trial. Intensive Care Med 2015; 41 (05) 887-894
- 96 Malhotra A, Hillman D. Obesity and the lung: 3. Obesity, respiration and intensive care. Thorax 2008; 63 (10) 925-931
- 97 Bime C, Fiero M, Lu Z. , et al. High positive end-expiratory pressure is associated with improved survival in obese patients with acute respiratory distress syndrome. Am J Med 2017; 130 (02) 207-213
- 98 Umbrello M, Chiumello D. Interpretation of the transpulmonary pressure in the critically ill patient. Ann Transl Med 2018; 6 (19) 383
- 99 Akoumianaki E, Maggiore SM, Valenza F. , et al; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine). The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014; 189 (05) 520-531
- 100 Grasso S, Terragni P, Birocco A. , et al. ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med 2012; 38 (03) 395-403
- 101 Pirrone M, Fisher D, Chipman D. , et al. Recruitment maneuvers and positive end-expiratory pressure titration in morbidly obese ICU patients. Crit Care Med 2016; 44 (02) 300-307
- 102 Fumagalli J, Berra L, Zhang C. , et al. Transpulmonary pressure describes lung morphology during decremental positive end-expiratory pressure trials in obesity. Crit Care Med 2017; 45 (08) 1374-1381
- 103 Chiumello D, Carlesso E, Cadringher P. , et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med 2008; 178 (04) 346-355
- 104 Richard JC, Marini JJ. Transpulmonary pressure as a surrogate of plateau pressure for lung protective strategy: not perfect but more physiologic. Intensive Care Med 2012; 38 (03) 339-341
- 105 Amato MB, Meade MO, Slutsky AS. , et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015; 372 (08) 747-755
- 106 Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D. Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl 2003; 47: 15s-25s
- 107 Aoyama H, Pettenuzzo T, Aoyama K, Pinto R, Englesakis M, Fan E. Association of driving pressure with mortality among ventilated patients with acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care Med 2018; 46 (02) 300-306
- 108 De Jong A, Cossic J, Verzilli D. , et al. Impact of the driving pressure on mortality in obese and non-obese ARDS patients: a retrospective study of 362 cases. Intensive Care Med 2018; 44 (07) 1106-1114
- 109 Bein T. Driving pressure in obese ventilated patients: another brick in the (chest) wall. Intensive Care Med 2018; 44 (08) 1349-1351
- 110 Gattinoni L, Pesenti A. The concept of “baby lung”. Intensive Care Med 2005; 31 (06) 776-784
- 111 Chiumello D, Coppola S, Froio S. Prone position in ARDS: a simple maneuver still underused. Intensive Care Med 2018; 44 (02) 241-243
- 112 Guérin C, Reignier J, Richard JC. , et al; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368 (23) 2159-2168
- 113 Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Rationale, indications, and limits. Am J Respir Crit Care Med 2013; 188 (11) 1286-1293
- 114 Park SY, Kim HJ, Yoo KH. , et al. The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. J Thorac Dis 2015; 7 (03) 356-367
- 115 Chergui K, Choukroun G, Meyer P, Caen D. Prone positioning for a morbidly obese patient with acute respiratory distress syndrome: an opportunity to explore intrinsic positive end-expiratory pressure-lower inflexion point interdependence. Anesthesiology 2007; 106 (06) 1237-1239
- 116 De Jong A, Molinari N, Sebbane M. , et al. Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study. Chest 2013; 143 (06) 1554-1561
- 117 Weig T, Janitza S, Zoller M. , et al. Influence of abdominal obesity on multiorgan dysfunction and mortality in acute respiratory distress syndrome patients treated with prone positioning. J Crit Care 2014; 29 (04) 557-561
- 118 Chiumello D, Brochard L, Marini JJ. , et al. Respiratory support in patients with acute respiratory distress syndrome: an expert opinion. Crit Care 2017; 21 (01) 240
- 119 Tonetti T, Vasques F, Rapetti F. , et al. Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med 2017; 5 (14) 286
- 120 Gattinoni L, Carlesso E, Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care 2011; 15 (06) 243
- 121 Combes A, Hajage D, Capellier G. , et al; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018; 378 (21) 1965-1975
- 122 Goligher EC, Tomlinson G, Hajage D. , et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc bayesian analysis of a randomized clinical trial. JAMA 2018; 320 (21) 2251-2259
- 123 Brogan TV, Thiagarajan RR, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intensive Care Med 2009; 35 (12) 2105-2114
- 124 Al-Soufi S, Buscher H, Nguyen ND, Rycus P, Nair P. Lack of association between body weight and mortality in patients on veno-venous extracorporeal membrane oxygenation. Intensive Care Med 2013; 39 (11) 1995-2002
- 125 Mongero LB, Beck JR, Charette KA, Stewart A. Respiratory failure of two sp gastric bypass patients and subsequent rescue with extracorporeal membrane oxygenation. Perfusion 2006; 21 (01) 73-76
- 126 Belliato M, Cremascoli L, Aliberti A, Pagani M, Pellegrini C, Iotti GA. A case of veno-venous extracorporeal membrane oxygenation for severe respiratory failure in a superobese patient. Clin Case Rep 2016; 4 (12) 1147-1150
- 127 Kadakia S, Ambur V, Moore R, Toyoda Y, Shiose A. Venovenous extracorporeal membrane oxygenation in two morbidly obese patients. Gen Thorac Cardiovasc Surg 2017; 65 (10) 594-597
- 128 Kon ZN, Dahi S, Evans CF. , et al. Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support. Ann Thorac Surg 2015; 100 (05) 1855-1860
- 129 Lazzeri C, Bonizzoli M, Cianchi G. , et al. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs 2017; 20 (01) 50-56
- 130 Salna M, Chicotka S, Biscotti III M. , et al. Morbid obesity is not a contraindication to transport on extracorporeal support. Eur J Cardiothorac Surg 2018; 53 (04) 793-798
- 131 Martino JL, Stapleton RD, Wang M. , et al. Extreme obesity and outcomes in critically ill patients. Chest 2011; 140 (05) 1198-1206
- 132 De Baerdemaeker L, Mortier E, Struys M. Pharmacokinetics in obese patients. Contin Educ Anaesth Crit Care Pain 2004; 4: 152-155
- 133 Mahul M, Jung B, Galia F. , et al. Spontaneous breathing trial and post-extubation work of breathing in morbidly obese critically ill patients. Crit Care 2016; 20 (01) 346
- 134 Fernandez MM, González-Castro A, Magret M. , et al. Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces reintubation in critically ill patients: a multicenter randomized controlled trial. Intensive Care Med 2017; 43 (11) 1660-1667
- 135 Burns SM, Egloff MB, Ryan B, Carpenter R, Burns JE. Effect of body position on spontaneous respiratory rate and tidal volume in patients with obesity, abdominal distension and ascites. Am J Crit Care 1994; 3 (02) 102-106
- 136 Bry C, Jaffré S, Guyomarc'h B. , et al. Noninvasive ventilation in obese subjects after acute respiratory failure. Respir Care 2018; 63 (01) 28-35
- 137 Chao CM, Lai CC, Cheng AC. , et al. Establishing failure predictors for the planned extubation of overweight and obese patients. PLoS One 2017; 12 (08) e0183360
- 138 Alhajhusain A, Ali AW, Najmuddin A, Hussain K, Aqeel M, El-Solh AA. Timing of tracheotomy in mechanically ventilated critically ill morbidly obese patients. Crit Care Res Pract 2014; 2014: 840638
- 139 Headley WB, Rodning CB. Fabricated single lumen tracheal cannula for a morbidly obese patient. J Otolaryngol 1993; 22 (06) 438-441
- 140 Mansharamani NG, Koziel H, Garland R, LoCicero III J, Critchlow J, Ernst A. Safety of bedside percutaneous dilatational tracheostomy in obese patients in the ICU. Chest 2000; 117 (05) 1426-1429
- 141 Byhahn C, Lischke V, Meininger D, Halbig S, Westphal K. Peri-operative complications during percutaneous tracheostomy in obese patients. Anaesthesia 2005; 60 (01) 12-15
- 142 Aldawood AS, Arabi YM, Haddad S. Safety of percutaneous tracheostomy in obese critically ill patients: a prospective cohort study. Anaesth Intensive Care 2008; 36 (01) 69-73
- 143 El Solh AA, Jaafar W. A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients. Crit Care 2007; 11 (01) R3
- 144 Cordes SR, Best AR, Hiatt KK. The impact of obesity on adult tracheostomy complication rate. Laryngoscope 2015; 125 (01) 105-110
- 145 Fattahi T, Chafin C, Bunnell A. Tracheostomy in the morbidly obese: difficulties and challenges. J Oral Maxillofac Surg 2017; 75 (07) 1372-1375
- 146 Romero CM, Cornejo RA, Ruiz MH. , et al. Fiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study. J Crit Care 2009; 24 (04) 494-500
- 147 McCague A, Aljanabi H, Wong DT. Safety analysis of percutaneous dilational tracheostomies with bronchoscopy in the obese patient. Laryngoscope 2012; 122 (05) 1031-1034
- 148 Sustić A, Zupan Z, Antoncić I. Ultrasound-guided percutaneous dilatational tracheostomy with laryngeal mask airway control in a morbidly obese patient. J Clin Anesth 2004; 16 (02) 121-123
- 149 Guinot PG, Zogheib E, Petiot S. , et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients. Crit Care 2012; 16 (02) R40
- 150 Song J, Xuan L, Wu W, Zhu D, Zheng Y. Comparison of percutaneous dilatational tracheostomy guided by ultrasound and bronchoscopy in critically ill obese patients. J Ultrasound Med 2018; 37 (05) 1061-1069