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Chest. 2011 Nov;140(5):1198-1206. doi: 10.1378/chest.10-3023. Epub 2011 Aug 4.

Extreme obesity and outcomes in critically ill patients.

Author information

1
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT.
2
Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Vermont, Burlington, VT. Electronic address: renee.stapleton@uvm.edu.
3
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
4
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada.
5
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada.

Abstract

BACKGROUND:

Recent literature suggests that obese critically ill patients do not have worse outcomes than patients who are normal weight. However, outcomes in extreme obesity (BMI ≥ 40 kg/m(2)) are unclear. We sought to determine the association between extreme obesity and ICU outcomes.

METHODS:

We analyzed data from a multicenter international observational study of ICU nutrition practices that occurred in 355 ICUs in 33 countries from 2007 to 2009. Included patients were mechanically ventilated adults ≥ 18 years old who remained in the ICU for > 72 h. Using generalized estimating equations and Cox proportional hazard modeling with clustering by ICU and adjusting for potential confounders, we compared extremely obese to normal-weight patients in terms of duration of mechanical ventilation (DMV), ICU length of stay (LOS), hospital LOS, and 60-day mortality.

RESULTS:

Of the 8,813 patients included in this analysis, 3,490 were normal weight (BMI 18.5-24.9 kg/m(2)), 348 had BMI 40 to 49.9 kg/m(2), 118 had BMI 50 to 59.9 kg/m(2), and 58 had BMI ≥ 60 kg/m(2). Unadjusted analyses suggested that extremely obese critically ill patients have improved mortality (OR for death, 0.77; 95% CI, 0.62-0.94), but this association was not significant after adjustment for confounders. However, an adjusted analysis of survivors found that extremely obese patients have a longer DMV and ICU LOS, with the most obese patients (BMI ≥ 60 kg/m(2)) also having longer hospital LOS.

CONCLUSIONS:

During critical illness, extreme obesity is not associated with a worse survival advantage compared with normal weight. However, among survivors, BMI ≥ 40 kg/m(2) is associated with longer time on mechanical ventilation and in the ICU. These results may have prognostic implications for extremely obese critically ill patients.

PMID:
21816911
PMCID:
PMC3205847
DOI:
10.1378/chest.10-3023
[Indexed for MEDLINE]
Free PMC Article

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