Impact of Obesity in Critical Illness.
Impact of Obesity in Critical Illness.
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DOI：
10.1016/j.chest.2021.08.001
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发表时间：
2021-12
期刊：
影响因子：
9.6
通讯作者：
Shashaty MGS
中科院分区：
文献类型：
--
作者：
Anderson MR;Shashaty MGS
肥胖症的流行率在世界范围内不断上升。脂肪组织发挥解剖学和生理学作用，对危重疾病具有重要意义。呼吸力学的改变引起呼气流量限制、肺不张和V今/Q不匹配，并导致低氧血症。呼吸功改变和肥胖低通气综合征可引起高碳酸血症。面罩通气和插管周围低氧血症可能使插管复杂化。肥胖患者发生ARDS的风险增加，应根据预测的体重接受肺保护性通气。增加呼气末正压（PEEP），加上适当的患者体位，可以克服基线胸膜压升高引起的肺泡减少和内源性PEEP;然而，关于高PEEP策略对结局的影响的证据不足。静脉-静脉体外膜肺氧合可安全用于肥胖患者。液体管理应考虑慢性心脏病和肾脏疾病的患病率增加，血容量增加和急性肾损伤风险升高。药物药效学和药代动力学可能会因疏水性药物分布到脂肪库和共病肝脏或肾脏疾病而改变。肥胖与静脉血栓栓塞和感染的风险增加有关;适当剂量的预防性抗凝和早期拔除留置导管可能会降低这些风险。在一些研究中，肥胖与提高危重病生存率有关。目前尚不清楚这是否反映了观察性研究固有的保护作用或局限性。肥胖与SARS-CoV-2感染中插管和死亡风险增加相关。正在进行的脂肪组织分子研究可能会加深我们对肥胖如何影响危重病病理生理学的理解。
The prevalence of obesity is rising worldwide. Adipose tissue exerts anatomic and physiological effects with significant implications for critical illness. Changes in respiratory mechanics cause expiratory flow limitation, atelectasis, and V̇/Q̇ mismatch with resultant hypoxemia. Altered work of breathing and obesity hypoventilation syndrome may cause hypercapnia. Challenging mask ventilation and peri-intubation hypoxemia may complicate intubation. Patients with obesity are at increased risk of ARDS and should receive lung-protective ventilation based on predicted body weight. Increased positive end expiratory pressure (PEEP), coupled with appropriate patient positioning, may overcome the alveolar decruitment and intrinsic PEEP caused by elevated baseline pleural pressure; however, evidence is insufficient regarding the impact of high PEEP strategies on outcomes. Venovenous extracorporeal membrane oxygenation may be safely performed in patients with obesity. Fluid management should account for increased prevalence of chronic heart and kidney disease, expanded blood volume, and elevated acute kidney injury risk. Medication pharmacodynamics and pharmacokinetics may be altered by hydrophobic drug distribution to adipose depots and comorbid liver or kidney disease. Obesity is associated with increased risk of VTE and infection; appropriate dosing of prophylactic anticoagulation and early removal of indwelling catheters may decrease these risks. Obesity is associated with improved critical illness survival in some studies. It is unclear whether this reflects a protective effect or limitations inherent to observational research. Obesity is associated with increased risk of intubation and death in SARS-CoV-2 infection. Ongoing molecular studies of adipose tissue may deepen our understanding of how obesity impacts critical illness pathophysiology.
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影响因子：
120.7
作者：
Cavalcanti, Alexandre Biasi;Suzumura, Erica Aranha;Ribeiro de Carvalho, Carlos Roberto
通讯作者：
Ribeiro de Carvalho, Carlos Roberto
影响因子：
9.6
作者：
Busetto, L;Enzi, G;Vianello, A
通讯作者：
Vianello, A
重症患者的气管插管：对随机试验的全面系统综述。
DOI：
10.1186/s13054-017-1927-3
发表时间：
2018-01-20
期刊：
Critical care (London, England)
影响因子：
--
作者：
Cabrini L;Landoni G;Baiardo Redaelli M;Saleh O;Votta CD;Fominskiy E;Putzu A;Snak de Souza CD;Antonelli M;Bellomo R;Pelosi P;Zangrillo A
通讯作者：
Zangrillo A
影响因子：
3.3
作者：
Behazin, Negin;Jones, Stephanie B.;Loring, Stephen H.
通讯作者：
Loring, Stephen H.
影响因子：
8.9
作者：
Anderson, Michaela R.;Udupa, Jayaram K.;Lederer, David J.
通讯作者：
Lederer, David J.