Thomas Weig1, Silke Janitza2, Michael Zoller3, Michael E Dolch3, Jens Miller3, Lorenz Frey3, Nikolaus Kneidinger4, Thorsten Johnson5, Mirjam I Schubert5, Michael Irlbeck3. 1. Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany. Electronic address: tweig@med.lmu.de. 2. Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, 81377 Munich, Germany. 3. Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany. 4. Department of Internal Medicine V, Comprehensive Pulmonary Center, Member of the German Center for Lung Research, Ludwig-Maximilians-University, 81377 Munich, Germany. 5. Department of Clinical Radiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
Abstract
PURPOSE: Obesity is a worldwide pandemic, and obese patients face an increased risk of developing acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a frequently used intervention in the treatment of ARDS. There are no data describing the impact of PP on morbidity and mortality in abdominally obese patients. We report our observations in abdominally obese ARDS patients treated with PP. MATERIALS AND METHODS: Patients with ARDS (n=82) were retrospectively divided into 2 groups characterized by presence (n=41) or absence (n=41) of abdominal obesity as defined by a sagittal abdominal diameter of 26 cm or more. RESULTS: There was no difference in cumulative time abdominally obese patients were placed in prone position from admission to day 7 (41.0 hours [interquartile range, 50.5 hours] vs 39.5 hours [interquartile range, 61.5 hours]; P=.65) or in overall intensive care unit mortality (34% vs 34%; P=1). However, abdominally obese patients developed renal failure (83% vs 35%; P<.001) and hypoxic hepatitis (22% vs 2%; P=.015) more frequently. A significant interaction effect between abdominal obesity and prone position with respect to mortality risk (likelihood ratio, P=.0004) was seen if abdominally obese patients were treated with prolonged cumulative PP. CONCLUSION: A cautious approach to PP should be considered in abdominally obese patients.
PURPOSE: Obesity is a worldwide pandemic, and obesepatients face an increased risk of developing acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a frequently used intervention in the treatment of ARDS. There are no data describing the impact of PP on morbidity and mortality in abdominally obesepatients. We report our observations in abdominally obese ARDSpatients treated with PP. MATERIALS AND METHODS:Patients with ARDS (n=82) were retrospectively divided into 2 groups characterized by presence (n=41) or absence (n=41) of abdominal obesity as defined by a sagittal abdominal diameter of 26 cm or more. RESULTS: There was no difference in cumulative time abdominally obesepatients were placed in prone position from admission to day 7 (41.0 hours [interquartile range, 50.5 hours] vs 39.5 hours [interquartile range, 61.5 hours]; P=.65) or in overall intensive care unit mortality (34% vs 34%; P=1). However, abdominally obesepatients developed renal failure (83% vs 35%; P<.001) and hypoxic hepatitis (22% vs 2%; P=.015) more frequently. A significant interaction effect between abdominal obesity and prone position with respect to mortality risk (likelihood ratio, P=.0004) was seen if abdominally obesepatients were treated with prolonged cumulative PP. CONCLUSION: A cautious approach to PP should be considered in abdominally obesepatients.
Authors: T Bein; M Bischoff; U Brückner; K Gebhardt; D Henzler; C Hermes; K Lewandowski; M Max; M Nothacker; T Staudinger; M Tryba; S Weber-Carstens; H Wrigge Journal: Anaesthesist Date: 2015-08 Impact factor: 1.041
Authors: Th Bein; M Bischoff; U Brückner; K Gebhardt; D Henzler; C Hermes; K Lewandowski; M Max; M Nothacker; Th Staudinger; M Tryba; S Weber-Carstens; H Wrigge Journal: Anaesthesist Date: 2015-12 Impact factor: 1.041