rss
Thorax doi:10.1136/thx.2009.117572

Body Mass Index is Associated with the Development of Acute Respiratory Distress Syndrome

  1. Michelle Ng Gong (mgong{at}montefiore.org)
  1. Montefiore Medical Center and Albert Einstein School of Medicine, United States
    1. Ednan Bajwa (ebajwa{at}partners.org)
    1. Massachusetts General Hospital, United States
      1. B Taylor Thompson (tthompson1{at}partners.org)
      1. Massachusetts General Hospital, United States
        1. David C Christiani (dchris{at}hsph.harvard.edu)
        1. Harvard School of Public Health, United States
          • Published Online First 21 September 2009

          Abstract

          Background: The relationship between body mass index (BMI) and development of acute respiratory distress syndrome (ARDS) is unknown.

          Methods: Cohort study of critically ill patients at risk for ARDS. BMI was calculated from admission height and weight. Patients were screened daily for AECC-defined ARDS and 60-day ARDS mortality.

          Results: Of 1795 patients, 83 (5%) patients were underweight (BMI<18.5 kg/m2), 627 (35%) normal (BMI 18.5-24.9), 605 (34%) overweight (BMI 25-29.9), 364 (20%) obese (BMI 30-39.9) and 116 (6%) severely obese (BMI>=40)). Increasing weight was associated with younger age (p< 0.001), diabetes (p<0.0001), higher blood glucoses (p < 0.0001), lower prevalence of direct pulmonary injury (p<0.0001), and later development of ARDS (p=0.01). BMI was associated with ARDS on multivariate analysis (ORadj 1.24 per SD increase; 95% CI 1.11–1.39; ). Similarly, obesity was associated with ARDS compared to normal weight (ORadj 1.66; 95% CI 1.21-2.28 for obese; ORadj 1.78; 95% CI 1.12-2.92 for severely obese). Exploratory analysis in a subgroup of intubated patients without ARDS on admission (N=1045) found that obese patients received higher peak (p<0.0001) and positive end-expiratory pressures (p<0.0001) than non-obese patients. Among ARDS patients, increasing BMI was associated with increased length of stay (p=0.007) but not with mortality (ORadj 0.89 per SD increase; 95% CI 0.71 – 1.12).

          Conclusion: BMI was associated with increased risk of ARDS in a weight dependent manner and increased length of stay but not mortality. Additional studies are needed to determine whether differences in initial ventilator settings may contribute to ARDS development in the obese.

          This Article

          1. Abstract
          2. PDF
          3. All Versions of this Article:
            1. thx.2009.117572v1
            2. 65/1/44 most recent

          Services

          1. Email this link to a friend
          2. Alert me when this article is cited
          3. Alert me if a correction is posted
          4. Article Usage Statistics
          5. Similar articles in this journal
          6. Similar articles in PubMed
          7. Add article to my folders
          8. Download to citation manager
          9. Request permissions

          Social bookmarking

          Register for free content


          Free sample
           This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of Thorax.
          View free sample issue >>

          Free archive
          The full back archive is now available for Thorax. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006, back to volume 1 issue 1.
          Register to access the free archive >>

          Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.