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Mechanical Ventilation in the Obese Critically Ill
- Rates of obesity have steadily risen over the past three decades. In fact, the prevalance of obesity in the ICU is now estimated at 20%.
- Obesity affects numerous organ systems and impacts the resuscitation and management of these patients.
- The pulmonary systems undergoes several changes that include decreased lung compliance, decreased chest wall compliance, increased O2 consumption, increased CO2 production, and increased work of breathing.
- When initiating mechanical ventilation in the obese patient without ARDS, consider the following initial settings:
- Tidal volume 6 ml/kg ideal body weight
- PEEP of 10-12 cm H2O
- RR to achieve a PaCO2 35-45 mmHg
- FiO2 to maintain SpO2 92-95%
- Driving pressure < 15 cm H2O
References
Schetz M, et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019 [epub ahead of print].