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Original Research: CRITICAL CARE MEDICINE |

Obesity and Pulmonary Complications in Critically Injured Adults

Lesly A. Dossett, MD, MPH; Daithi Heffernan, MD; Michelle Lightfoot, BS; Bryan Collier, MD; Jose J. Diaz, MD; Robert G. Sawyer, MD; Addison K. May, MD
Author and Funding Information

*From the the Department of Surgery (Drs. Dossett, Heffernan, Collier, Diaz, and May, and Ms. Lightfoot), Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; and the Department of Surgery (Dr. Sawyer), University of Virginia Health System, Charlottesville, VA.

Correspondence to: Lesly A. Dossett, MD, MPH, 404 Medical Arts Building, 1211 Twenty-First Ave South, Nashville, TN 37212; e-mail: lesly.dossett@vanderbilt.edu


Portions of these data were presented in poster form at the 2008 Society for Critical Care Medicine Congress, Honolulu, HI.

This work was supported by National Institutes of Health grant RO1 AI49989-01 and Agency for Healthcare Research and Quality grant T32 HS 013833.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(5):974-980. doi:10.1378/chest.08-0079
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Background:  Pulmonary complications following injury significantly contribute to subsequent mortality. Obese patients have preexisting risk factors for pulmonary complications, and are at risk for these complications following elective surgery. Whether or not obesity contributes to pulmonary complications after critical injury is poorly understood.

Methods:  A secondary analysis of a prospective cohort study of critically injured adults requiring at least 48 h of intensive care was performed. Patients were classified into the following body mass index groups: ≤ 18.5 kg/m2 (underweight); 18.5 to 24.9 kg/m2 (normal); 25 to 29.9 kg/m2 (overweight); 30.0 to 39.9 kg/m2 (obese); and ≥ 40.0 kg/m2 (severely obese). Outcomes included the rates of ARDS and pneumonia, the placement of a tracheostomy tube, and in-hospital mortality rate.

Results:  A total of 1,291 patients were available for analysis, and 30% of these patients were classified as either obese or severely obese. The age-, gender-, and severity-adjusted rate of ARDS was lower in severely obese patients (odds ratio, 0.36; 95% confidence interval [CI], 0.13 to 0.99) compared to normal weight patients. The rates of pneumonia (37%), tracheostomy (10%), and in-hospital mortality (11%) did not differ among the groups. Despite no difference in pulmonary complications, the severely obese group had an ICU length of stay that was 4.8 days (95% CI, 1.8 to 7.7 days) longer than the normal weight group.

Conclusion:  Obesity does not appear to be an independent risk factor for increased pulmonary complications after critical injury, but severely obese patients are likely to require longer ICU stays.Trial registration: Clinicaltrials.gov Identifier: NCT00170560

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