Critical Care of Patients With Obesity

The effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients: A randomised controlled trial

AIMS AND OBJECTIVES

To investigate the effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients.

BACKGROUND

Reverse Trendelenburg position is recommended for obese patients; however, the effect among critically ill patients, especially those on mechanical ventilation, has limited study.

DESIGN

Randomised, controlled pretest, repeated post-test trial with two parallel groups.

METHODS

The study started from 13 January 2020-12 March 2020. Adult critically ill patients with a body mass index ≥30 were randomly assigned by computer-generated randomisation to either reverse Trendelenburg position group (intervention) or semi-recumbent position group (active comparator control). Outcome measures were ventilation parameters (dynamic compliance, partial pressure of arterial carbon dioxide and minute volume) and oxygenation parameters (hypoxaemic index and partial pressure of arterial oxygen). Measures were assessed immediately before positioning and after positioning in 10 minutes, 20 minutes and 30 minutes. CONSORT checklist was used to report the current study.

SETTINGS

Four general intensive care units.

RESULTS

One hundred and ten patients (55 patients in each group) completed the study. The reverse Trendelenburg position group had a higher improvement than the semi-recumbent position group as estimated by mean differences in their dynamic compliance, minute volume, partial pressure of carbon dioxide, partial pressure of oxygen and hypoxaemic index.

CONCLUSION

Reverse Trendelenburg position improves obese patients' respiratory parameters more than semi-recumbent position.

RELEVANCE TO CLINICAL PRACTICE

This study directs nurses to use the reverse Trendelenburg position, which is an important position for enhancing the parameters of ventilation and oxygenation of obese mechanically ventilated patients.

Weight Bias and Psychosocial Implications for Acute Care of Patients With Obesity

Obesity is a complex medical condition that has psychosocial and physiological implications for those suffering from the disease. Factors contributing to obesity such as depression, childhood experiences, and the physical environment should be recognized and addressed. Weight bias and stigmatization by health care providers and bedside clinicians negatively affect patients with obesity, hindering those patients from receiving appropriate care. To provide optimal care of patients with obesity or adiposity, health care providers must understand the physiological needs and requirements of this population while recognizing and addressing their own biases. The authors describe psychosocial and environmental factors that contribute to obesity, discuss health care providers' weight biases, and highlight implications for acute care of patients suffering from obesity.

Comprehensive Care for Bariatric Surgery Patients

Obesity is a worldwide epidemic, and those suffering from obesity have increased morbidity and mortality rates. There are various causes of obesity and many treatment options for patients suffering from obesity, including nonsurgical treatments. However, bariatric surgery is often the best choice for optimal weight loss and the attenuation of comorbidities. Currently, laparoscopic sleeve gastrectomy is the most common type of bariatric surgery in the United States due to its technical simplicity, feasibility, and overall positive outcomes. This article discusses bariatric surgical criteria and selection, expected perioperative course, potential complications after surgery, and nursing implications for the care of bariatric patients. A case report is used to exemplify stages of surgical care and follow-up treatment for patients who undergo laparoscopic sleeve gastrectomy.

LEFT LATERAL POSITIONING WITH HEAD ELEVATION INCREASE THE PARTIAL PRESSURE OF OXYGEN ON PATIENTS WITH MECHANICAL VENTILATION

Introduction: Breathing literally means the movement of oxygen from the atmosphere and reach the cells and carbon dioxide into the atmosphere. Partial pressure of oxygen (pO2) is one of the important components in the process of respiration, especially in patients with mechanical ventilation. There are several interventions that can be performed in an effort to improve the ventilation, one of them is patients positioning: left lateral position with 30 degrees head elevation. This study aimed to determine the effect of left lateral position with 30 degrees head elevation to the value of partial pressure of oxygen in patients with mechanical ventilation in intensive care unit RSUP DR. M. Djamil Padang. Method: This study was Pra Experiments with one group pretest posttest design. 15 samples taken by purposive sampling method. Data obtained by blood gasses analysis and it was conducted since May 8th untill June 5th, 2013. Univariate data presented in frequency distribution table, while the bivariate data using the paired T test. Result: Univariate analysis showed the value of the partial pressure of oxygen ( pO2 ) before intervention between 119-228 mmHg , while the value of the partial pressure of oxygen ( pO2 ) after intervention between 132-269 mmHg . Paired T test results showed a signifi cant difference between the value of the partial pressure of oxygen (pO2) before and after intervention (p = 0.040, p < 0.05 ). Discussion: The left lateral position with 30 degrees head elevation could increase the partial pressure of oxygen (pO2) in patients with mechanical ventilation. The results of this study can be used for increasing the nursingcare quality of patients with mechanical ventilation in order to reduce the time of hospitalization. Further research on these positioning interventions can be developed for patients with primary respiratory problems or lung disease.Keywords: left lateral position, partial pressure of oxygen (pO2), mechanical ventilation

Prevalence of obesity in an intensive care unit patient population

BACKGROUND

The Australian health survey (2011-2012) reported that 63.4% of Australian adults were overweight or obese. Critical care medicine is expensive, with intensive care unit (ICU) services accounting for a substantial proportion of total hospital costs. These costs may be multiplied in the overweight cohort.

OBJECTIVES

The primary aim was to compare the body mass index (BMI) of a critically ill ICU patient cohort to Australian population norms in order to see if overweight people were over-represented. The secondary aim was to identify if any medical specialty was associated with overweight patients.

METHODS

A retrospective observational case note audit of 230 ICU patients between November 2012 and August 2013, with BMI as the primary outcome measure.

RESULTS

Approximately 75% of the cohort were overweight or obese (median BMI 28.7; IQR 25.0-32.7) representing a rate 12% higher than Australian normative data. Based on population, this equates to an estimated additional 5279 unanticipated overweight or obese ICU patients at our facility during 2013.

CONCLUSIONS

This study has shown that Australian ICU patients may have higher BMI than those of the general Australian population, and therefore there may be unanticipated costs associated with their care. No medical specialty was associated with higher BMI than another.

[Physiotherapeutic treatment of adipose patients. Options and limitations on intensive care units]

BACKGROUND

Obese patients in the intensive care unit (ICU) represent an interesting topic, which is currently receiving increased attention from physiotherapists.

OBJECTIVE

The aim of this article is to present the options and limitations of physiotherapy which must be overcome in the daily routine in the ICU.

RESULTS

The quality of therapeutic treatment of obese inpatients has shown a clear increase during the last 20 years; however, sufficient studies have not yet been carried out, international standards are not available and many therapists work differently with their patients. Additionally, the disease patterns of obesity consist of a large variety of different diseases.

CONCLUSION

Despite the many demanding problems obesity is by no means an unsolvable puzzle. A literature search of lectures, studies and scientific articles was carried out to elucidate which options in the form of resources and devices are available to physiotherapists.

Evidence-based prevention of pressure ulcers in the intensive care unit

The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.

Cardiovascular effects of obesity: implications for critical care

Obesity has become a global health crisis. The effects of obesity on the cardiovascular system pose a unique challenge for the critical care nurse. This article reviews the scope of the problem, the alterations in the cardiovascular structures and function, and the implications for critical care nursing.

Impact of obesity on care of postoperative coronary bypass patients

Obesity has become a major health problem in the United States and is well known to be a risk factor for the development of cardiovascular disease. Many clinicians perceive obesity, particularly severe or morbid obesity, to be associated with increased risk for mortality and morbidity following coronary artery bypass graft (CABG) surgery. This article provides a review of the literature related to mortality and morbidity, including the impact of diabetes, risk for acute respiratory failure, and sternal wound infection associated with obese patients undergoing CABG surgery. Implications for nursing practice are addressed with recommendations for practice in this patient population.

Pain management in critically ill obese patients

Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient.

Pulmonary aspects of obesity in critical care

Critically ill obese patients have many challenging pulmonary problems. The first key is to understand pathophysiology in the pulmonary system related to obesity. Second, it is important to identify the altered physical assessments and diagnostics that occur because of the pulmonary pathophysiology of obesity. Lastly, one should be aware of medical and nursing intervention options that treat symptoms or pulmonary problems of obesity. This article summarizes pulmonary issues related to obesity in critical care.

[The role of respiratory physiotherapy in the lung function of obese patients undergoing bariatric surgery. A review]

INTRODUCTION

Obesity, considered a new worldwide epidemic, is characterised by excess adipose tissue and contributes to a series of chronic diseases and increased mortality. Obesity associated to surgical procedure in these patients makes respiratory physiotherapy a must to recover lung function and prevent postoperative pulmonary complications.

AIMS

To assess the effects of respiratory physiotherapy on the lung function of obese patients undergoing weight loss surgery.

MATERIAL AND METHODS

We conducted a literature review October 2008-June 2009 of data which had been published over the last thirty years and which was available on the Medline, Pubmed ans Scielo databases.

CONCLUSION

Pre- and postoperative respiratory physiotherapy is vital for patients undergoing weight loss surgery irrespective of technique used, as it can prevent pulmonary complications inherent in the surgical procedure and aid lung function recovery.