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Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review

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Abstract

Purpose of Review

Since the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has infected nearly 800 million people and caused almost seven million deaths. Obesity was quickly identified as a risk factor for severe COVID-19, ICU admission, acute respiratory distress syndrome, organ support including mechanical ventilation and prolonged length of stay. The relationship among obesity; COVID-19; and respiratory, thrombotic, and renal complications upon admission to the ICU is unclear.

Recent Findings

The predominant effect of a hyperinflammatory status or a cytokine storm has been suggested in patients with obesity, but more recent studies have challenged this hypothesis. Numerous studies have also shown increased mortality among critically ill patients with obesity and COVID-19, casting doubt on the obesity paradox, with survival advantages with overweight and mild obesity being reported in other ICU syndromes. Finally, it is now clear that the increase in the global prevalence of overweight and obesity is a major public health issue that must be accompanied by a transformation of our ICUs, both in terms of equipment and human resources. Research must also focus more on these patients to improve their care.

Summary

In this review, we focused on the central role of obesity in critically ill patients during this pandemic, highlighting its specificities during their stay in the ICU, identifying the lessons we have learned, and identifying areas for future research as well as the future challenges for ICU activity.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

ACE-2:

Angiotensin-converting enzyme 2

AKI:

Acute kidney injury

ARDS:

Acute respiratory distress syndrome

BMI:

Body mass index

BSI:

Bloodstream infection

COVID-19:

Coronavirus disease 2019

CPAP:

Continuous positive airway pressure

ECMO:

Extracorporeal membrane oxygenation

HAI:

Hospital-acquired infection

HFNO:

High-flow nasal oxygenation

HR:

Hazard ratio

ICU:

Intensive care unit

IL:

Interleukin

MV:

Mechanical ventilation

NIV:

Noninvasive ventilation

OR:

Odds ratio

PEEP:

Positive end-expiratory pressure

RRT:

Renal replacement therapy

VAP:

Ventilator-acquired pneumonia

SARS:

Severe acute respiratory syndrome

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

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Acknowledgements

This manuscript was edited for proper English language, grammar, punctuation, spelling, and overall style by American Journal Experts.

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Authors and Affiliations

  1. Department of Intensive Care, Hôpital Tenon, APHP, Paris, France

    Alexandra Beurton

  2. UMR_S 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, Paris, France

    Alexandra Beurton

  3. Department of Intensive Care Medicine, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands

    Emma J. Kooistra & Peter Pickkers

  4. Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB, Nijmegen, The Netherlands

    Emma J. Kooistra & Peter Pickkers

  5. Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University Montpellier 1, Montpellier, France

    Audrey De Jong & Samir Jaber

  6. Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France

    Audrey De Jong & Samir Jaber

  7. Division of Nephrology, Department of Internal Medicine IV, University Hospital LMU Munich, Munich, Germany

    Helmut Schiffl

  8. CHU Lille, Univ-Lille, INSERM UMR 1190, ICU Department, F-59037, Lille, France

    Mercedes Jourdain & Bruno Garcia

  9. Anesthesia and Critical Care Department, Hôpital Necker, APHP, Paris, France

    Damien Vimpère

  10. Intensive Care Unit, Centre Hospitalier de Bastia, Bastia, Corsica, France

    Laurent Papazian

  11. Aix-Marseille University, Marseille, France

    Laurent Papazian

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  1. Alexandra Beurton
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Contributions

AB and LP wrote the review design. AB, EK, YJ, ADJ, HS, MJ, BG, DV, SJ, PP, and LP wrote the main manuscript. AB and LP prepared Fig. 1. ADJ and AB prepared Fig. 2. HS and AB prepared Fig. 3. All authors reviewed the manuscript. AB and LP approved the final version.

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Correspondence to Alexandra Beurton.

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Conflict of Interest

Alexandra Beurton: no conflicts of interest. Emma J Kooistra: no conflicts of interest. Audrey De Jong reports receiving fees for teaching presentations for Drager, Medtronic and Fisher & Paykel. Helmut Schiffl: no conflicts of interest. Mercé Jourdain: no conflicts of interest. Bruno Garcia: no conflicts of interest. Damien Vimpère: no conflicts of interest. Samir Jaber reports receiving consulting fees from Drager, Medtronic, Fresenius, Baxter and Fisher & Paykel. Peter Pickkers: no conflicts of interest. Laurent Papazian received consultancy fees from Air liquid MS, Faron and MSD.

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Beurton, A., Kooistra, E.J., De Jong, A. et al. Specific and Non-specific Aspects and Future Challenges of ICU Care Among COVID-19 Patients with Obesity: A Narrative Review. Curr Obes Rep (2024). https://doi.org/10.1007/s13679-024-00562-3

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