UMEM Educational Pearls

Category: Critical Care

Title: Obesity and Mechanical Ventilation

Posted: 11/16/2010 by Mike Winters, MD
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Positioning for Ventilated, Critically Ill Obese Patients

Up to one-quarter of patients in the ICU are obese, as defined by a BMI > 35 kg/m²
Obesity can significantly alter pulmonary physiology causing
- reduced lung volumes
- decreased compliance
- abnormal ventilation to perfusion relationships
- respiratory muscle inefficiency
For intubated obese patients, body position can affect ventilatory management
In the supine position, obese patients can have collapse of lung segments along with increased impedance of the diaphragm
Elevating the head of the bed to 30-45 degrees in intubated obese patients has been shown to improve tidal volumes and lower respiratory rates.

Ashburn DD, DeAntonio A, Reed MJ. Pulmonary system and obesity. Crit Care Clin 2010; 26:597-602