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Critical Care |

Obesity Paradox- Fact or Myth?

Navitha Ramesh, MD; Kartik Ramakrishna, MD; Oladunni Enilari, MD; Jason Lyons, MD
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Mount Sinai Beth Israel, Chesterfield, NJ


Chest. 2015;148(4_MeetingAbstracts):311A. doi:10.1378/chest.2252331
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Several studies have been conducted to determine the association between obesity and need for prolonged ventilation, duration of ICU stay and overall mortality. The lung mechanics of this subset of people would suggest worse outcomes for the above variables. However, results regarding these have been conflicting. We aim to determine the effect of morbid obesity on ICU outcomes.

METHODS: Retrospective analysis of all adult patients requiring invasive ventilation in the ICU of a University affiliated teaching hospital in one year. Chronically ventilated patients were excluded. Demographic data, co-morbidities, reason for ventilation and ICU admission and outcomes were recorded in predesigned case record forms. BMI was calculated and classified according to the WHO classification. Patients were divided into 2 groups based on BMI less than or greater than 40 kg/m2. Statistical analysis was performed using SPSS v15. The primary outcome was duration of invasive ventilation. Other outcomes assessed included length of ICU and hospital stay, ICU and hospital mortality, need for reintubation and tracheostomy.

RESULTS: A total of 66 consecutive ICU admission patients were included. Group I: 31 patients, mean BMI of 35.6±3.0, aged 59.8±10.3 years, with 17 males. Group II: 35 patients, mean BMI of 51.6±11.8, aged 58.0±14.7 years with 12 males. APACHE II at admission was 14.9± 8.1 vs 13.6±7.1, p= 0.46, duration of invasive ventilation was 9.6±15.3 days vs 7.7±13.0 days (p=0.57), length of ICU stay was 8.5±10.8 days vs 11.0±14.8 days (p=0.43), length of hospital stay was 19.6±24.3 days vs 30.4±43.2 days (p= 0.21), ICU mortality was 7/31(22.5%) vs 3/35(8.5%) (p = 0.17). There was a statistically significant association between morbid obesity and development of acute kidney injury (8/31 vs 17/35, p= 0.05). Tracheostomy and re-intubation rates were similar for both groups.

CONCLUSIONS: Morbidly obese patients in our cohort did not have significantly worse outcomes than those with lower BMI. However they had a higher incidence of acute kidney injury. This study is limited by its sample size.

CLINICAL IMPLICATIONS: Some physicians may exercise excessive caution while liberating the morbidly obese patients from ventilation due to fear of adverse outcomes. However this may not always be required solely based on their BMI alone.

DISCLOSURE: The following authors have nothing to disclose: Navitha Ramesh, Kartik Ramakrishna, Oladunni Enilari, Jason Lyons

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