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Original Research: CRITICAL CARE |

Extreme Obesity and Outcomes in Critically Ill PatientsObesity and Outcomes in Critically Ill Patients Obesity and Outcomes in Critically Ill Patients

Jenny L. Martino, MD, MSPH; Renee D. Stapleton, MD, PhD, FCCP; Miao Wang, MSc; Andrew G. Day, MSc; Naomi E. Cahill, RD, MSc; Anne E. Dixon, MD, FCCP; Benjamin T. Suratt, MD, FCCP; Daren K. Heyland, MD
Author and Funding Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine (Drs Martino, Stapleton, Dixon, and Suratt), University of Vermont, Burlington, VT; the Clinical Evaluation Research Unit (Mss Wang and Cahill, Mr Day, and Dr Heyland), Kingston General Hospital, Kingston, ON, Canada; the Department of Community Health and Epidemiology (Mr Day, Ms Cahill, and Dr Heyland), and the Department of Medicine (Dr Heyland), Queen’s University, Kingston, ON, Canada.

Correspondence to: Renee D. Stapleton, MD, PhD, FCCP, University of Vermont College of Medicine, 149 Beaumont Ave, HSRF 222, Burlington, VT 05405; e-mail: renee.stapleton@uvm.edu


Funding/Support: This study was supported by the National Institutes of Health [Grant R01-HL084200].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1198-1206. doi:10.1378/chest.10-3023
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Background:  Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI ≥ 40 kg/m2) are unclear. We sought to determine the association between extreme obesity and ICU outcomes.

Methods:  We analyzed data from a multicenter international observational study of ICU nutrition practices that occurred in 355 ICUs in 33 countries from 2007 to 2009. Included patients were mechanically ventilated adults ≥ 18 years old who remained in the ICU for > 72 h. Using generalized estimating equations and Cox proportional hazard modeling with clustering by ICU and adjusting for potential confounders, we compared extremely obese to normal-weight patients in terms of duration of mechanical ventilation (DMV), ICU length of stay (LOS), hospital LOS, and 60-day mortality.

Results:  Of the 8,813 patients included in this analysis, 3,490 were normal weight (BMI 18.5-24.9 kg/m2), 348 had BMI 40 to 49.9 kg/m2, 118 had BMI 50 to 59.9 kg/m2, and 58 had BMI ≥ 60 kg/m2. Unadjusted analyses suggested that extremely obese critically ill patients have improved mortality (OR for death, 0.77; 95% CI, 0.62-0.94), but this association was not significant after adjustment for confounders. However, an adjusted analysis of survivors found that extremely obese patients have a longer DMV and ICU LOS, with the most obese patients (BMI ≥ 60 kg/m2) also having longer hospital LOS.

Conclusions:  During critical illness, extreme obesity is not associated with a worse survival advantage compared with normal weight. However, among survivors, BMI ≥ 40 kg/m2 is associated with longer time on mechanical ventilation and in the ICU. These results may have prognostic implications for extremely obese critically ill patients.

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