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Mechanical Ventilation in the Obese Patient
- Obesity can result in decreased lung volumes, decreased lung and chest wall compliance, and increased work of breathing.
- Unfortunately, there is very little literature to guide the emergency physician on mechanical ventilation in obese patients.
- A recent study of intubated ED patients by Goyal, et al found that over 1 in 5 patients were ventilated with potentially injurious tidal volumes.
- Importantly, obesity increased the odds of inappropriate ventilator settings.
- In the intubated obese patient, be sure to set tidal volume based on ideal body weight and consider starting with a higher PEEP setting (i.e., 10 to 15 cm H2O).
References
Goyal M, et al. Body mass index is associated with inappropriate tidal volumes in adults intubated in the ED. Am J Emerg Med 2016; 34:1682-3.