Ventilatory Management and Early Mobilization of the Obese Patient in the Intensive Care Unit

Abstract

Following World Health Organization, obesity is considered as the first noninfectious epidemic in history. Globally, this characteristic is linked to more deaths than underweight. Obesity is defined as a body mass index (BMI) greater than 30 kg/m². Obesity is a chronic progressive disease. Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. In European intensive care units (ICU), a third of the patients have a BMI ≥ 30 kg/m² and 7% a BMI > 40 kg/m². In the medical literature concerning these ICU obese patients, there is no significant difference in terms of mortality and length of hospital stay in comparison to normal weight population. There would be even better survival at 30 days and 1 year after the admission. The obese patient requires, however, particular attention to medical procedures, the practice of physiotherapy, and nursing procedures. Appropriate medical facilities and sufficient staff are important for proper care. The ventilation strategy should be adapted to limit the atelectasis and hypoxemia. Using a current volume adapted to the theoretical ideal weight of the patient and a positive expiratory pressure sufficiently (≥ 10 cmH₂O) associated with recruitment maneuvers is necessary for the prevention of barotrauma limiting on alveolar distension. The physiotherapist has an important role before, during, and after extubation. Concerning the respiratory management, the physiotherapist’ role is various. He or she must fight against the restrictive syndrome by positioning correctly the patient and he or she must train the diaphragm and clear the bronchial secretions. The use of continuous positive airway pressure may be necessary as “preventive or curative” to provide ventilatory support, restore as quickly as possible lung volumes, and reduce postoperative complications. Concerning muscular system, the mobilization must be early. It is feasible and safe. It helps to fight against the risk of thromboembolism, skin necrosis, prolonged mechanical ventilation, muscle deconditioning (weakness and atrophy), and ICU acquired weakness. According to the literature, early mobilization might reduce the length of ICU and hospital stay and also hospital costs.