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Goals of Care, Critical Care Utilization and Clinical Outcomes in Obese Patients Admitted under General Medicine. J Clin Med 2022; 11:jcm11247267. [PMID: 36555885 PMCID: PMC9786344 DOI: 10.3390/jcm11247267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Obesity is associated with long-term morbidity and mortality, but it is unclear if obesity affects goals of care determination and intensive care unit (ICU) resource utilization during hospitalization under a general medicine service. In a cohort of 5113 adult patients admitted under general medicine, 15.3% were obese. Patients with obesity were younger and had a different comorbidity profile than patients who were not obese. In age-adjusted regression analysis, the distribution of goals of care categories for patients with obesity was not different to patients who were not obese (odds ratio for a lower category with more limitations, 0.94; 95% confidence interval [CI]: 0.79-1.12). Patients with obesity were more likely to be directly admitted to ICU from the Emergency Department, require more ICU admissions, and stayed longer in ICU once admitted. Hypercapnic respiratory failure and heart failure were more common in patients with obesity, but they were less likely to receive mechanical ventilation in favor of non-invasive ventilation. The COVID-19 pandemic was associated with 16% higher odds of receiving a lower goals of care category, which was independent of obesity. Overall hospital length of stay was not affected by obesity. Patients with obesity had a crude mortality of 3.8 per 1000 bed-days, and age-adjusted mortality rate ratio of 0.75 (95% CI: 0.49-1.14) compared to patients who were not obese. In conclusion, there was no evidence to suggest biased goals of care determination in patients with obesity despite greater ICU resource utilization.
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The association between BMI trajectories and bronchopulmonary dysplasia among very preterm infants. Pediatr Res 2022; 93:1609-1615. [PMID: 36414708 DOI: 10.1038/s41390-022-02358-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/01/2022] [Accepted: 10/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the association between change in body mass index (BMI) from birth to 36 weeks gestation (ΔBMI) and bronchopulmonary dysplasia (BPD) among infants born <30 weeks gestation. METHODS This was a multicenter retrospective cohort study (2015-2018) of infants born <30 weeks gestation and alive at ≥34 weeks corrected. Main exposure was a change in BMI z score from birth to 36 weeks corrected age grouped into quartiles of change. Association between ΔBMI z scores and BPD was assessed using generalized linear mixed models. RESULTS Among 772 included infants, 51% developed BPD. From birth to 36 weeks CGA, the weight z score of infants with BPD decreased less than for BPD-free infants, despite a greater decrease in length z score and similar caloric intake resulting in increases in BMI z score (median [IQR], 0.16 [-0.64; 1.03] vs -0.29 [-1.03; 0.49]; P < 0.01). In the adjusted analysis, higher ΔBMI z score quartiles were associated with higher odds of BPD (Q3 vs Q2, AOR [95% CI], 2.02 [1.23; 3.31] and Q4 vs Q2, AOR [95% CI], 2.00 [1.20; 3.34]). CONCLUSION Among preterm infants, an increase in BMI z score from birth to 36 weeks corrected is associated with higher odds of BPD. IMPACT Preterm infants with evolving lung disease often experience disproportionate growth in the neonatal period. In this multicenter cohort study, increases in BMI z score from birth to 36 weeks CGA were associated with higher odds of BPD. Despite similar caloric intake, infants with BPD had a higher weight- but lower length-for-age, resulting in higher BMI z score compared to BPD-free infants. This suggests that infants with evolving BPD may require different growth and nutritional targets compared to BPD-free infants.
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Barrera SC, Sanford EJ, Ammerman SB, Ferrell JK, Simpson CB, Dominguez LM. Postoperative Complications in Obese Patients After Tracheostomy. OTO Open 2020; 4:2473974X20953090. [PMID: 32923919 PMCID: PMC7453467 DOI: 10.1177/2473974x20953090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients. STUDY DESIGN A retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology-Head and Neck Surgery. SETTING All tracheostomies were performed at a single tertiary care center. METHODS Patients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications. RESULTS A total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients (P = .016). CONCLUSION Class III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.
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Affiliation(s)
- Shelby C. Barrera
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Evan J. Sanford
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Sarah B. Ammerman
- Department of Deaf Education and Hearing Science, UT Health San Antonio, San Antonio, Texas, USA
| | - Jay K. Ferrell
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - C. Blake Simpson
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Laura M. Dominguez
- Department of Otolaryngology–Head and Neck Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Frühbeck G, Baker JL, Busetto L, Dicker D, Goossens GH, Halford JCG, Handjieva-Darlenska T, Hassapidou M, Holm JC, Lehtinen-Jacks S, Mullerova D, O'Malley G, Sagen JV, Rutter H, Salas XR, Woodward E, Yumuk V, Farpour-Lambert NJ. European Association for the Study of Obesity Position Statement on the Global COVID-19 Pandemic. Obes Facts 2020; 13:292-296. [PMID: 32340020 PMCID: PMC7250342 DOI: 10.1159/000508082] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Gema Frühbeck
- European Association for the Study of Obesity, Teddington, United Kingdom,
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, IdiSNA, CIBEROBN, Spanish Health Institute Carlos III, Pamplona, Spain,
| | - Jennifer Lyn Baker
- European Association for the Study of Obesity, Teddington, United Kingdom
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Luca Busetto
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Medicine, University of Padova, Padova, Italy
| | - Dror Dicker
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Petah Tikva, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Gijs H Goossens
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jason C G Halford
- European Association for the Study of Obesity, Teddington, United Kingdom
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Teodora Handjieva-Darlenska
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University, Sofia, Bulgaria
| | - Maria Hassapidou
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Jens-Christian Holm
- European Association for the Study of Obesity, Teddington, United Kingdom
- The Children's Obesity Clinic, Department of Pediatrics, Holbæk University Hospital, Holbæk, Denmark
| | - Susanna Lehtinen-Jacks
- European Association for the Study of Obesity, Teddington, United Kingdom
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Dana Mullerova
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Public Health and Preventive Medicine, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Grace O'Malley
- European Association for the Study of Obesity, Teddington, United Kingdom
- School of Physiotherapy, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jørn V Sagen
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Harry Rutter
- European Association for the Study of Obesity, Teddington, United Kingdom
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Ximena Ramos Salas
- European Association for the Study of Obesity, Teddington, United Kingdom
- European Association for the Study of Obesity Secretariat, Teddington, United Kingdom
| | - Euan Woodward
- European Association for the Study of Obesity, Teddington, United Kingdom
- European Association for the Study of Obesity Secretariat, Teddington, United Kingdom
| | - Volkan Yumuk
- European Association for the Study of Obesity, Teddington, United Kingdom
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Nathalie J Farpour-Lambert
- European Association for the Study of Obesity, Teddington, United Kingdom
- Obesity Prevention and Care Program Contrepoids, Service of Endocrinology, Diabetology, Nutrition, and Therapeutic Patient Education, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Khalooeifard R, Djafarian K, Safabakhsh M, Rahmani J, Shab-Bidar S. Dose-Response Meta-Analysis of the Impact of Body Mass Index on Mortality in the Intensive Care Unit. Nutr Clin Pract 2020; 35:1010-1020. [PMID: 32181950 DOI: 10.1002/ncp.10473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Both low and high body mass index (BMI) are associated with mortality in the intensive care unit (ICU). Although many studies have been done to determine the relationship between BMI and risk of mortality in the ICU, their results were inconsistent. This study aimed to conduct a dose-response meta-analysis of published observational studies to assess the effect of BMI on the risk of mortality in patients admitted to the ICU. METHODS PubMed, Scopus, and Google Scholar were searched to identify articles up to May 2019. A total of 31 relevant articles, with 238,961 patients and a follow-up period of 1 month to 11 years, were analyzed. RESULTS Linear analysis showed a 0.6% decrease in mortality rate per unit (kg/m2 ) increase in BMI (odds ratio: 0.99; 95% CI, 0.98-0.99). In addition, nonlinear analysis showed a decrease in risk of mortality for a BMI of 35 (P < .001) and then increased the risk of mortality with a BMI > 35 (P < .001). CONCLUSION This dose-response meta-analysis revealed that a BMI ≤ 35 can be a protective agent against mortality, but a BMI > 35 is a life-threatening factor in patients admitted to the ICU.
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Affiliation(s)
- Razieh Khalooeifard
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical, Nutrition, School of Nutritional Sciences and Dietetics and School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Safabakhsh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamal Rahmani
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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Xu W, Pepper D, Sun J, Welsh J, Cui X, Eichacker PQ. The Effects of Obesity on Outcome in Preclinical Animal Models of Infection and Sepsis: A Systematic Review and Meta-Analysis. J Obes 2020; 2020:1508764. [PMID: 32211204 PMCID: PMC7053456 DOI: 10.1155/2020/1508764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Clinical studies suggest obesity paradoxically increases survival during bacterial infection and sepsis but decreases it with influenza, but these studies are observational. By contrast, animal studies of obesity in infection can prospectively compare obese versus nonobese controls. We performed a systematic review and meta-analysis of animal investigations to further examine obesity's survival effect in infection and sepsis. METHODS Databases were searched for studies comparing survival in obese versus nonobese controls. We performed a systematic review and meta-analysis of animal investigations to further examine obesity's survival effect in infection and sepsis. Methods. Databases were searched for studies comparing survival in obese versus nonobese animals following bacteria, lipopolysaccharide, or influenza virus challenges. RESULTS Twenty-one studies (761 obese and 603 control animals) met the inclusion criteria. Obesity reduced survival in 19 studies (11 significantly) and the odds ratio (95% CI) of survival (0.21(0.13, 0.35); I 2 = 64%, p < 0.01p < 0.01p < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies (n = 6 studies, 0.21(0.13, 0.34); I 2 = 64%, p < 0.01p < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies (n = 6 studies, 0.21(0.13, 0.34); I 2 = 64%, p < 0.01p < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies (n = 6 studies, 0.21(0.13, 0.34); I 2 = 64%, p < 0.01p < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies (n = 6 studies, 0.21(0.13, 0.34); I 2 = 64%, p < 0.01p < 0.01p < 0.01) but with high heterogeneity. Obesity reduced survival (1) consistently in both single-strain bacteria- and lipopolysaccharide-challenged studies (n = 6 studies, 0.21(0.13, 0.34); I 2 = 31%, p=0.20 and n = 5, 0.22(0.13, 0.36); I 2 = 0%, p=0.59, respectively), (2) not significantly with cecal ligation and puncture (n = 4, 0.72(0.08, 6.23); I 2 = 75%, p < 0.01), and (3) significantly with influenza but with high heterogeneity (n = 6, 0.12(0.04, 0.34); I 2 = 73%, p < 0.01). Obesity's survival effects did not differ significantly comparing the four challenge types (p=0.49). Animal models did not include antimicrobials or glycemic control and study quality was low. CONCLUSIONS Preclinical and clinical studies together emphasize the need for prospective studies in patients accurately assessing obesity's impact on survival during severe infection.
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Affiliation(s)
- Wanying Xu
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Dominique Pepper
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Junfeng Sun
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Judith Welsh
- National Institutes of Health Library, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xizhong Cui
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter Q. Eichacker
- Critical Care Medicine Department, NIH Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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Othman F, Ismaiel Y, Alkhathran S, Alshamrani A, Alghamdi M, Ismaeil T. The duration of mechanical ventilation in patients with chronic obstructive pulmonary disease and acute respiratory distress syndrome admitted to the intensive care unit: Epidemiological findings from a tertiary hospital. J Nat Sci Biol Med 2020. [DOI: 10.4103/jnsbm.jnsbm_188_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bailly S, Galerneau LM, Ruckly S, Seiller A, Terzi N, Schwebel C, Dupuis C, Tamisier R, Mourvillier B, Pepin JL, Timsit JF. Impact of obstructive sleep apnea on the obesity paradox in critically ill patients. J Crit Care 2019; 56:120-124. [PMID: 31896445 DOI: 10.1016/j.jcrc.2019.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Patients admitted to an intensive care unit (ICU) frequently suffer from multiple chronic diseases, including obstructive sleep apnea (OSA). Until recently OSA was not considered as a key determinant in an ICU patient's prognosis. The objective of this study was to document the impact of OSA on the prognosis of ICU patients. METHODS Data were retrospectively collected concerning adult patients admitted to ICU at two university hospitals. In a nested study OSA status was checked using the hospital electronic medical records to identify exposed and unexposed cases. The following outcomes were considered: length of stay in the ICU, ICU mortality, in-hospital mortality, ventilator-associated pneumonia (VAP). RESULTS Out of 5146 patients included in the study, 289 had OSA at ICU admission (5.6%). After matching, the overall impact of OSA on length of ICU stay was not significant (p = .24). In a predefined subgroup analysis, there was a significant impact of OSA on the length of ICU stay for patients with BMI over 40 kg/m2 (IRR: 1.56 [1.05; 2.32], p = .03). OSA status had no impact on ICU or hospital mortality and VAP. CONCLUSION In general, known OSA did not increase the ICU stay except for patients with both OSA and morbid obesity.
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Affiliation(s)
- Sébastien Bailly
- Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France; EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France.
| | - Louis-Marie Galerneau
- Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France; Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Stéphane Ruckly
- INSERM U1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Alexandre Seiller
- INSERM U1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France
| | - Nicolas Terzi
- Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France; Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Carole Schwebel
- Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France; INSERM U1039 Radiopharmaceutiques Biocliniques, Grenoble, France
| | - Claire Dupuis
- INSERM U1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France; Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France; EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Bernard Mourvillier
- INSERM U1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France; Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, INSERM U1042, HP2, 38000 Grenoble, France; EFCR laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-François Timsit
- INSERM U1137, Université Paris Diderot, Sorbonne Paris Cite, Paris, France; Medical and Infectious Intensive Care Unit, Bichat Claude Bernard University Hospital, AP-HP, Paris, France
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Liu X, Zhang W, Wang L, Wang S, Yu Y, Chen S, Ao H. Male patients with diabetes undergoing coronary artery bypass grafting have increased major adverse cerebral and cardiovascular events. Interact Cardiovasc Thorac Surg 2019; 28:607-612. [PMID: 30325425 DOI: 10.1093/icvts/ivy287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The role of body mass index (BMI) in the prognosis of patients with diabetes undergoing coronary artery bypass grafting (CABG) has been of great interest for a long time. However, the precise relationship between BMI and major adverse cerebral and cardiovascular events (MACCEs) in these patients is still unclear. The goal of this study was to investigate the outcome of patients with diabetes with different BMIs undergoing CABG and the results from the 5-year follow-up. METHODS This study included 771 patients with diabetes undergoing CABG from 1 January 2003 to 31 December 2009. They were classified based on the Chinese standard for BMI as follows: underweight: <18.5 kg/m2; normal weight: 18.5-23.9 kg/m2; overweight: 24-27.9 kg/m2; and obese: >28 kg/m2. Short-term outcomes and 5-year MACCEs were compared among various BMI groups after surgery. RESULTS Obese and overweight patients with diabetes tended to be younger than normal weight patients [57 years (49-64) vs 62 years (54-68) and 64 years (59-69); P < 0.001]. There were fewer male patients (25.20% vs 17.78% and 16.54%, P = 0.041). More smokers were in the 2 groups (38.8% vs 51.55% and 57.14%, P < 0.001). Glucose concentration was highest in the overweight group [6.40 (5.40-7.80) vs 6.96 (5.69-8.22) and 6.80 (5.90-8.40); P = 0.041)]. Cox regression analysis of the 5-year follow-up data indicated that various BMI groups were not associated with significant differences in 5-year MACCEs; however, male sex was the risk factor for MACCEs (hazard ratio 1.83, 95% confidence interval 1.11-3.04; P = 0.019). CONCLUSIONS The BMI of the patients with diabetes undergoing CABG had no effect on MACCEs. Male sex was the risk factor in these patients.
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Affiliation(s)
- Xiaojie Liu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Wenyuan Zhang
- Department of Anesthesiology, The First affiliated Hospital, Nanchang University, Nanchang, China
| | - Lijuan Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sudena Wang
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Yu
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Sipeng Chen
- The Department of Information Center, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Dunn H, Quinn L, Corbridge S, Kapella M, Eldeirawi K, Steffen A, Collins E. A latent class analysis of prolonged mechanical ventilation patients at a long-term acute care hospital: Subtype differences in clinical outcomes. Heart Lung 2019; 48:215-221. [PMID: 30655004 PMCID: PMC6874913 DOI: 10.1016/j.hrtlng.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/29/2018] [Accepted: 01/02/2019] [Indexed: 01/15/2023]
Abstract
RATIONALE Patients on prolonged mechanical ventilation (PMV) at Long-Term Acute Care Hospital's (LTACHs) are clinically heterogeneous making it difficult to manage care and predict clinical outcomes. OBJECTIVES Identify and describe subgroups of patients on PMV at LTACHs and examine for group differences. METHODS Latent class analysis was completed on data obtained during medical record review at Midwestern LTACH. MAIN RESULTS A three-class solution was identified. Class 1 contained young, obese patients with low clinical and co-morbid burden; Class 2 contained the oldest patients with low clinical burden but multiple co-morbid conditions; Class 3 contained patients with multiple clinical and co-morbid burdens. There were no differences in LTACH length of stay [F(2,246) = 2.243, p = 0.108] or number of ventilator days [F(2,246) = 0.641, p = 0.528]. Class 3 patients were less likely to wean from mechanical ventilation [χ2(2, N = 249) = 25.48, p < 0.001] and more likely to die [χ2(2, N = 249) = 23.68, p < 0.001]. CONCLUSION Patient subgroups can be described that predict clinical outcomes. Class 3 patients are at higher risk for poor clinical outcomes when compared to patients in Class 1 or Class 2.
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Affiliation(s)
- Heather Dunn
- The University of Iowa College of Nursing, United States.
| | - Laurie Quinn
- University of Illinois at Chicago College of Nursing, United States
| | - Susan Corbridge
- University of Illinois at Chicago College of Nursing, United States
| | - Mary Kapella
- University of Illinois at Chicago College of Nursing, United States
| | - Kamal Eldeirawi
- University of Illinois at Chicago College of Nursing, United States
| | - Alana Steffen
- University of Illinois at Chicago College of Nursing, United States
| | - Eileen Collins
- University of Illinois at Chicago College of Nursing, United States
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11
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Bonatti G, Robba C, Ball L, Silva PL, Rocco PRM, Pelosi P. Controversies when using mechanical ventilation in obese patients with and without acute distress respiratory syndrome. Expert Rev Respir Med 2019; 13:471-479. [PMID: 30919705 DOI: 10.1080/17476348.2019.1599285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION As the prevalence of obesity increases, so does the number of obese patients undergoing surgical procedures and being admitted into intensive care units. Obesity per se is associated with reduced lung volume. The combination of general anaesthesia and supine positioning involved in most surgeries causes further reductions in lung volumes, thus resulting in alveolar collapse, decreased lung compliance, increased airway resistance, and hypoxemia. These complications can be amplified by common obesity-related comorbidities. In otherwise healthy obese patients, mechanical ventilation strategies should be optimised to prevent lung damage; in those with acute distress respiratory syndrome (ARDS), strategies should seek to mitigate further lung damage. Areas covered: This review discusses non-invasive and invasive mechanical ventilation strategies for surgical and critically ill adult obese patients with and without ARDS and proposes practical clinical insights to be implemented at bedside both in the operating theatre and in intensive care units. Expert opinion: Large multicentre trials on respiratory management of obese patients are required. Although the indication of lung protective ventilation with low tidal volume is apparently translated to obese patients, optimal PEEP level and recruitment manoeuvres remain controversial. The use of non-invasive respiratory support after extubation must be considered in individual cases.
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Affiliation(s)
- Giulia Bonatti
- a Department of Surgical Sciences and Integrated Diagnostics , University of Genoa , Genoa , Italy
| | - Chiara Robba
- b Department of Anaesthesiology and Intensive Care , San Martino Policlinico Hospital , Genoa , Italy
| | - Lorenzo Ball
- a Department of Surgical Sciences and Integrated Diagnostics , University of Genoa , Genoa , Italy
| | - Pedro Leme Silva
- c Laboratory of Pulmonary Investigation - Carlos Chagas Filho Institute of Biophysics , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,d National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
| | - Patricia Rieken Macêdo Rocco
- c Laboratory of Pulmonary Investigation - Carlos Chagas Filho Institute of Biophysics , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil.,d National Institute of Science and Technology for Regenerative Medicine , Rio de Janeiro , Brazil
| | - Paolo Pelosi
- a Department of Surgical Sciences and Integrated Diagnostics , University of Genoa , Genoa , Italy.,b Department of Anaesthesiology and Intensive Care , San Martino Policlinico Hospital , Genoa , Italy
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Zhao Y, Li Z, Yang T, Wang M, Xi X. Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS One 2018; 13:e0198669. [PMID: 29883469 PMCID: PMC5993298 DOI: 10.1371/journal.pone.0198669] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial. METHODS MEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: "body weight", "body mass index", "overweight" or "obesity" and "ventilator", "mechanically ventilated", "mechanical ventilation", without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; obese, 30-39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale. RESULTS A total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84-0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74-0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74-0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60-0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82-0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53-0.94, I2 = 74%, and OR 0.80, 95% CI 0.73-0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75-0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66-0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18-0.83, and OR 0.63, 95% CI 0.46-0.86, I2 = 56%, and OR 0.66, 95% CI 0.57-0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16-0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38-1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17-0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status. CONCLUSIONS In ICU patients receiving mechanical ventilation, higher BMI is associated with lower mortality and longer duration on mechanical ventilation.
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Affiliation(s)
- Yonghua Zhao
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- Department of Critical Care Medicine, Langfang People’s Hospital, Langfang, China
| | - Zhiqiang Li
- Department of Critical Care Medicine, Hebei United University Affiliated Hospital, Tangshan, China
| | - Tao Yang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Meiping Wang
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Xiuming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China
- * E-mail:
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