O'Brien James M, Welsh Carolyn H, Fish Ronald H, Ancukiewicz Marek, Kramer Andrew M
University of Colorado Health Sciences Center, Denver, Colorado 80262, USA.
Ann Intern Med. 2004 Mar 2;140(5):338-45. doi: 10.7326/0003-4819-140-5-200403020-00009.
Despite an epidemic of obesity among adults, the effect of excess body weight on outcome from critical illness is not well studied.
To examine the association between excess body weight and outcome in mechanically ventilated patients with acute lung injury.
Secondary analysis of participants in trials of therapy for acute lung injury.
10 U.S. medical centers that participate in the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.
902 mechanically ventilated patients who were enrolled in randomized, controlled trials of therapy for acute lung injury.
Assignment to higher (12 mL/kg of predicted weight) or lower (6 mL/kg of predicted weight) tidal volume ventilation strategies with specified weaning protocols. Some patients also received ketoconazole, lisofylline, or placebo by factorial design.
Mortality rate, rate of unassisted ventilation by day 28, and number of ventilator-free days.
Indirect causes of lung injury, including trauma, were more common in obese patients. Overweight and obese patients had higher peak and plateau airway pressures before enrollment because of higher set tidal volumes. After risk adjustment, excess body weight was not associated with death, achievement of unassisted ventilation, or number of ventilator-free days. This lack of effect persisted with categorical or continuous measures of body mass index (BMI). We found no significant interaction between ventilator protocol assignment and BMI category.
After risk adjustment, overweight and obese patients with acute lung injury have outcomes similar to those of patients with normal BMI. The lack of interaction between ventilator protocol assignment and BMI suggests that patients with normal, overweight, or obese BMI benefit from lower tidal volume ventilation for acute lung injury.
尽管成年人中肥胖现象盛行，但超重对危重病结局的影响尚未得到充分研究。
探讨超重与急性肺损伤机械通气患者结局之间的关联。
对急性肺损伤治疗试验参与者进行二次分析。
美国10家参与国立心、肺、血液研究所急性呼吸窘迫综合征网络的医疗中心。
902名参与急性肺损伤治疗随机对照试验的机械通气患者。
根据特定的撤机方案，分配采用较高（预计体重的12 mL/kg）或较低（预计体重的6 mL/kg）潮气量通气策略。部分患者还通过析因设计接受酮康唑、利索茶碱或安慰剂治疗。
死亡率、第28天无辅助通气率和无呼吸机天数。
肥胖患者中，包括创伤在内的肺损伤间接原因更为常见。由于设定的潮气量较高，超重和肥胖患者入组前的气道峰压和平台压更高。风险调整后，超重与死亡、实现无辅助通气或无呼吸机天数无关。体重指数（BMI）的分类或连续测量均未改变这一结果。我们发现通气方案分配与BMI类别之间无显著交互作用。
风险调整后，超重和肥胖的急性肺损伤患者结局与BMI正常的患者相似。通气方案分配与BMI之间缺乏交互作用表明，BMI正常、超重或肥胖的急性肺损伤患者均可从低潮气量通气中获益。
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