Giuseppe
Emeritus
[Source: Chest, full text: (LINK). Abstract, edited.]
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Original Research| February 28, 2013
Feasibility and effectiveness of prone position in morbidly obese ARDS patients: a case-control clinical study
Audrey De Jong; Nicolas Molinari; Mustapha Sebbane, MD; Albert Prades; Emmanuel Futier, MD; Boris Jung, MD; G?rald Chanques, MD; Samir Jaber, MD
Author and Funding Information: Intensive Care Unit and Transplantation Department (DAR B) Saint Eloi Hospital. University Hospital of Montpellier-INSERM U1046, 80 Avenue Augustin Fliche. 34295 Montpellier cedex 5, France (De Jong, Sebbane, Prades, Futier, Jung, Chanques, Jaber); Medical and Informatic department, Lapeyronie University Hospital of Montpellier. UMR 729 MISTEA, Route de Ganges. 34295 Montpellier cedex 5, France (Molinari)
Corresponding author: Pr Samir JABER, Unit? de R?animation-D?partement d'Anesth?sie-R?animation ?B?, University hospital. CHU de MONTPELLIER HOPITAL SAINT ELOI, 80, avenue Augustin Fliche. 34295 Montpellier Cedex 5. FRANCE, e-mail: s-jaber@chu-montpellier.fr
Funding sources: This study was supported by University Hospital of Montpellier.
CHEST. February 28, 2013doi:10.1378/chest.12-2115 - Published online
Abstract
Background:
Obese patients are at risk of developing atelectasis and acute respiratory distress syndrome (ARDS). Prone position (PP) may reduce atelectasis, improves oxygenation and outcome in severe hypoxemic patients in ARDS, but little is known about its effect in obese ARDS patients.
Methods:
Morbidly obese patients (body mass index (BMI)≥35kg/m<SUP>2</SUP>) in PP with ARDS (PaO2/FiO2 ratio≤200mmHg) were matched to non-obese (BMI<30kg/m<SUP>2</SUP>) ARDS patients in a case-control clinical study. The primary endpoints were safety and complications of PP; the second endpoints were the effect on oxygenation (PaO2/FiO2 ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections and mortality.
Results:
Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese were matched with 33 non-obese patients. Median PP duration was 9(6-11) hours in obese patients and 8(7-12) hours in non-obese patients (P=0.28). We collected 51 complications, of which 25 in obese and 26 in non-obese patients. Number of patients with at least one complication was similar across groups (n=10, 30%). PaO2/FiO2 ratio increased significantly more in obese patients (from 118?43 to 222?84 mmHg) than in non-obese patients (from 113?43 mmHg to 174?80mmHg, P=0.03). Length of mechanical ventilation, ICU stay and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27 vs 48%, P<0.05).
Conclusions:
PP seems safe in obese patients and may improve oxygenation more than in non-obese patients. Obese patients could be a subgroup of ARDS patients who may benefit the most of PP.
-Feasibility and effectiveness of prone position in morbidly obese ARDS patients: a case-control clinical study
Audrey De Jong; Nicolas Molinari; Mustapha Sebbane, MD; Albert Prades; Emmanuel Futier, MD; Boris Jung, MD; G?rald Chanques, MD; Samir Jaber, MD
Author and Funding Information: Intensive Care Unit and Transplantation Department (DAR B) Saint Eloi Hospital. University Hospital of Montpellier-INSERM U1046, 80 Avenue Augustin Fliche. 34295 Montpellier cedex 5, France (De Jong, Sebbane, Prades, Futier, Jung, Chanques, Jaber); Medical and Informatic department, Lapeyronie University Hospital of Montpellier. UMR 729 MISTEA, Route de Ganges. 34295 Montpellier cedex 5, France (Molinari)
Corresponding author: Pr Samir JABER, Unit? de R?animation-D?partement d'Anesth?sie-R?animation ?B?, University hospital. CHU de MONTPELLIER HOPITAL SAINT ELOI, 80, avenue Augustin Fliche. 34295 Montpellier Cedex 5. FRANCE, e-mail: s-jaber@chu-montpellier.fr
Funding sources: This study was supported by University Hospital of Montpellier.
CHEST. February 28, 2013doi:10.1378/chest.12-2115 - Published online
Abstract
Background:
Obese patients are at risk of developing atelectasis and acute respiratory distress syndrome (ARDS). Prone position (PP) may reduce atelectasis, improves oxygenation and outcome in severe hypoxemic patients in ARDS, but little is known about its effect in obese ARDS patients.
Methods:
Morbidly obese patients (body mass index (BMI)≥35kg/m<SUP>2</SUP>) in PP with ARDS (PaO2/FiO2 ratio≤200mmHg) were matched to non-obese (BMI<30kg/m<SUP>2</SUP>) ARDS patients in a case-control clinical study. The primary endpoints were safety and complications of PP; the second endpoints were the effect on oxygenation (PaO2/FiO2 ratio at the end of PP), length of mechanical ventilation and ICU stay, nosocomial infections and mortality.
Results:
Between January 2005 and December 2009, 149 patients were admitted for ARDS. Thirty-three obese were matched with 33 non-obese patients. Median PP duration was 9(6-11) hours in obese patients and 8(7-12) hours in non-obese patients (P=0.28). We collected 51 complications, of which 25 in obese and 26 in non-obese patients. Number of patients with at least one complication was similar across groups (n=10, 30%). PaO2/FiO2 ratio increased significantly more in obese patients (from 118?43 to 222?84 mmHg) than in non-obese patients (from 113?43 mmHg to 174?80mmHg, P=0.03). Length of mechanical ventilation, ICU stay and nosocomial infections did not differ significantly, but mortality at 90 days was significantly lower in obese patients (27 vs 48%, P<0.05).
Conclusions:
PP seems safe in obese patients and may improve oxygenation more than in non-obese patients. Obese patients could be a subgroup of ARDS patients who may benefit the most of PP.
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