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Original article
Influence of body mass index on outcome of the mechanically ventilated patients
  1. A Anzueto1,
  2. F Frutos-Vivar2,
  3. A Esteban2,
  4. N Bensalami1,
  5. D Marks1,
  6. K Raymondos3,
  7. C Apezteguía4,
  8. Y Arabi5,
  9. J Hurtado6,
  10. M González7,
  11. V Tomicic8,
  12. F Abroug9,
  13. J Elizalde10,
  14. N Cakar11,
  15. P Pelosi12,
  16. N D Ferguson13,
  17. for the Ventila group
  1. 1University of Texas Health Science Center and South Texas Veterans Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, Texas, USA
  2. 2Hospital Universitario de Getafe & CIBER Enfermedades Respiratorias, Madrid, Spain
  3. 3Medizinische Hochschule Hannover, Germany
  4. 4Hospital Profesor A Posadas, Buenos Aires, Argentina
  5. 5King Fahad National Guard Hospital, Riyadh, Saudi Arabia
  6. 6Hospital de Clínicas, Montevideo, Uruguay
  7. 7Clínica Medellín y Universidad Pontificia Bolivariana, Medellín, Colombia
  8. 8Clínica Alemana de Santiago, Santiago, Chile
  9. 9Fattouma Bourguiba, Monastir, Tunisia
  10. 10Hospital ABC, México DF, México
  11. 11Istanbul Medical Faculty, Turkey
  12. 12Department of Ambient, Health and Safety, University of Insubria, Varese, Italy
  13. 13Interdepartmental Division of Critical Care Medicine, and Department of Medicine, Division of Respirology, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Antonio Anzueto, M.D.111E, 7400 Merton Minter Boulevard, San Antonio, TX 78229, USA; anzueto{at}uthscsa.edu

Abstract

Background There are limited data on the impact of body mass index on outcomes in mechanically ventilated patients.

Methods Secondary analysis of a cohort including 4698 patients mechanically ventilated. Patients were screened daily for management of mechanical ventilation, complications (acute respiratory distress syndrome, sepsis, ventilator associated pneumonia, barotrauma), organ failure (cardiovascular, respiratory, renal, hepatic, haematological) and mortality in the intensive care unit. To estimate the impact of body mass index on acute respiratory distress syndrome and mortality, the authors constructed models using generalised estimating equations (GEE).

Results Patients were evaluated based on their body mass index: 184 patients (3.7%) were underweight, 1995 patients (40%) normal weight, 1781 patients (35.8%) overweight, 792 patients (15.9%) obese and 216 patients (4.3%) severely obese. Severely obese patients were more likely to receive low tidal volume based on actual body weight but high volumes based on predicted body weight. In obese patients, the authors observed a higher incidence of acute respiratory distress syndrome and acute renal failure. After adjustment, the body mass index was significantly associated with the development of acute respiratory distress syndrome: compared with normal weight; OR 1.69 (95% CI 1.07 to 2.69) for obese and OR 2.38 (95% CI 1.15 to 4.89) for severely obese. There were no differences in outcomes (duration of mechanical ventilation, length of stay and mortality in intensive care unit and hospital) based on body mass index categories.

Conclusions In this cohort, obese patients were more likely to have significant complications but there were no associations with increased mortality.

  • Obesity
  • body mass index
  • mechanical ventilation
  • acute respiratory distress syndrome (ARDS)
  • mortality
  • assisted ventilation
  • clinical epidemiology
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Footnotes

  • Funding Other Funders: CIBER Enfermedades Respiratorias, Instituto Carlos III, Madrid, Spain.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the study protocol was approved by local Institutional Review Boards of all the participating centers with a waiver for consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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