Weaning patients with obesity from ventilatory support.

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Abstrakt

Tytuł:: Weaning patients with obesity from ventilatory support.
Autorzy:: Kacmarek RM; Harvard Medical School.; Massachusetts General Hospital.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Wanderley HV; Harvard Medical School.; Massachusetts General Hospital.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Villar J; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid.; Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain.
Berra L; Harvard Medical School.; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Źródło:: Current opinion in critical care [Curr Opin Crit Care] 2021 Jun 01; Vol. 27 (3), pp. 311-319.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review
Język:: English
Imprint Name(s):: Publication: <1999->: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Philadelphia, PA : Current Science, c1995-
MeSH Terms:: Positive-Pressure Respiration*
Pulmonary Atelectasis*
Electric Impedance ; Humans ; Obesity/complications ; Obesity/therapy ; Respiration, Artificial/adverse effects
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Grant Information:: K23 HL128882 United States HL NHLBI NIH HHS
Entry Date(s):: Date Created: 20210402 Date Completed: 20210520 Latest Revision: 20220701
Update Code:: 20240104
DOI:: 10.1097/MCC.0000000000000823
PMID:: 33797429
: Czasopismo naukowe

Purpose of Review: Obesity prevalence is increasing in most countries in the world. In the United States, 42% of the population is obese (body mass index (BMI) > 30) and 9.2% is obese class III (BMI > 40). One of the greatest challenges in critically ill patients with obesity is the optimization of mechanical ventilation. The goal of this review is to describe respiratory physiologic changes in patients with obesity and discuss possible mechanical ventilation strategies to improve respiratory function.
Recent Findings: Individualized mechanical ventilation based on respiratory physiology after a decremental positive end-expiratory pressure (PEEP) trial improves oxygenation and respiratory mechanics. In a recent study, mortality of patients with respiratory failure and obesity was reduced by about 50% when mechanical ventilation was associated with the use of esophageal manometry and electrical impedance tomography (EIT).
Summary: Obesity greatly alters the respiratory system mechanics causing atelectasis and prolonged duration of mechanical ventilation. At present, novel strategies to ventilate patients with obesity based on individual respiratory physiology showed to be superior to those based on standard universal tables of mechanical ventilation. Esophageal manometry and EIT are essential tools to systematically assess respiratory system mechanics, safely adjust relatively high levels of PEEP, and improve chances for successful weaning.
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