Lee Cindy K, Tefera Eshetu, Colice Gene
INOVA Loudoun Hospital, Leesburg, Va., USA.
Respiration. 2014;87(3):219-26. doi: 10.1159/000357317. Epub 2014 Jan 23.
The effect of obesity on outcomes in critically ill patients requiring invasive mechanical ventilation in a medical intensive care unit (ICU) is uncertain.
This study was intended to further explore the relationship between outcomes and obesity in patients admitted to a medical ICU who required invasive mechanical ventilation.
All adult patients admitted to the medical ICU at Washington Hospital Center requiring intubation and invasive mechanical ventilation for at least 24 h between January 1 and December 31, 2009, were retrospectively studied. Patients were categorized as nonobese (BMI <30) and obese (BMI ≥30). The primary outcome measure was 30-day mortality following intubation. Secondary outcomes included ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation.
There were 504 eligible patients: 306 nonobese and 198 (39%) obese. Obese patients had significantly higher rates of diabetes (43 vs. 30%, p = 0.004), hyperlipidemia (32 vs. 24%, p = 0.04), asthma (16 vs. 8%, p = 0.004) and obstructive sleep apnea requiring continuous positive airway pressure treatment (12 vs. 1%, p < 0.001). Nonobese patients had a significantly higher rate of HIV infection (10 vs. 5%, p = 0.05) and malignancy (21 vs. 13%, p = 0.03). There were no significant differences in mortality up to 30 days following intubation and secondary outcomes between obese and nonobese patients. Multivariate analysis using logistic regression showed no significant relationship between mortality rate at 30 days following intubation and obesity. Outcomes were similar for the black obese (n = 153) and nonobese (n = 228) patients and the obese (n = 85) and very obese (n = 113) patients.
Obesity did not influence outcomes in critically ill patients requiring invasive mechanical ventilation in a medical ICU. Black obese patients had similar outcomes to black nonobese patients, and very obese patients also had similar outcomes to obese patients.
肥胖对内科重症监护病房（ICU）中需要有创机械通气的重症患者预后的影响尚不确定。
本研究旨在进一步探讨内科ICU中需要有创机械通气的患者的预后与肥胖之间的关系。
对2009年1月1日至12月31日期间入住华盛顿医院中心内科ICU且需要插管并有创机械通气至少24小时的所有成年患者进行回顾性研究。患者分为非肥胖（BMI<30）和肥胖（BMI≥30）两组。主要结局指标是插管后30天死亡率。次要结局包括ICU住院时间（LOS）、医院住院时间和机械通气时间。
共有504例符合条件的患者：306例非肥胖患者和198例（39%）肥胖患者。肥胖患者的糖尿病（43%对30%，p = 0.004）、高脂血症（32%对24%，p = 0.04）、哮喘（16%对8%，p = 0.004）和需要持续气道正压通气治疗的阻塞性睡眠呼吸暂停（12%对1%，p<0.001）发生率显著更高。非肥胖患者的HIV感染率（10%对5%，p = 0.05）和恶性肿瘤发生率（21%对13%，p = 0.03）显著更高。肥胖患者和非肥胖患者在插管后30天内的死亡率及次要结局方面无显著差异。使用逻辑回归进行的多变量分析显示，插管后30天的死亡率与肥胖之间无显著关系。黑人肥胖患者（n = 153）和非肥胖患者（n = 228）以及肥胖患者（n = 85）和极度肥胖患者（n = 113）的结局相似。
肥胖并未影响内科ICU中需要有创机械通气的重症患者的预后。黑人肥胖患者与黑人非肥胖患者的结局相似，极度肥胖患者与肥胖患者的结局也相似。
