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Anesthetic Considerations for the Trauma Patient with Obesity

  • ANESTHESIA FOR TRAUMA (TE GRISSOM, SECTION EDITOR)
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Abstract

Purpose of Review

This article aims to review the specific challenges anesthesiologists may face when caring for trauma patients with obesity and provide current anesthetic strategies to treat injuries and reduce complications.

Recent Findings

The concept of the cushion effect and obesity paradox is controversial. While some studies state that obesity may be protective in the setting of penetrating or blunt trauma, other studies find that obesity increases the risk of complications, perhaps due to the increased incidence of associated comorbidities in this population.

Summary

Trauma is one of the leading causes of death worldwide. As the prevalence of obesity continues to rise, it is imperative to understand the best practices to manage the trauma patient with obesity. Trauma patients with obesity present unique challenges after motor vehicle crashes, penetrating injury, and falls due to physiological and anatomical alterations. Furthermore, there are several comorbidities and complications associated with obesity that can lead to serious consequences if not adequately managed.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Heron M. Deaths: Leading causes for 2018. Natl Vital Stat Rep. 2021;70(4):1–115.

    PubMed  Google Scholar 

  2. Glance LG, Li Y, Osler TM, Mukamel DB, Dick AW. Impact of obesity on mortality and complications in trauma patients. Ann Surg. 2014;259(3):576–81. https://doi.org/10.1097/SLA.0000000000000330.

    Article  PubMed  Google Scholar 

  3. • Gray S, Dieudonne B. Optimizing care for trauma patients with obesity. Cureus. 2018;10(7):e3021. doi: https://doi.org/10.7759/cureus.3021. This review discussed the recognition of obesity as a chronic disease and analyzed its contribution to the pathophysiology of trauma patients. By analyzing the contributing factors of obesity in the settings of critical care and initial resusicitation, this review also provided evidence-based recommendations for the optimal resuscitation for patients with obesity.

  4. Jehle D, Doshi C, Karagianis J, Consiglio J, Jehle G. Obesity and seatbelt use: a fatal relationship. Am J Emerg Med. 2014;32(7):756–60. https://doi.org/10.1016/j.ajem.2014.01.010.

    Article  PubMed  Google Scholar 

  5. Jehle D, Gemme S, Jehle C. Influence of obesity on mortality of drivers in severe motor vehicle crashes. Am J Emerg Med. 2012;30(1):191–5. https://doi.org/10.1016/j.ajem.2010.10.017.

    Article  PubMed  Google Scholar 

  6. Carter PM, Flannagan CA, Reed MP, Cunningham RM, Rupp JD. Comparing the effects of age, BMI and gender on severe injury (AIS 3+) in motor-vehicle crashes. Accid Anal Prev. 2014;72:146–60. https://doi.org/10.1016/j.aap.2014.05.024.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rupp JD, Flannagan CAC, Leslie AJ, Hoff CN, Reed MP, Cunningham RM. Effects of BMI on the risk and frequency of AIS 3+ injuries in motor-vehicle crashes. Obesity. 2013;21(1):E88–97. https://doi.org/10.1002/oby.20079.

    Article  PubMed  Google Scholar 

  8. Kent RW, Forman JL, Bostrom O. Is there really a “cushion effect”?: a biomechanical investigation of crash injury mechanisms in the obese. Obesity (Silver Spring). 2010;18(4):749–53. https://doi.org/10.1038/oby.2009.315.

    Article  Google Scholar 

  9. Chuang JF, Rau CS, Kuo PJ, Chen YC, Hsu SY, Hsieh HY, et al. Traumatic injuries among adult obese patients in southern Taiwan: a cross-sectional study based on a trauma registry system. BMC Public Health. 2016;16:275. https://doi.org/10.1186/s12889-016-2950-z.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Desapriya E, Giulia S, Subzwari S, Peiris DC, Turcotte K, Pike I, et al. Does obesity increase the risk of injury or mortality in motor vehicle crashes? A systematic review and meta-analysis. Asia Pac J Public Health. 2014;26(5):447–60. https://doi.org/10.1177/1010539511430720.

    Article  PubMed  Google Scholar 

  11. Elkbuli A, Dowd B, Spano PJ 2nd, Hai S, Boneva D, McKenney M. The association between seatbelt use and trauma outcomes: does body mass index matter? Am J Emerg Med. 2019;37(9):1716–9. https://doi.org/10.1016/j.ajem.2018.12.023.

    Article  PubMed  Google Scholar 

  12. Hartka TR, Carr HM, Smith BR, Melmer M, Sochor MR. Does obesity affect the position of seat belt loading in occupants involved in real-world motor vehicle collisions? Traffic Inj Prev. 2018;19(sup1):S70–5. https://doi.org/10.1080/15389588.2017.1381337.

    Article  PubMed  Google Scholar 

  13. Xu G, Zhou Y, Zhou F. Development and validation of an immunity-related classifier of nine chemokines for predicting recurrence in stage I-III patients with colorectal cancer after operation. Cancer Manag Res. 2018;10:4051–64. https://doi.org/10.2147/CMAR.S174452.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Arbabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma. 2003;54(6):1090–3. https://doi.org/10.1097/01.Ta.0000064449.11809.48.

    Article  PubMed  Google Scholar 

  15. Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol. 2014;29(11):801–12. https://doi.org/10.1007/s10654-014-9961-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Tee YS, Cheng CT, Hsieh CH, Kang SC, Fu CY, Derstine BA, et al. Does a “cushion effect” really exist? A morphomic analysis of vulnerable road users with serious blunt abdominal injury. Healthcare (Basel). 2021;9(8). https://doi.org/10.3390/healthcare9081006.

  17. Ryb GE, Dischinger PC. Injury severity and outcome of overweight and obese patients after vehicular trauma: a crash injury research and engineering network (CIREN) study. J Trauma. 2008;64(2):406–11. https://doi.org/10.1097/ta.0b013e31802beff9.

    Article  PubMed  Google Scholar 

  18. Pal C, Tomosaburo O, Vimalathithan K, Jeyabharath M, Muthukumar M, Satheesh N, et al. Effect of weight, height and BMI on injury outcome in side impact crashes without airbag deployment. Accid Anal Prev. 2014;72:193–209. https://doi.org/10.1016/j.aap.2014.06.020.

    Article  PubMed  Google Scholar 

  19. Bloom MB, Ley EJ, Liou DZ, Tran T, Chung R, Melo N, et al. Impact of body mass index on injury in abdominal stab wounds: implications for management. J Surg Res. 2015;197(1):162–6. https://doi.org/10.1016/j.jss.2015.03.052.

    Article  PubMed  Google Scholar 

  20. • Nash N, Kimbrough CW, Mackowski M, Benns MV, Smith JW, Harbrecht BG, et al. Is obesity protective in thoracoabdominal penetrating trauma? Am Surg. 2019;85(1):34-8. This retrospective study evaluated the protective effect of obesity in thoracoabdominal trauma. It found that there was no difference in the rate of operative intervention for significant injuries after penetrating trauma in patients with obesity and that obesity was not associated with increased complications, prolonged length of stay, or death.

  21. Osborne Z, Rowitz B, Moore H, Oliphant U, Butler J, Olson M, et al. Obesity in trauma: outcomes and disposition trends. Am J Surg. 2014;207(3):387-92; discussion 91-2. https://doi.org/10.1016/j.amjsurg.2013.10.013.

  22. • Drury B, Kocharians C, Dong F, Tran L, Beroukhim S, Hajjafar R, et al. Impact of obesity on mortality in adult trauma patients. Cureus. 2021;13(2):e13352. https://doi.org/10.7759/cureus.13352. This retrospective review article investigated whether differences in BMI had an impact on the mortality of trauma patients. It revealed that there was no statistically significant difference in mortality among patients with obesity, patients without obesity, and patient who are overweight.

  23. Dvorak JE, Lester ELW, Maluso PJ, Tatebe L, Schlanser V, Kaminsky M, et al. The Obesity Paradox in the Trauma Patient: Normal May not Be Better. World J Surg. 2020;44(6):1817–23. https://doi.org/10.1007/s00268-020-05398-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chen JL, Urman RD, Moon TS. The trauma patient with obesity: anesthetic challenges. Int Anesthesiol Clin. 2020;58(3):58–65. https://doi.org/10.1097/AIA.0000000000000279.

    Article  PubMed  Google Scholar 

  25. Pandey A, LaMonte M, Klein L, Ayers C, Psaty BM, Eaton CB, et al. Relationship between physical activity, body mass index, and risk of heart failure. J Am Coll Cardiol. 2017;69(9):1129–42. https://doi.org/10.1016/j.jacc.2016.11.081.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Packer M. The conundrum of patients with obesity, exercise intolerance, elevated ventricular filling pressures and a measured ejection fraction in the normal range. Eur J Heart Fail. 2019;21(2):156–62. https://doi.org/10.1002/ejhf.1377.

    Article  CAS  PubMed  Google Scholar 

  27. Sterling SA, Jones AE, Coleman TG, Summers RL. Theoretical analysis of the relative impact of obesity on hemodynamic stability during acute hemorrhagic shock. Arch Trauma Res. 2015;4(3): e22602. https://doi.org/10.5812/atr.22602.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO Jr, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care. 2007;11(5):R100. https://doi.org/10.1186/cc6117.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41(7):1774–81. https://doi.org/10.1097/CCM.0b013e31828a25fd.

    Article  PubMed  Google Scholar 

  30. Hasler RM, Nuesch E, Juni P, Bouamra O, Exadaktylos AK, Lecky F. Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: Multicentre cohort study. Resuscitation. 2012;83(4):476–81. https://doi.org/10.1016/j.resuscitation.2011.10.018.

    Article  PubMed  Google Scholar 

  31. Jin J. Obesity and the Heart. JAMA. 2013;310(19):2113. https://doi.org/10.1001/jama.2013.281901.

    Article  CAS  PubMed  Google Scholar 

  32. Csige I, Ujvárosy D, Szabó Z, Lőrincz I, Paragh G, Harangi M, et al. The impact of obesity on the cardiovascular system. Journal of Diabetes Research. 2018;2018:3407306. https://doi.org/10.1155/2018/3407306.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52. https://doi.org/10.1016/S0140-6736(04)17018-9.

    Article  PubMed  Google Scholar 

  34. Fotopoulou G, Vasileiou I, Dre K, Ntoka P, Lampadariou A, Tsinari K. Can we predict difficult intubation in obese patients?: 19AP4-7. Eur J Anaesthesiol. 2011;28:234.

    Article  Google Scholar 

  35. Moon TS, Fox PE, Somasundaram A, Minhajuddin A, Gonzales MX, Pak TJ, et al. The influence of morbid obesity on difficult intubation and difficult mask ventilation. J Anesth. 2019;33(1):96–102. https://doi.org/10.1007/s00540-018-2592-7.

    Article  PubMed  Google Scholar 

  36. Lundstrom LH, Moller AM, Rosenstock C, Astrup G, Wetterslev J. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology. 2009;110(2):266–74. https://doi.org/10.1097/ALN.0b013e318194cac8.

    Article  PubMed  Google Scholar 

  37. Wang T, Sun S, Huang S. The association of body mass index with difficult tracheal intubation management by direct laryngoscopy: a meta-analysis. BMC Anesthesiol. 2018;18(1):79. https://doi.org/10.1186/s12871-018-0534-4.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Aceto P, Perilli V, Modesti C, Ciocchetti P, Vitale F, Sollazzi L. Airway management in obese patients. Surg Obes Relat Dis. 2013;9(5):809–15. https://doi.org/10.1016/j.soard.2013.04.013.

    Article  PubMed  Google Scholar 

  39. Moon TS, Tai K, Kim A, Gonzales MX, Lu R, Pak T, et al. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, double-blinded, controlled trial of nasal cannula oxygen administration. Obes Surg. 2019;29(12):3992–9. https://doi.org/10.1007/s11695-019-04077-y.

    Article  PubMed  Google Scholar 

  40. •• Moon TS, Van de Putte P, De Baerdemaeker L, Schumann R. The obese patient: facts, fables, and best practices. Anesth Analg. 2020. doi: https://doi.org/10.1213/ANE.0000000000004772. This review article provides up-to-date information in managing patients with obesity including best practices for airway management.

  41. De Jong A, Wrigge H, Hedenstierna G, Gattinoni L, Chiumello D, Frat JP, et al. How to ventilate obese patients in the ICU. Intensive Care Med. 2020;46(12):2423–35. https://doi.org/10.1007/s00134-020-06286-x.

    Article  PubMed  Google Scholar 

  42. • Costa Souza GM, Santos GM, Zimpel SA, Melnik T. Intraoperative ventilation strategies for obese patients undergoing bariatric surgery: systematic review and meta-analysis. BMC Anesthesiol. 2020;20(1):36. https://doi.org/10.1186/s12871-020-0936-y. This systematic review assessed the effectiveness of different ventilation strategies in patients with obesity undergoing bariatric surgery.

  43. •• de Raaff CAL, Gorter-Stam MAW, de Vries N, Sinha AC, Jaap Bonjer H, Chung F, et al. Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline. Surg Obes Relat Dis. 2017;13(7):1095-109. https://doi.org/10.1016/j.soard.2017.03.022. This expert consensus guideline provided best practices for the perioperative management of patients with obstructive sleep apnea undergoing bariatric surgery.

  44. Opperer M, Cozowicz C, Bugada D, Mokhlesi B, Kaw R, Auckley D, et al. Does obstructive sleep apnea influence perioperative outcome? A qualitative systematic review for the society of anesthesia and sleep medicine task force on preoperative preparation of patients with sleep-disordered breathing. Anesth Analg. 2016;122(5):1321–34. https://doi.org/10.1213/ANE.0000000000001178.

    Article  PubMed  Google Scholar 

  45. Singh M, Liao P, Kobah S, Wijeysundera DN, Shapiro C, Chung F. Proportion of surgical patients with undiagnosed obstructive sleep apnoea. Br J Anaesth. 2013;110(4):629–36. https://doi.org/10.1093/bja/aes465.

    Article  CAS  PubMed  Google Scholar 

  46. Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, et al. Society of anesthesia and sleep medicine guidelines on preoperative screening and assessment of adult patients with obstructive sleep apnea. Anesth Analg. 2016;123(2):452–73. https://doi.org/10.1213/ANE.0000000000001416.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Chung F, Yang Y, Liao P. Predictive performance of the STOP-Bang score for identifying obstructive sleep apnea in obese patients. Obes Surg. 2013;23(12):2050–7. https://doi.org/10.1007/s11695-013-1006-z.

    Article  PubMed  Google Scholar 

  48. Lam KK, Kunder S, Wong J, Doufas AG, Chung F. Obstructive sleep apnea, pain, and opioids: is the riddle solved? Curr Opin Anaesthesiol. 2016;29(1):134–40. https://doi.org/10.1097/ACO.0000000000000265.

    Article  PubMed  Google Scholar 

  49. Alvarez A, Singh PM, Sinha AC. Postoperative analgesia in morbid obesity. Obes Surg. 2014;24(4):652–9. https://doi.org/10.1007/s11695-014-1185-2.

    Article  PubMed  Google Scholar 

  50. • de Raaff CAL, de Vries N, van Wagensveld BA. Obstructive sleep apnea and bariatric surgical guidelines: summary and update. Curr Opin Anaesthesiol. 2018;31(1):104-9. https://doi.org/10.1097/ACO.0000000000000542. This review provides guideline regarding patients with obstructive sleep apnea undergoing bariatric surgery including proper identification and management of obstructive sleep apnea.

  51. Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga M. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28(151). https://doi.org/10.1183/16000617.0097-2018.

  52. •• Kaw R, Wong J, Mokhlesi B. Obesity and obesity hypoventilation, sleep hypoventilation, and postoperative respiratory failure. Anesth Analg. 2021;132(5):1265-73. doi: https://doi.org/10.1213/ANE.0000000000005352. This review highlights the clinical distinction between obesity hypoventilation syndrome and obstructive sleep apnea including up to date screening and management practices.

  53. Mokhlesi B, Masa JF, Brozek JL, Gurubhagavatula I, Murphy PB, Piper AJ, et al. Evaluation and management of obesity hypoventilation syndrome. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019;200(3):e6-e24. https://doi.org/10.1164/rccm.201905-1071ST.

  54. Nelson JA, Loredo JS, Acosta JA. The obesity-hypoventilation syndrome and respiratory failure in the acute trauma patient. J Emerg Med. 2011;40(4):e67-9. https://doi.org/10.1016/j.jemermed.2007.12.022.

    Article  PubMed  Google Scholar 

  55. Lai HC, Lai HC, Wang KY, Lee WL, Ting CT, Liu TJ. Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth. 2007;99(2):184–90. https://doi.org/10.1093/bja/aem126.

    Article  PubMed  Google Scholar 

  56. Hrymak C, Strumpher J, Jacobsohn E. Acute right ventricle failure in the intensive care unit: assessment and management. Can J Cardiol. 2017;33(1):61–71. https://doi.org/10.1016/j.cjca.2016.10.030.

    Article  PubMed  Google Scholar 

  57. Wattanakit K, Lutsey PL, Bell EJ, Gornik H, Cushman M, Heckbert SR, et al. Association between cardiovascular disease risk factors and occurrence of venous thromboembolism. A time-dependent analysis Thromb Haemost. 2012;108(3):508–15. https://doi.org/10.1160/th11-10-0726.

    Article  CAS  PubMed  Google Scholar 

  58. Toker S, Hak DJ, Morgan SJ. Deep vein thrombosis prophylaxis in trauma patients. Thrombosis. 2011;2011: 505373. https://doi.org/10.1155/2011/505373.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Obokata M, Reddy YNV, Pislaru SV, Melenovsky V, Borlaug BA. Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation. 2017;136(1):6–19. https://doi.org/10.1161/CIRCULATIONAHA.116.026807.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Ihaddadene R, Carrier M. The use of anticoagulants for the treatment and prevention of venous thromboembolism in obese patients: implications for safety. Expert Opin Drug Saf. 2016;15(1):65–74. https://doi.org/10.1517/14740338.2016.1120718.

    Article  CAS  PubMed  Google Scholar 

  61. Chang P, Friedenberg F. Obesity and GERD. Gastroenterol Clin North Am. 2014;43(1):161–73. https://doi.org/10.1016/j.gtc.2013.11.009.

    Article  PubMed  Google Scholar 

  62. Zalar A, Haddouche B, Antonietti M, Alhameedi R, Iwanicki-Caron I, Lecleire S, et al. Lack of correlation between morbid obesity and severe gastroesophageal reflux disease in candidates for bariatric surgery: results of a large prospective study. Obes Surg. 2013;23(11):1939–41. https://doi.org/10.1007/s11695-013-1064-2.

    Article  PubMed  Google Scholar 

  63. Reis Lde A, Reis GF, Oliveira MR. The airways and gastric contents in obese patients. Rev Bras Anestesiol. 2010;60(1):98–103. https://doi.org/10.1016/s0034-7094(10)70012-x.

    Article  PubMed  Google Scholar 

  64. Patell R, Dosi R, Joshi H, Sheth S, Shah P, Jasdanwala S. Non-alcoholic fatty liver disease (NAFLD) in obesity. J Clin Diagn Res. 2014;8(1):62–6. https://doi.org/10.7860/JCDR/2014/6691.3953.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Hunt H, Stanworth S, Curry N, Woolley T, Cooper C, Ukoumunne O, et al. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) for trauma induced coagulopathy in adult trauma patients with bleeding. Cochrane Database Syst Rev. 2015;2015(2):Cd010438. https://doi.org/10.1002/14651858.CD010438.pub2.

    Article  PubMed Central  Google Scholar 

  66. •• Anderson MR, Shashaty MGS. Impact of obesity in critical illness. Chest. 2021. https://doi.org/10.1016/j.chest.2021.08.001. This review article highlights the important physiological changes that accompany obesity and provides insight into how these changes can affect the various aspects of anesthestic management including VTE prophyalxis, drug dosing, and ventilation strategies.

  67. Moon T, Ogunnaike B. Pharmacokinetics and pharmacodynamics in obesity. In: Sinha A, editor. Oxford Textbook of Anaesthesia for the Obese Patient. Oxford University Press; 2021.

  68. Bano G. Glucose homeostasis, obesity and diabetes. Best Pract Res Clin Obstet Gynaecol. 2013;27(5):715–26. https://doi.org/10.1016/j.bpobgyn.2013.02.007.

    Article  PubMed  Google Scholar 

  69. Karunakar MA, Staples KS. Does stress-induced hyperglycemia increase the risk of perioperative infectious complications in orthopaedic trauma patients? J Orthop Trauma. 2010;24(12):752–6. https://doi.org/10.1097/BOT.0b013e3181d7aba5.

    Article  PubMed  Google Scholar 

  70. Richards JE, Kauffmann RM, Obremskey WT, May AK. Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit. J Orthop Trauma. 2013;27(1):16–21. https://doi.org/10.1097/BOT.0b013e31825d60e5.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Rau CS, Wu SC, Chen YC, Chien PC, Hsieh HY, Kuo PJ, et al. Higher mortality in trauma patients is associated with stress-induced hyperglycemia, but not diabetic hyperglycemia: a cross-sectional analysis based on a propensity-score matching approach. Int J Environ Res Public Health. 2017;14(10). https://doi.org/10.3390/ijerph14101161.

  72. Di Luzio R, Dusi R, Mazzotti A, Petroni ML, Marchesini G, Bianchi G. Stress Hyperglycemia and complications following traumatic injuries in individuals with/without diabetes: the case of orthopedic surgery. Diabetes Metab Syndr Obes. 2020;13:9–17. https://doi.org/10.2147/dmso.S225796.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Meizoso JP, Ray JJ, Karcutskie CAT, Teisch LF, Allen CJ, Namias N, et al. Admission hyperglycemia is associated with different outcomes after blunt versus penetrating trauma. J Surg Res. 2016;206(1):83–9. https://doi.org/10.1016/j.jss.2016.07.012.

    Article  CAS  PubMed  Google Scholar 

  74. Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12):1471–8. https://doi.org/10.4065/78.12.1471.

    Article  PubMed  Google Scholar 

  75. Hsu CW. Glycemic control in critically ill patients. World J Crit Care Med. 2012;1(1):31–9. https://doi.org/10.5492/wjccm.v1.i1.31.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, McArthur C, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med. 2012;367(12):1108–18. https://doi.org/10.1056/NEJMoa1204942.

    Article  CAS  PubMed  Google Scholar 

  77. Finfer S, Chittock DR, Su SY, Blair D, Foster D, Dhingra V, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97. https://doi.org/10.1056/NEJMoa0810625.

    Article  PubMed  Google Scholar 

  78. Byrnes MC, McDaniel MD, Moore MB, Helmer SD, Smith RS. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7. https://doi.org/10.1097/01.ta.0000152081.67588.10.

    Article  PubMed  Google Scholar 

  79. Farhat A, Grigorian A, Nguyen NT, Smith B, Williams BJ, Schubl SD, et al. Obese trauma patients have increased need for dialysis. Eur J Trauma Emerg Surg. 2020;46(6):1327–34. https://doi.org/10.1007/s00068-019-01147-9.

    Article  PubMed  Google Scholar 

  80. Thongprayoon C, Cheungpasitporn W, Akhoundi A, Ahmed AH, Kashani KB. Actual versus ideal body weight for acute kidney injury diagnosis and classification in critically ill patients. BMC Nephrol. 2014;15:176. https://doi.org/10.1186/1471-2369-15-176.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Jiang J, Zhang J, Liu Y, Xu D, Peng Z. Urine output calculated using actual body weight may result in overestimation of acute kidney injury for obese patients. Shock. 2021. https://doi.org/10.1097/shk.0000000000001789.

    Article  PubMed  PubMed Central  Google Scholar 

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Matthew W. Oh, B.S.: drafting and revision of manuscript; Jesus Valencia, B.S.: drafting and revision of manuscript; Tiffany Sun Moon, M.D.: drafting and revision of manuscript.

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Correspondence to Tiffany S. Moon.

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Oh, M.W., Valencia, J. & Moon, T.S. Anesthetic Considerations for the Trauma Patient with Obesity. Curr Anesthesiol Rep 12, 200–209 (2022). https://doi.org/10.1007/s40140-021-00508-8

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