Skip to main content
SpringerLink
Log in

Der adipöse Patient im Rettungsdienst

The obese patient and emergency medicine

  • Rettungsdienst
  • Published:
Notfall & Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Die Prävalenz der Adipositas ist in Deutschland in den letzten Jahren stetig angestiegen, ungefähr 50% der deutschen Bevölkerung sind übergewichtig. Zur Beurteilung der Adipositas werden verschiedene Größen herangezogen, wie BMI, Fettverteilungsmuster, Waist-to-hip-ratio (WHR) oder Taillen-Hüft-Quotient (THQ). Übergewicht ist mit chronischen Erkrankungen, wie arterieller Hypertonie, pulmonalarterieller Hypertonie, Kardiomyopathie mit Links- und Rechtsherzinsuffizienz, koronarer Herzerkrankung, Diabetes mellitus Typ 2, assoziiert, welche mit einem erhöhten Morbiditäts- und Mortalitätsrisiko einhergehen. Auch psychiatrische Komorbidität ist bekannt. Die Versorgung adipöser Patienten stellt mit ansteigendem BMI eine medizinische und einsatztechnische Herausforderung in der Notfallmedizin dar. Auf die besonderen Schwierigkeiten im Notarzteinsatz bei adipösen Patienten bei der körperlichen Untersuchung (schlechte Zugänglichkeit bestimmter Regionen, erschwerte Befundung aufgrund vermehrtem Fettgewebe), beim Monitoring, bei der Anlage eines venösen bzw. intraossären Zugangs, bei der Intubation, beim Airwaymanagement, bei Atmung und Beatmung, bei Rettung und Transport wird eingegangen, und es werden Lösungsansätze aufgezeigt. Das Outcome ist bei adipösen Patienten grundsätzlich schlechter als bei Normalgewichtigen.

Abstract

The prevalence of obesity in Germany has risen steadily in the last years; about 50% of the German population are overweight. There are various methods for determining obesity, such as BMI, the pattern of fat distribution, and the waist to hip ratio. Overweight is associated with chronic illnesses such as arterial hypertension, pulmoarterial hypertension, cardiomyopathy with left and right heart insufficiency, diabetes mellits type 2, all of which lead to an increased risk of morbidity and mortality. In addition, psychiatric comorbidity is known to occur. The care of obese patients provides an increasing medical and technical challenge in emergency medicine. We discuss the particular difficulties of examining obese patients in the emergency room (problems examining certain areas and in diagnosis due to excessive fatty tissue), at monitoring, in determining venous or intraosseous entrances, in airway management, respiration and artificial respiration, and during rescue and transport, and solutions offered. The outcome is, as a matter of course, worse in obese patients than in those with normal weight.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

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

    Google Scholar 

  2. Agro FE, Galli B, Cataldo R et al. (2002) Relationship between body mass index and ventilation with the Laryngeal Tube® in 228 anesthetized paralyzed patients: a pilot study. Can J Anaesth 49: 641–642

    Google Scholar 

  3. Alpert MA, Terry BE, Cohen MV et al. (2000) The electrocardiogramm in morbid obesity. Am J Cardiol 85: 908–910

    Google Scholar 

  4. Asai T, Kawashima A, Hidaka I, Kawachi S (2002) The laryngeal tube compared with the laryngeal mask: insertion, gas leak pressure and gastric insufflation. Br J Anaesth 89: 729–32

    Article  CAS  PubMed  Google Scholar 

  5. Avidan M, Harvey A, Chitkara N, Ponte J (1999) The intubating laryngeal mask compared with direct laryngoscopy. Br J Anaesth 83: 615–617

    CAS  PubMed  Google Scholar 

  6. Backmann L, Freyschuss V, Hallberg D, Melcher A (1973) Cardiovascular function in extreme obesity. Acta Med Scand 193: 437–446

    Google Scholar 

  7. Bardoczky GI, Yernault JC, Houben JJ, d‚Hollander AA (1995) Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg 81: 385–388

    Google Scholar 

  8. Bergmann KE, Mensink GBM (1999) Körpermaße und Übergewicht. Gesundheitswesen 61 Sonderheft 2: 115–120

    Google Scholar 

  9. Berthoud MC, Peacock JE, Reilly CS (1991) Effectiveness of preoxygenation in morbidly obese patients. Br J Anaesth 67: 464–466

    Google Scholar 

  10. Biddle C (1996) Comparative aspects of the airway during general anesthesia in obese sufferers of sleep apnea and matched normals. Adv Pract Nurs Q 2: 14–19

    Google Scholar 

  11. Biring MS, Lewis MI, Liu JT, Mohsenifar Z (1999) Pulmonary physiologic chances of morbid obesity. Am J Med Sci 318: 293–297

    Google Scholar 

  12. Blanding R, Stiff J (1999) Perioperative anesthetic management of patients with burns. Anesth Clin North Am 17: 237–250

    Google Scholar 

  13. Bond A (1993) Obesity and difficult intubation. Anaesth Intensive Care 21: 828–830

    Google Scholar 

  14. Boulanger BR, Milzmann D, Mitchell K, Rodriguez A (1992) Body habitus as a predictor of injury pattern after blunt trauma. J Trauma 33: 228–232

    Google Scholar 

  15. Brodsky JB (1986) Anesthetic management of the morbidly obese. Int Anesth Clin 24: 93–103

    Google Scholar 

  16. Brugger S, Staudinger T, Frottier P, Frass M (1993) Erfolgreiche Intubation mit dem Combitube bei zwei Patienten mit Stiernacken. AMA 20: 78–80

    Google Scholar 

  17. Brunette DD (2004) Resuscitation of the morbidly obese patient. Am J Emerg Med 22: 40–77

    Google Scholar 

  18. Burns SM, Egloff MB, Ryan B, Carpenter R, Burns JE (1994) Effect of body position on spontaneous respiratory rate and tidal volume in patients with obesity, abdominal distension and ascites. Am J Crit Care 3: 102–106

    Google Scholar 

  19. Burton WN, Chen CY, Schultz AB, Edington DW (1999) The costs of body mass index levels in an employed population. Stat Bull Metrop Insur Co 80: 8–14

    Google Scholar 

  20. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW (1999) Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341: 1097–1105

    Google Scholar 

  21. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1994) Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabet Care 17: 961–969

    Google Scholar 

  22. Clem M, Tierney P (2004) Intraosseous infusions via the calcaneus. Resuscitation 62: 107–112

    Google Scholar 

  23. Cook TM, McCormick B, Asai T (2003) Randomized comparison of laryngeal tube with classic laryngeal mask airway for anaesthesia with controlled ventilation. Br J Anaesth 91: 373–378

    Article  Google Scholar 

  24. Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn DR, Magnusson L (2004) Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg 98: 1491–1505

    Google Scholar 

  25. Damia G, Mascheroni D, Groci M, Tarenzi L (1988) Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth 60: 574–578

    Google Scholar 

  26. Della Puppa A, Pittoni G, Frass M (2002) Tracheal esophageal combitube: a useful airway for morbidly obese patients who cannot intubate or ventilate. Acta Anesth Scand 46: 911–913

    Google Scholar 

  27. Deutsche Adipositas-Gesellschaft (2004) Evidenzbasierte Leitlinie Adipositas, Prävention und Therapie der Adipositas.http://www.adipositas-gesellschaft.de

  28. Duflou J, Virmani R, Rabin I, Burke A, Farb A, Smialek J (1995) Sudden death as a result of heart disease in morbid obesity. Am Heart J 130: 306–313

    Google Scholar 

  29. El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J (2001) Morbid obesity in the medical ICU. Chest 120: 1989–1997

    Article  PubMed  Google Scholar 

  30. European Association for the Study of Obesity (2002) Guidelines for the management of obesity in adults. European Project for Primary Care.http://www.iotf.org/oonet/easo

  31. Ferno Deutschland — Produktübersicht.http://www.ferno.de

  32. Finteis T, Genzwürker H, Blankenburg A, Ellinger K, Kuhnert-Frey B (2001) Atemwegsmanagement durch nicht-ärztliches Personal. Notfall Rettungsmed 4: 327–334

    Article  Google Scholar 

  33. Frappier J, Guenoun T, Journois D, Philippe H, Aka E, Cadi P, Silleran-Chassany J, Safran D (2003) Airway management using the intubating laryngeal mask airway for the morbidly obese patient. Anesth Analg 96: 1510–1515

    Google Scholar 

  34. Gaitini LA, Vaida SJ, Yanovski B, Ben-David B, Hagberg CA (2004) A randomized controlled trial comparing the ProSeal laryngeal mask airway with the laryngeal tube suction in mechanically ventilated patients. Anesthesiology 101: 316–320

    Google Scholar 

  35. Gardner G, Halweil B (2000) The global epidemic of malnutrition. Worldwatch Paper 150, Worldwatch Institute,http://www.worldwatch.org/pubs/paper150/

  36. Garrison RJ, Castelli WP (1985) Weight and thirty-year mortality of men in the Framingham Study. Ann Intern Med 103: 1006–1009

    Google Scholar 

  37. Genzwürker H, Finteis T, Hinkelbein J, Ellinger K (2003) Erste klinische Erfahrungen mit dem neuen LTS. Anaesthesist 52: 697–702

    Article  PubMed  Google Scholar 

  38. Genzwürker H, Hundt A, Finteis T, Ellinger K (2003) Vergleich verschiedene Larynxmasken am Reanimationsmodell. AINS 38: 94–101

    Google Scholar 

  39. Gilbert TB, Seneff MG, Becker RB (1995) Facilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device: results from a prospective dual-center, randomized, crossover clinical study. Crit Care Med 23: 60–65

    Google Scholar 

  40. Goldhaber SZ, Savage DD, Garrison RJ et al. (1983) Risk factors for pulmonary embolism. The Framingham Study. Am J Med 74: 1023–1028

    Google Scholar 

  41. Gottschlich MM, Mayes T, Khoury JC, Warden GD (1993) Significance of obesity on nutritional, immunologic, hormonal, and clinical outcome parameters in burns. J Am Diet Assoc 93: 1261–1268

    Google Scholar 

  42. Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A (2004) Influence of overweight on ICU mortality: a prospective study. Chest 125: 1441–1445

    Google Scholar 

  43. Grant P, Newcombe M (2004) Emergency management of the morbidly obese. Emerg Med Australas 16: 309–317

    Google Scholar 

  44. Gratz I, Afshar M, Kidwell P, Weinmann DS, Shariff HM (1994) Doppler-guided canulation of the internal jugular vein: a prospective randomized trial. J Clin Monitor 10: 185–188

    Google Scholar 

  45. Hatfield A, Bodenham A (1999) Portable ultrasound for difficult central venous access. Br J Anaesth 82: 822–826

    Google Scholar 

  46. Hebebrand J, Dabrock P, Lingenfelder M, Mand E, Rief W, Voit W (2004) Ist Adipositas eine Krankheit? Dtsch Ärztebl 101: 2080–2086

  47. Ho AM, Wong W, Ling E, Chung DC, Tay BA (2001) Airway difficulties caused by improperly applied cricoid pressure. J Emerg Med 20: 29–31

    Google Scholar 

  48. Hoffmeister H, Mensink GBM, Stolzenberg H et al. (1996) Reduction of coronary heart disease risk factors in the German Cardiovascular Prevention Study. Prev Med 25: 135–145

    Google Scholar 

  49. entfällt

  50. Koenig SM (2001) Pulmonary complications of obesity. Am J Med Sci 321: 249–279

    Google Scholar 

  51. Langenstein H, Möller F (1998) Erste Erfahrungen mit der Intubationslarynxmaske. Anästhesist 48: 311–319

  52. Lean ME, Han TS, Morrison CE (1995) Waist circumference as a measure for indicating need for weight management. BMJ 311: 158–161

    Google Scholar 

  53. Lee JJ, Larson RH, Buckley JJ, Roberts RB (1980) Airway maintenance in the morbidly obese. Anesth Rev 7: 33–36

    Google Scholar 

  54. Lobstein T, Frelut ML (2003) Prevalence of overweight among children in Europe. Obes Rev 4: 195–200

    Article  CAS  PubMed  Google Scholar 

  55. Luce JM (1980) Respiratory complications of obesity. Chest 78: 626–631

    Google Scholar 

  56. Mallampati SR, Gatt SP, Gugino LD et al. (1985) A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 32: 429–434

    Google Scholar 

  57. Maxwell MH, Waks AU, Schroth PC, Karam M, Dornfeld LP (1982) Error in blood-pressure measurement due to incorrect cuff size in obese patients. Lancet 2: 33–36

    Google Scholar 

  58. Mock CN, Grossmann DC, Kaufmann RP, Mack CD, Rivara FP (2002) The relationship between body weight and risk of death and serious injury in motor vehicle crashes. Accid Anal Prev 34: 221–228

    Google Scholar 

  59. Natalini G, Franceschetti ME, Pantelidi T, Rosano A, Lanza G, Bernardini A (2003) Comparison of the standard laryngeal mask airway and the ProSeal laryngeal mask airway in obese patients. Br J Anaesth 90: 323–326

    Google Scholar 

  60. Nolan JD (2001) Prehospital and resuscitation airway care: should the goldstandard be reassessed? Curr Opin Crit Care 7: 413–421

    Article  CAS  PubMed  Google Scholar 

  61. Oberg B, Poulson TD (1996) Obesity: an anaesthetic challenge. Acta Anaesth Scand 40: 191–200

    Google Scholar 

  62. Ochi G, Arai T (1992) The influence of obesity and underweightness on respiratory function of geriatric patients undergoing surgery. J Anesth 6: 57–62

    Google Scholar 

  63. Ocker H, Dörges V, Heringlake M, Schmucker P (2000) Der neue Larynx-Tubus vs. Larynxmaske — suffiziente Beatmung mit Aspirationsschutz? Anaesth Intensivmed 41: 376

    Google Scholar 

  64. Pelosi P, Ravagnan I, Giurati G, Panigada M, Bottino N, Tredici S, Eccher G, Gattinoni L (1999) Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. Anesthesiology 91: 1221–1231

    Google Scholar 

  65. Pelosi P, Croci M, Ravagnan I, Cerisara M, Vicardi P, Lissoni A, Gattinoni L (1997) Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. Appl Physiol 82: 811–818

    Google Scholar 

  66. Pelosi P, Croci M, Ravagna I, Tredici S, Pedoto A, Lissoni A, Gattinoni L (1998) The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 87: 654–660

    Google Scholar 

  67. Pelosi P, Croci M, Ravagna I, Vicardi P, Gattinoni L (1996) Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest 109: 144–151

    Google Scholar 

  68. Perilli V, Solazzi L, Bozza P, Modesti C, Chierichini A, Tacchino RM, Ranieri R (2000) The effect of the reverse Trendelenburg position on respiratory mechanics and blood gases in morbidly obese patients during bariatric surgery. Anesth Analg 91: 520–525

    Google Scholar 

  69. Purdue GF, Hunt JL, Lang ED (1990) Obesity: a risk factor in the burn patient. J Burn Care Rehabil 11: 32–34

    Google Scholar 

  70. Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24: 2053–2058

    Google Scholar 

  71. Robertson IK, Eltringham RJ (1985) Anaesthetic management of the morbidly obese. Br J Hosp Med 34: 224–228

    Google Scholar 

  72. Rocke DA, Murray WB, Rout CC, Gouws E (1992) Relative risk analysis of factors associated with difficult intubation in obstetric anesthesia. Anesthesiology 77: 67–73

    Google Scholar 

  73. Sahebjami H, Gartside PS (1996) Pulmonary function in obese subjects with a normal FEV1/FVC ratio. Chest 110: 1425–1429

    Google Scholar 

  74. Schnitzler Transportgeräte — Produktübersicht.http://www.schnitzler-transportgeraete.de

  75. Schröder T, Nolte M, Kox WJ, Spies C (2001) Anästhesie bei extremer Adipositas. Herz 26: 222–228

    Google Scholar 

  76. Schwimmer JB, Burwinkel TM, Varni JW (2003) Health-related quality of life of severely obese children and adolescents. JAMA 289: 1813–1819

    Article  Google Scholar 

  77. Seidell JC (1994) Obesity in Europe: prevalence and consequences for use of medicale care. Pharmacoeconomics [Suppl 1] 5: 38–44

  78. Seidell JC (1998) Societal and personal costs of obesity. Exp Clin Endocrinol Diab [Suppl 2] 106: 7–9

    Google Scholar 

  79. Shenkman Z, Shir Y, Brodsky JB (1993) Perioperative management of the obese patient. Br J Anaesth 70: 349–359

    Google Scholar 

  80. Sjostrom LV (1992) Mortality of severely obese subjects. Am J Clin Nutr [Suppl 2] 55: 516–523

    Google Scholar 

  81. Smith-Choban P, Weireter LJ, Maynes C (1991) Obesity and increased mortality in blunt trauma. J Trauma 31: 1253–1257

    Google Scholar 

  82. Smith HL, Meldrum DJ, Brennan LJ (2002) Childhood obesity: a challenge for the anaesthetist? Paediatr Anaesth 12: 750–761

    Google Scholar 

  83. Sprung J, Whalley DG, Falcone T, Wilks W, Navratil JE, Bourke DL (2003) The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth Analg 97: 268–274

    Google Scholar 

  84. Stryker EMS Equipment — Produktmonographie M1.http://www.ruggedcots.com

  85. System Strobel — Handbuch Aero Komfort Patientenlagerung, S 4

  86. Vaughan RW, Bauer S, Wise L (1975) Volume and pH of gastric juice in obese patients. Anesthesiology 43: 686–689

    Google Scholar 

  87. Vissers RJ, Raftery KA (2000) The morbidly obese patient. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds) Emergency medicine: a comprehensive study guide, 5th edn. McGraw-Hill, New York

  88. Voyagis GS, Kyriakis KP, Dimitriou V et al. (1998) Value of oropharyngeal Mallampati classification in predicting difficult laryngoscopy among obese patients. Eur J Anaesth 15: 330–334

    Google Scholar 

  89. Walther A, Bardenheuer HJ (2001) Das Schlaf-Apnoe-Syndrom. Anaesthesist 50: 295–308

    Google Scholar 

  90. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348: 1625–1638

    Article  PubMed  Google Scholar 

  91. Spiegelman BM, Flier JS (2001) Obesity and the regulation of energy balance. Cell 23: 531–543

    Article  Google Scholar 

  92. Ahima RS, Flier JS (2001) Leptin. Ann Rev Physiol 62: 413–37

    Google Scholar 

  93. Marks DL, Cone RD (2001) Central melanocortins and the regulation of weight during acute and chronic disease. Rec Prog Horm Res 56: 359–375

    Google Scholar 

  94. Kalra SP, Dube MG, Pu S, Xu B, Ilorvath TL, Kalra PS (1999) Interacting appetite-regulation pathways in the hypothalamic regulation of body weight. Endocrinol Rev 20: 68–100

    Google Scholar 

  95. Boss O, Ilagen T, Lowell BB (2000) Uncoupling proteins 2 and 3: potential regulators of mitochondrial energy metabolism. Diabetes 49: 143–156

    CAS  PubMed  Google Scholar 

  96. Lipp M, Thierbach A (1998) Atemwegsmanagement beim traumatisierten Patienten. Notfall Rettungsmed 1: 242–255

    Article  Google Scholar 

  97. Finteis T, Genzwürker H, Becker FS, Ellinger K (2001) Einsatz des Larynxtubus bei einem polytraumatisierten Patienten. Notfall Rettungsmed 4: 511–514

    Google Scholar 

  98. Schlechtriemen T, Reeb R, Ensle G, Altemeyer KH (2004) Überprüfung der korrekten Tubuslage in der Notfallmedizin. Notfall Rettungsmed 7: 231–236

    Google Scholar 

  99. Maier B (1999) Notfallnarkose. Notfall Rettungsmed 2: 313–322

    Article  Google Scholar 

  100. Thierbach A, Maybauer M, Piepho T, Wolcke B (2003) Monitoring in der Notfallmedizin. Notfall Rettungsmed 6: 206–218

    Article  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Abteilung für Anästhesiologie und operative Intensivmedizin, Allgemeines Krankenhaus Barmbek, Hamburg

    S. W. Hauschild & S. Wirtz

  2. Zentrum Akute Medizin, Allgemeines Krankenhaus Barmbek, Hamburg

    N. Köster

  3. Technikzentrum, Berufsfeuerwehr , Hamburg

    W. Nölken

  4. Abteilung für Anästhesiologie und operative Intensivmedizin, Allgemeines Krankenhaus Barmbek, Rübenkamp 148, 22291 , Hamburg

    S. W. Hauschild

Authors
  1. S. W. Hauschild
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. Köster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Nölken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. W. Hauschild.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hauschild, S.W., Wirtz, S., Köster, N. et al. Der adipöse Patient im Rettungsdienst. Notfall & Rettungsmedizin 8, 207–215 (2005). https://doi.org/10.1007/s10049-005-0725-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-005-0725-7

Schlüsselwörter

Keywords

Search

Navigation