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Obesity and ARDSObesity and ARDS

Kathryn Hibbert, MD; Mary Rice, MD; Atul Malhotra, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care (Drs Hibbert and Rice), Massachusetts General Hospital; and Divisions of Pulmonary, Sleep, and Critical Care (Dr Malhotra), Brigham and Women’s Hospital, Boston, MA.

Correspondence to: Kathryn Hibbert, MD, Divisions of Pulmonary and Critical Care, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114; e-mail: kahibbert@partners.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(3):785-790. doi:10.1378/chest.12-0117
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Obesity prevalence continues to increase globally, with figures exceeding 30% of some populations. Patients who are obese experience alterations in baseline pulmonary mechanics, including airflow obstruction, decreased lung volumes, and impaired gas exchange. These physiologic changes have implications in many diseases, including ARDS. The unique physiology of patients who are obese affects the presentation and pathophysiology of ARDS, and patients who are obese who have respiratory failure present specific management challenges. Although more study is forthcoming, ventilator strategies that focus on transpulmonary pressure as a measure of lung stress show promise in pilot studies. Given the increasing prevalence of obesity and the variable effects of obesity on respiratory mechanics and ARDS pathophysiology, we recommend an individualized approach to the management of the obese patient with ARDS.

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