Lemyze M, Granier M
Service de réanimation polyvalente, hôpital d'Arras, boulevard Besnier, 62000 Arras, France; Service de réanimation polyvalente, hôpital Schaffner, 62300 Lens, France.
Service de réanimation polyvalente, hôpital d'Arras, boulevard Besnier, 62000 Arras, France.
Rev Mal Respir. 2019 Oct;36(8):971-984. doi: 10.1016/j.rmr.2018.10.621. Epub 2019 Sep 11.
As a result of the constantly increasing epidemic of obesity, it has become a common problem in the intensive care unit. Morbid obesity has numerous consequences for the respiratory system. It affects both respiratory mechanics and pulmonary gas exchange, and dramatically impacts on the patient's management and outcome. With the potential for causing devastating respiratory complications, the particular anatomical and physiological characteristics of the respiratory system of the morbidly obese subject should be carefully taken into consideration. The present article reviews the management of obese patients in respiratory failure, from noninvasive ventilation to tracheostomy, including postural and technical issues, and explains the physiologically based ventilatory strategy both for NIV and invasive mechanical ventilation up to the weaning from the ventilatory support.
由于肥胖症的流行持续加剧，它已成为重症监护病房中的一个常见问题。病态肥胖对呼吸系统有诸多影响。它既影响呼吸力学又影响肺气体交换，并对患者的管理和预后产生重大影响。鉴于可能引发严重的呼吸并发症，病态肥胖患者呼吸系统的特殊解剖学和生理学特征应予以仔细考虑。本文回顾了肥胖呼吸衰竭患者从无创通气到气管切开术的管理，包括体位和技术问题，并解释了基于生理学的无创通气和有创机械通气直至撤机的通气策略
