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Mechanical Ventilation of Patients with Severe Obesity

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Obesity and Lung Disease

Part of the book series: Respiratory Medicine ((RM,volume 19))

Abstract

In recent years, obesity has become endemic in developed countries. Medical care of the obese patient is extremely challenging, especially critically ill obese individuals. The challenge of providing medical care to obese patients is multifactorial and stems from difficulty performing diagnostic and therapeutic procedures, difficulty providing logistical support, and the necessity of extrapolating data usually obtained from the study of leaner populations. Obesity affects respiratory physiology and also predisposes to obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS). As a result, patients with obesity may be at higher risk for respiratory failure and greater duration of mechanical ventilation.

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References

  1. McTigue K, Larson JC, Valoski A, Burke G, Kotchen J, Lewis CE, et al. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA. 2006;296(1):79–86.

    Article  PubMed  CAS  Google Scholar 

  2. Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36(1):151–8.

    Article  PubMed  Google Scholar 

  3. Dixon AE, Holguin F, Sood A, Salome CM, Pratley RE, Beuther DA, et al. An official American thoracic society workshop report: obesity and asthma. Proc Am Thorac Soc. 2010;7(5):325–35.

    Article  PubMed  Google Scholar 

  4. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):144–53.

    Article  PubMed  Google Scholar 

  5. Koenig SM. Pulmonary complications of obesity. Am J Med Sci. 2001;321(4):249–79.

    Article  PubMed  CAS  Google Scholar 

  6. Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318(5):293–7.

    Article  PubMed  CAS  Google Scholar 

  7. Rubinstein I, Zamel N, DuBarry L, Hoffstein V. Airflow limitation in morbidly obese, nonsmoking men. Ann Intern Med. 1990;112(11):828–32.

    PubMed  CAS  Google Scholar 

  8. Berger KI, Norman RG, Ayappa I, Oppenheimer BW, Rapoport DM, Goldring RM. Potential mechanism for transition between acute hypercapnia during sleep to chronic hypercapnia during wakefulness in obstructive sleep apnea. Adv Exp Med Biol. 2008;605:431–6.

    Article  PubMed  Google Scholar 

  9. Zwillich CW, Sutton FD, Pierson DJ, Greagh EM, Weil JV. Decreased hypoxic ventilatory drive in the obesity-hypoventilation syndrome. Am J Med. 1975;59(3):343–8.

    Article  PubMed  CAS  Google Scholar 

  10. Sampson MG, Grassino K. Neuromechanical properties in obese patients during carbon dioxide rebreathing. Am J Med. 1983;75(1):81–90.

    Article  PubMed  CAS  Google Scholar 

  11. Lee WY, Mokhlesi B. Diagnosis and management of obesity hypoventilation syndrome in the ICU. Crit Care Clin. 2008;24(3):533–49. vii.

    Article  PubMed  Google Scholar 

  12. Mantzoros CS. The role of leptin in human obesity and disease: a review of current evidence. Ann Intern Med. 1999;130(8):671–80.

    PubMed  CAS  Google Scholar 

  13. O’Donnell CP, Schaub CD, Haines AS, Berkowitz DE, Tankersley CG, Schwartz AR, et al. Leptin prevents respiratory depression in obesity. Am J Respir Crit Care Med. 1999;159(5 Pt 1):1477–84.

    PubMed  Google Scholar 

  14. Yee BJ, Cheung J, Phipps P, Banerjee D, Piper AJ, Grunstein RR. Treatment of obesity hypoventilation syndrome and serum leptin. Respiration. 2006;73(2):209–12.

    PubMed  CAS  Google Scholar 

  15. Phipps PR, Starritt E, Caterson I, Grunstein RR. Association of serum leptin with hypoventilation in human obesity. Thorax. 2002;57(1):75–6.

    Article  PubMed  CAS  Google Scholar 

  16. Storre JH, Seuthe B, Fiechter R, Milioglou S, Dreher M, Sorichter S, et al. Average volume-assured pressure support in obesity hypoventilation: a randomized crossover trial. Chest. 2006;130(3):815–21.

    Article  PubMed  Google Scholar 

  17. Gross JB, Bachenberg KL, Benumof JL, Caplan RA, Connis RT, Cote CJ, et al. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2006;104(5):1081–93. quiz 117–8.

    Article  PubMed  Google Scholar 

  18. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case–control study. Mayo Clin Proc. 2001;76(9):897–905.

    PubMed  CAS  Google Scholar 

  19. Passannante AN, Tielborg M. Anesthetic management of patients with obesity with and without sleep apnea. Clin Chest Med. 2009;30(3):569–79.

    Article  PubMed  Google Scholar 

  20. Brodsky JB. Positioning the morbidly obese patient for anesthesia. Obes Surg. 2002;12(6):751–8.

    Article  PubMed  Google Scholar 

  21. Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  PubMed  Google Scholar 

  22. Davies RJ, Stradling JR. The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome. Eur Respir J. 1990;3(5):509–14.

    PubMed  CAS  Google Scholar 

  23. Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85(1):91–108.

    Article  PubMed  CAS  Google Scholar 

  24. Fox GS, Whalley DG, Bevan DR. Anaesthesia for the morbidly obese. Experience with 110 patients. Br J Anaesth. 1981;53(8):811–6.

    Article  PubMed  CAS  Google Scholar 

  25. Juvin P, Lavaut E, Dupont H, Lefevre P, Demetriou M, Dumoulin JL, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg. 2003;97(2):595–600.

    Article  PubMed  Google Scholar 

  26. Davidovic L, LaCovey D, Pitetti RD. Comparison of 1- versus 2-person bag-valve-mask techniques for manikin ventilation of infants and children. Ann Emerg Med. 2005;46(1):37–42.

    Article  PubMed  Google Scholar 

  27. Collins JS, Lemmens HJ, Brodsky JB, Brock-Utne JG, Levitan RM. Laryngoscopy and morbid obesity: a comparison of the “sniff” and “ramped” positions. Obes Surg. 2004;14(9):1171–5.

    Article  PubMed  Google Scholar 

  28. Lee BJ, Kang JM, Kim DO. Laryngeal exposure during laryngoscopy is better in the 25 degrees back-up position than in the supine position. Br J Anaesth. 2007;99(4):581–6.

    Article  PubMed  CAS  Google Scholar 

  29. Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U. Glomerular hemodynamics in severe obesity. Am J Physiol. 2000;278(5):F817–22.

    CAS  Google Scholar 

  30. Hernandez LA, Peevy KJ, Moise AA, Parker JC. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits. J Appl Physiol. 1989;66(5):2364–8.

    PubMed  CAS  Google Scholar 

  31. Dreyfuss D, Saumon G. Ventilator-induced lung injury: lessons from experimental studies. Am J Respir Crit Care Med. 1998;157(1):294–323.

    PubMed  CAS  Google Scholar 

  32. Talmor D, Sarge T, Malhotra A, O’Donnell CR, Ritz R, Lisbon A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med. 2008;359(20):2095–104.

    Article  PubMed  CAS  Google Scholar 

  33. Pelosi P, Chiumello D, Calvi E, Taccone P, Bottino N, Panigada M, et al. Effects of different continuous positive airway pressure devices and periodic hyperinflations on respiratory function. Crit Care Med. 2001;29(9):1683–9.

    Article  PubMed  CAS  Google Scholar 

  34. Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol. 1970;28(5):596–608.

    PubMed  CAS  Google Scholar 

  35. Loring SH, O’Donnell CR, Behazin N, Malhotra A, Sarge T, Ritz R, et al. Esophageal pressures in acute lung injury: do they represent artifact or useful information about transpulmonary pressure, chest wall mechanics, and lung stress? J Appl Physiol. 2010;108(3):515–22.

    Article  PubMed  Google Scholar 

  36. Malhotra A. Low-tidal-volume ventilation in the acute respiratory distress syndrome. N Engl J Med. 2007;357(11):1113–20.

    Article  PubMed  CAS  Google Scholar 

  37. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347–54.

    Article  PubMed  CAS  Google Scholar 

  38. Caramez MP, Kacmarek RM, Helmy M, Miyoshi E, Malhotra A, Amato MB, et al. A comparison of methods to identify open-lung PEEP. Intensive Care Med. 2009;35(4):740–7.

    Article  PubMed  Google Scholar 

  39. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351(4):327–36.

    Article  PubMed  Google Scholar 

  40. Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, et al. 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(6):637–45.

    Article  PubMed  CAS  Google Scholar 

  41. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299(6):646–55.

    Article  PubMed  CAS  Google Scholar 

  42. Malbrain ML, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med. 2004;30(5):822–9.

    Article  PubMed  Google Scholar 

  43. Owens RL, Harris RS, Malhotra A. Is the way to man’s heart (and lung) through the abdomen? Crit Care (Lond). 2009;13(6):199.

    Article  Google Scholar 

  44. The 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):1301–8.

    Article  Google Scholar 

  45. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group. Am J Respir Crit Care Med. 1999;159(4 Pt 1):1249–56.

    PubMed  CAS  Google Scholar 

  46. Horner RL, Innes JA, Holden HB, Guz A. Afferent pathway(s) for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia. J Physiol. 1991;436: 31–44.

    PubMed  CAS  Google Scholar 

  47. Parlow JL, Ahn R, Milne B. Obesity is a risk factor for failure of “fast track” extubation following coronary artery bypass surgery. Can J Anaesth. 2006;53(3):288–94.

    Article  PubMed  Google Scholar 

  48. Borracci RA, Dayan R, Rubio M, Axelrud G, Ochoa G, Rodriguez LD. Operating room extubation (ultra fast-track anesthesia) in patients undergoing on-pump and off-pump cardiac surgery. Arch Cardiol Mex. 2006;76(4):383–9.

    PubMed  Google Scholar 

  49. Girault C, Daudenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G. Noninvasive ventilation as a systematic extubation and weaning technique in acute-on-chronic respiratory failure: a prospective, randomized controlled study. Am J Respir Crit Care Med. 1999;160(1):86–92.

    PubMed  CAS  Google Scholar 

  50. Heinzer RC, Stanchina ML, Malhotra A, Fogel RB, Patel SR, Jordan AS, et al. Lung volume and continuous positive airway pressure requirements in obstructive sleep apnea. Am J Respir Crit Care Med. 2005;172(1):114–7.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA

    Mikhail Litinski M.D.

  2. Divisions of Sleep and Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, 221 Longwood Avenue, BLI 035Q, Boston, MA, 02115, USA

    Robert L. Owens M.D.

  3. Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Atul Malhotra M.D.

Authors
  1. Mikhail Litinski M.D.
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  2. Robert L. Owens M.D.
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  3. Atul Malhotra M.D.
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Corresponding author

Correspondence to Mikhail Litinski M.D. .

Editor information

Editors and Affiliations

  1. , Pulmonary and Critical Care Medicine, University of Vermont College of Medicin, 89 Beaumont Ave., Burlington, 05405, Vermont, USA

    Anne E. Dixon

  2. , Clinical Development Medical Affairs, Respiratory Boehringer Ingelheim Pharmac, N/A, Ridgefield, 06877, Connecticut, USA

    Emmanuelle M. Clerisme-Beaty

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Litinski, M., Owens, R.L., Malhotra, A. (2013). Mechanical Ventilation of Patients with Severe Obesity. In: Dixon, A., Clerisme-Beaty, E. (eds) Obesity and Lung Disease. Respiratory Medicine, vol 19. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-053-3_11

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  • DOI: https://doi.org/10.1007/978-1-62703-053-3_11

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-62703-052-6

  • Online ISBN: 978-1-62703-053-3

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