Zusammenfassung
Adipositas ist in den westlichen Industrienationen auf dem Vormarsch und daher auch für die Intensivmedizin zunehmend von Bedeutung. Entgegen der landläufigen Meinung, dass adipöse Intensiv-Patienten wohl eine erhöhte Mortalität haben dürften, zeigen überzeugende Meta-Analysen dass dem nicht so ist. Nichtsdestotrotz sind adipöse Intensiv-Patienten eine Herausforderung. Insbesondere die Beatmung dieser Patienten ist erwähnenswert: neben den anatomischen Besonderheiten, die die Intubation adipöser Patienten erschweren können, sind obstruktive Schlafapnoe, das Adipositas-Hypoventilations-Syndrom und der erhöhte intraabdominale Druck in Hinblick auf Beatmung, Entwöhnung und erfolgreiche Extubation zu nennen. Auch das Risiko für Infektionen ist bei adipösen Intensivpatienten erhöht, wenngleich damit kein erhöhtes Sepsisrisiko einherzugehen scheint. Unabhängig davon ist die mögliche Interaktion von Adipositas und Sepsis faszinierend, wenngleich die Rolle der Adipokine in der Sepsis des adipösen Patienten noch nicht aufgeklärt ist.
Summary
Obesity is on the advance in western industrialised countries and is therefore increasingly relevant also to intensive care medicine. In contrast to the common prejudice that obese patients probably have a higher ICU mortality than lean patients, convincing meta-analyses have revealed that this is not the case. Nevertheless, obese ICU patients are challenging. Especially mechanic ventilation has to be addressed: besides obesity-related anatomical problems that may complicate intubation, obstructive sleep apnoea, obesity hypoventilation syndrome and increased intra-abdominal pressure are of major relevance concerning ventilation, weaning and successful extubation. Also the risk of infections is increased in obese ICU patients, although this does not seem to increase the risk of sepsis. Nevertheless, the interplay of obesity and sepsis is a fascinating field in that adipous tissue is not just a passive reservoir of energy but an active endocrine and immunomodulating organ. However, the way of how adipokines interact with inflammation and coagulation in sepsis has yet to be clarified.
Article PDF
Avoid common mistakes on your manuscript.
References
Wang Y, Beydun M. The obesity epidemic in the United States – gender, age, socioeconomic, racial/ethnic and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev, 29: 6–28, 2007
Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med, 359: 2105–2120, 2008
Klenk J, Nagel G, Ulmer H, et al. Body mass index and mortality: results of a cohort of 184,697 adults in Austria. Europ J Epidemiol, 24: 83–91, 2009
Sakr Y, Madl C, Filipescu D, et al. Obesity is associated with increased morbidity but not mortality in critically ill patients. Intensive Care Med, 34: 1999–2009, 2008
Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obesity, 16: 515–521, 2008
Akinnusi M, Pineda L, Solh A. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med, 36: 151–158, 2008
El-Solh A, Sikka P, Bozkanat E, et al. Morbid obesity in the medical ICU. Chest, 120: 1989–1997, 2001
Bochicchio G, Joshi M, Bochicchio K, et al. Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg, 203: 533–538, 2006
Newell M, Bard M, Goettler C, et al. Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg, 204: 1056–1061, 2007
Frat JP, Gissot V, Ragot S, et al. Impact of obesity in mechanically ventilated patients. Intensive Care Med, 34: 1991–1998, 2008
Malhotra A, Hillman D. Obesity and the lung: obesity, respiration and intensive care. Thorax, 63: 925–931, 2008
Ceylan E, Cömlekci A, Akkoclu A, et al. The effects of body fat distribution on pulmonary function tests in the overweight and obese. South Med J, 102: 30–35, 2009
Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg, 97: 595–600, 2003
Malbrain M, Cheatham M, Kirkpatrick A, et al. Results from the international Conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med, 32: 1453–1458, 2006
Leone N, Courbon D, Thomas F, et al. Lung function impairment and metabolic syndrom; the critical role of abdominal obesity. Am J Resp Crit Care Med, 179: 509–516, 2009
Marik P, Varon J. The obese patient in the ICU. Chest, 113: 492–498, 1998
Talmor D, Sarge T, O'Donnel C, et al. Esophageal and transpulmonary pressure in acute respiratory failure. Crit Care Med, 34: 1389–1394, 2006
Al Lawati N, Patel S, Ayas N. Epidemiology, risk factors, and consequences of obstructive sleep apnea and short sleep duration. Prog Cardiovasc Dis, 51: 285–293, 2009
Nowbar S, Burkart K, Gonzales R, et al. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects and outcome. Am J Med, 116: 1–7, 2004
El-Solh A, Aquilina A, Pineda L, et al. Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients. Eur Resp J, 28: 588–595, 2006
Heinzer R, Stanchina M, Malhotra A, et al. Lung volume and continuous positive airway pressure requirements in obstructive sleep apnoea. Am J Resp Crit Care Med, 172: 114–117, 2005
Lee W, Mokhlesi B. Diagnosis and management of obesity hypoventilation syndrome in the ICU. Crit Care Clin, 24: 533–549, 2008
Dossett L, Dageforde L, Swenson B, et al. Obesity and site-specific nosocomial infection risk in the intensive care unit. Surg Infect, 10: 137–142, 2009
Newell M, Bard M, Goettler C, et al. Body mass index and outcome in critically injures blunt trauma patients: weighing the impact. J Am Coll Surg, 204: 1056–1064, 2007
Smith R, Chong T, Hedrick T, et al. Does body mass index affect infection-related outcomes in the intensive care unit? Surg Infect, 8: 581–588, 2007
Bernard G, Vincent J, Laterre P, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med, 344: 699–709, 2001
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, 342: 1301–1308, 2000
Vachharajani V. Influence of obesity on sepsis. Pathophysiology, 15: 123–134, 2008
Hauner H. Secretory factors from human adipous tissue and their functional role. Proc Nutr Soc, 64: 163–169, 2005
Lord G, Matarese G, Howard J, et al. Leptin modulates the T-cell immune response and reverses starvation-induced immunosuppression. Nature, 394: 897–901, 1998
Rodriguez L, Graniel J, Ortitz R. Effect of leptin on activation and cytokine synthesis in peripheral blood lymphocytes of malnurishes infected children. Clin Exp Immunol, 148: 478–485, 2007
Considine R, Sinha M, Heiman M, et al. Serum immunoreactive-leptin concentrations in normal-weight and obese humans. N Engl J Med, 334: 292–295, 1996
Hsu A, Aronoff D, Phipps J, et al. Leptin improves pulmonary bacterial clearance and survival in ob/ob mice during pneumococcal pneumonia. Clin Exp Immunol, 150: 332–339, 2007
Bornstein S, Licinio J, Tauchnitz R, et al. Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab, 83: 280–283, 1998
Bracho-Riquelme R, Reyes-Romero M, Pescador N, et al. A leptin serum concentration less than 10 ng/ml is a predictive marker of outcome in patients with moderate to severe secondary peritonitis. Eur Surg Res, 41: 238–244, 2008
Blanco-Quirós A, Casado-Flores J, Nieto-Moro M, et al. Meningococcal sepsis in pediatrics. Parameters associated with poor outcome. An Pediatr, 61: 305–313, 2004
Blanco-Quiros A, Casado-Flores J, Arranz E, et al. Influence of leptin levels and body weight in survival of children with sepsis. Acta Paediatr, 91: 626–631, 2002
Ouchi N, Kihara S, Arita Y, et al. Novel modulator for endothelial adhesion molecules: adipocyte-derived plasma protein adiponectin. Circulation, 100(25): 2473–2476, 1999
Uji Y, Yamamoto H, Tsuchihashi H, et al. Adiponectin deficiency is associated with severe polymicrobial sepsis, high inflammatory cytokine levels, and high mortality. Surgery, 145: 550–557, 2009
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Miehsler, W. Mortality, morbidity and special issues of obese ICU patients. Wien Med Wochenschr 160, 124–128 (2010). https://doi.org/10.1007/s10354-010-0767-4
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10354-010-0767-4