Audrey De Jong1, Nicolas Molinari2, Mustapha Sebbane1, Albert Prades1, Emmanuel Futier1, Boris Jung1, Gérald Chanques1, Samir Jaber3. 1. Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France. 2. Medical and Informatic Department, Lapeyronie University Hospital of Montpellier, UMR 729 MISTEA, Route de Ganges, Montpellier cedex 5, France. 3. Intensive Care Unit and Transplantation Department (DAR B), Saint Eloi Hospital, University Hospital of Montpellier-INSERM U1046, France. Electronic address: s-jaber@chu-montpellier.fr.
Abstract
BACKGROUND: Obese patients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obese patients with ARDS. METHODS: Morbidly obese patients (BMI ≥ 35 kg/m²) with ARDS (Pao₂/FIo₂ ratio ≤ 200 mm Hg) were matched to nonobese (BMI < 30 kg/m²) patients with ARDS in a case-control clinical study. The primary end points were safety and complications of PP; the secondary end points were the effect on oxygenation (Pao₂/FIo₂ ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections, and mortality. RESULTS: Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese patients were matched with 33 nonobese patients. Median (25th-75th percentile) PP duration was 9 h (6-11 h) in obese patients and 8 h (7-12 h) in nonobese patients (P = .28). We collected 51 complications: 25 in obese and 26 in nonobese patients. The number of patients with at least one complication was similar across groups (n = 10, 30%). Pao₂/FIo₂ ratio increased significantly more in obese patients (from 118 ± 43 mm Hg to 222 ± 84 mm Hg) than in nonobese patients (from 113 ± 43 mm Hg to 174 ± 80 mm Hg; P = .03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27% vs 48%, P < .05). CONCLUSIONS: PP seems safe in obese patients and may improve oxygenation more than in nonobese patients. Obese patients could be a subgroup of patients with ARDS who may benefit the most of PP.
BACKGROUND:Obesepatients are at risk for developing atelectasis and ARDS. Prone position (PP) may reduce atelectasis, and it improves oxygenation and outcome in severe hypoxemic patients with ARDS, but little is known about its effect in obesepatients with ARDS. METHODS: Morbidly obesepatients (BMI ≥ 35 kg/m²) with ARDS (Pao₂/FIo₂ ratio ≤ 200 mm Hg) were matched to nonobese (BMI < 30 kg/m²) patients with ARDS in a case-control clinical study. The primary end points were safety and complications of PP; the secondary end points were the effect on oxygenation (Pao₂/FIo₂ ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections, and mortality. RESULTS: Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obesepatients were matched with 33 nonobese patients. Median (25th-75th percentile) PP duration was 9 h (6-11 h) in obesepatients and 8 h (7-12 h) in nonobese patients (P = .28). We collected 51 complications: 25 in obese and 26 in nonobese patients. The number of patients with at least one complication was similar across groups (n = 10, 30%). Pao₂/FIo₂ ratio increased significantly more in obesepatients (from 118 ± 43 mm Hg to 222 ± 84 mm Hg) than in nonobese patients (from 113 ± 43 mm Hg to 174 ± 80 mm Hg; P = .03). Length of mechanical ventilation, ICU stay, and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obesepatients (27% vs 48%, P < .05). CONCLUSIONS: PP seems safe in obesepatients and may improve oxygenation more than in nonobese patients. Obesepatients could be a subgroup of patients with ARDS who may benefit the most of PP.
Authors: Maria Plataki; LiChao Fan; Elizabeth Sanchez; Ziling Huang; Lisa K Torres; Mitsuru Imamura; Yizhang Zhu; David E Cohen; Suzanne M Cloonan; Augustine Mk Choi Journal: JCI Insight Date: 2019-07-09
Authors: C Guérin; P Beuret; J M Constantin; G Bellani; P Garcia-Olivares; O Roca; J H Meertens; P Azevedo Maia; T Becher; J Peterson; A Larsson; M Gurjar; Z Hajjej; F Kovari; A H Assiri; E Mainas; M S Hasan; D R Morocho-Tutillo; L Baboi; J M Chrétien; G François; L Ayzac; L Chen; L Brochard; A Mercat Journal: Intensive Care Med Date: 2017-12-07 Impact factor: 17.440