Morbid obesity in the medical ICU
Morbid obesity in the medical ICU
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DOI：
10.1378/chest.120.6.1989
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发表时间：
2001-12-01
期刊：
影响因子：
9.6
通讯作者：
Davies, J
中科院分区：
文献类型：
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作者：
El-Solh, A;Sikka, P;Davies, J
研究目的：描述入住ICU的病态肥胖患者与对照组非肥胖患者的临床病程、并发症和预后因素。设计：一项回顾性研究。设置：两所大学附属医院。方法：我们回顾了117例病态肥胖患者的医疗记录1994年1月至2000年6月期间入住医学ICU的患者（体重指数大于或等于40 kg/m2）。收集的数据包括人口统计学信息，共病情况，APACHE（急性生理学和慢性健康评价）II评分，侵入性操作，器官衰竭，并在医院mortals.Results：阻塞性气道疾病，肺炎，败血症的主要原因是在病态肥胖组入住ICU。61%的病态肥胖患者和46%的非肥胖患者需要机械通气（p = 0.02）。病态肥胖组的平均机械通气时间和ICU住院时间显著延长（分别为7.7 +/- 9.6天和9.3 +/- 10.5天vs 4.6 +/- 7.1天和5.8 +/- 8.2天; p < 0.001）。两组的APACHE II评分无显著差异（19.1 +/- 7.6和20.6 +/- 12.2; p = 0.6）。病态肥胖组的总死亡率为30%，非肥胖组为17%（p = 0.019）。通过多变量分析，多器官衰竭（比值比[OR]，4.6; 95%置信区间[CI]，2.1至16.6），PaO 2/吸入氧分数< 200 for >48小时（OR，2.3; 95%CI，1.2 - 7.8），左室射血分数降低< 40%（OR，1.4; 95%CI，1.03 ~ 13.8）与病态肥胖组ICU死亡率独立相关。我们的结论是，重症病态肥胖患者的发病率和死亡率的风险增加相比，非肥胖患者。
Study objective: To describe the clinical course, complications, and prognostic factors of morbidly obese patients admitted to the ICU compared to a control group of nonobese patients.Design: A retrospective study.Setting: Two university-affiliated hospitals.Methods: We reviewed the medical records of 117 morbidly obese patients (body mass index greater than or equal to 40 kg/m(2)) admitted to the medical ICU between January 1994 and June 2000. Data collected included demographic information, comorbid condition, APACHE (acute physiology and chronic health evaluation) II score, invasive procedures, organ failure, and in-hospital mortality.Results: Obstructive airway disease, pneumonia, and sepsis were the main reasons for admission to the ICU in the morbidly obese group. Sixty-one percent of the morbidly obese patients and 46% of the nonobese group required mechanical ventilation (p = 0.02). The mean lengths of mechanical ventilation and ICU stay, were significantly longer for the morbidly obese group (7.7 +/- 9.6 days and 9.3 +/- 10.5 days vs 4.6 +/- 7.1 days and 5.8 +/- 8.2 days, respectively; p < 0.001). APACHE II scores were not significantly different in the two groups (19.1 +/- 7.6 and 20.6 +/- 12.2; p = 0.6). Overall mortality was 30% for the morbidly obese patients and 17% for the nonobese group (p = 0.019). By multivariate analysis, multiorgan failure (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.1 to 16.6), PaO2/fraction of inspired oxygen < 200 for > 48 h (OR, 2.3; 95% CI, 1.2 to 7.8), and depressed left ventricular ejection fraction < 40% (OR, 1.4; 95% CI, 1.03 to 13.8) were independently associated with ICU mortality in the morbidly obese group.Conclusion: We conclude that critically ill morbidly obese patients are at increased risk of morbidity and mortality compared to the nonobese patients.