Study objective: To describe the clinical course,
complications, and prognostic factors of morbidly obese patients
admitted to the ICU compared to a control group of nonobese
Design: A retrospective study.
Setting: Two university-affiliated hospitals.
Methods: We reviewed the medical records of 117 morbidly
obese patients (body mass index ≥ 40 kg/m2) admitted to
the medical ICU between January 1994 and June 2000. Data collected
included demographic information, comorbid condition, APACHE (acute
physiology and chronic health evaluation) II score, invasive
procedures, organ failure, and in-hospital mortality.
Results: Obstructive airway disease, pneumonia, and sepsis
were the main reasons for admission to the ICU in the morbidly obese
group. Sixty-one percent of the morbidly obese patients and 46% of the
nonobese group required mechanical ventilation (p = 0.02). The mean
lengths of mechanical ventilation and ICU stay were significantly
longer for the morbidly obese group (7.7 ± 9.6 days and
9.3 ± 10.5 days vs 4.6 ± 7.1 days and 5.8 ± 8.2 days,
respectively; p < 0.001). APACHE II scores were not significantly
different in the two groups (19.1 ± 7.6 and 20.6 ± 12.2;
p = 0.6). Overall mortality was 30% for the morbidly obese patients
and 17% for the nonobese group (p = 0.019). By multivariate
analysis, multiorgan failure (odds ratio [OR], 4.6; 95% confidence
interval [CI], 2.1 to 16.6), Pao2/fraction of
inspired oxygen < 200 for > 48 h (OR, 2.3; 95% CI, 1.2 to 7.8),
and depressed left ventricular ejection fraction < 40% (OR, 1.4;
95% CI, 1.03 to 13.8) were independently associated with ICU mortality
in the morbidly obese group.
Conclusion: We conclude
that critically ill morbidly obese patients are at increased risk of
morbidity and mortality compared to the nonobese