Influence of body mass index on outcome of the mechanically ventilated patients
Influence of body mass index on outcome of the mechanically ventilated patients
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DOI：
10.1136/thx.2010.145086
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发表时间：
2011-01-01
期刊：
影响因子：
10
通讯作者：
Ferguson, N. D.
中科院分区：
文献类型：
--
作者：
Anzueto, A.;Frutos-Vivar, F.;Ferguson, N. D.
背景关于体重指数对机械通气患者预后的影响的数据有限。方法对4698名机械通气患者进行二次队列分析。在重症监护病房，每天对患者进行机械通气、并发症(急性呼吸窘迫综合征、败血症、呼吸机相关性肺炎、气压创伤)、器官衰竭(心血管、呼吸、肾脏、肝脏、血液学)和死亡率的筛查。为了评估体重指数对急性呼吸窘迫综合征和死亡率的影响，采用广义估计方程建立模型。结果根据体重指数对患者进行评估：体重不足184例(3.7%)，正常体重1995例(40%)，超重1781例(35.8%)，肥胖792例(15.9%)，重度肥胖216例(4.3%)。严重肥胖患者更有可能接受基于实际体重的低潮气量，但基于预测体重的高潮气量。在肥胖患者中，作者观察到急性呼吸窘迫综合征和急性肾功能衰竭的发生率更高。校正后，体重指数与急性呼吸窘迫综合征的发生显著相关：与正常体重相比，肥胖的OR1.69(95%可信区间1.07~2.69)，重度肥胖的OR 2.38(95%可信区间1.15~4.89)。根据体重指数分类，结果(机械通气时间、在重症监护病房和医院的住院时间和死亡率)没有差异。结论在这一队列中，肥胖患者更有可能出现显著的并发症，但与死亡率的增加无关。
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.