Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey.
Minerva Anestesiol. 2011 Jan;77(1):17-25.
Obesity rates are increasing in the general population and are also prevalent in intensive care units (ICUs). Patients are sometimes admitted to ICUs for hypercapnic respiratory failure or cor pulmonale, but more often, they are admitted for pneumonia, excessive daytime sleepiness, heart failure, chronic obstructive pulmonary disease (COPD), asthma attacks or pulmonary embolism, and hypercapnic respiratory failure is coincidentally noticed during this period. The optimal noninvasive mechanical ventilation strategy is often not used during ICU treatment. The aim of this study was to assess the differences between non-invasive ventilation (NIV) strategies and the outcomes of obese and non-obese patients with acute hypercapnic respiratory failure.
In this retrospective cohort study, 73 patients who were ventilated with a face mask were studied. Patients were divided into two groups: obese (BMI>35 kg/m2) and non-obese (BMI<35 kg/m2), and the differences between these two groups in necessary pressure, volume, mode, ventilator and time to reduce PaCO2 <50 mmHg were investigated.
The mean age of the patients was 66 ± 14 years, and the mean admission APACHE II score was 18 ± 4. Forty-one (56%) of the patients were female. For the obese patients, the reason for ICU admission was more frequently pulmonary edema and less frequently pulmonary infections, which was significantly different (P=0.003 and 0.043, respectively) than the rates for the non-obese patients. While there was no significant difference across the groups between the ventilators, modes and inspiratory pressure levels, obese patients required higher end-expiratory pressure levels and more time to reduce their PaCO2 levels below 50 mmHg than non-obese patients. The lengths of NIV and ICU stay and intubation and the mortality rates were similar in both groups.
These results suggest that improvement in hypercapnia in obese patients may require higher PEEP levels and longer times than that of non-obese patients during acute hypercapnic respiratory failure attack.
肥胖率在普通人群中不断增加，在重症监护病房（ICU）中也很普遍。患者有时因高碳酸血症性呼吸衰竭或肺心病而入住 ICU，但更常见的是因肺炎、日间嗜睡、心力衰竭、慢性阻塞性肺疾病（COPD）、哮喘发作或肺栓塞而入住 ICU，在此期间意外发现高碳酸血症性呼吸衰竭。在 ICU 治疗过程中，通常不会采用最佳的无创机械通气策略。本研究旨在评估肥胖和非肥胖急性高碳酸血症性呼吸衰竭患者的无创通气（NIV）策略和结局之间的差异。
在这项回顾性队列研究中，研究了 73 例使用面罩通气的患者。患者分为两组：肥胖组（BMI>35 kg/m2）和非肥胖组（BMI<35 kg/m2），并比较了两组之间所需压力、容量、模式、呼吸机和降低 PaCO2<50 mmHg 的时间。
患者的平均年龄为 66±14 岁，平均入院时急性生理学与慢性健康状况评分系统 II（APACHE II）评分为 18±4。41（56%）名患者为女性。对于肥胖患者，入住 ICU 的原因更常为肺水肿，而较少为肺部感染，这与非肥胖患者相比差异有统计学意义（分别为 P=0.003 和 0.043）。两组之间在呼吸机、模式和吸气压力水平方面没有显著差异，但肥胖患者需要更高的呼气末正压水平和更多的时间来降低 PaCO2 水平至 50 mmHg 以下。两组患者的 NIV 时间、ICU 入住时间、插管时间和死亡率相似。
这些结果表明，在急性高碳酸血症性呼吸衰竭发作期间，肥胖患者改善高碳酸血症可能需要比非肥胖患者更高的 PEEP 水平和更长的时间。
