Obesity Archives - Critical Care Science (CCS)

  • Original Article

    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19

    Crit Care Sci. 2024;36:e20240253en

    Abstract

    Original Article

    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19

    Crit Care Sci. 2024;36:e20240253en

    DOI 10.62675/2965-2774.20240253-en

    Views52

    ABSTRACT

    Objective

    To identify the influence of obesity on mortality, time to weaning from mechanical ventilation and mobility at intensive care unit discharge in patients with COVID-19.

    Methods

    This retrospective cohort study was carried out between March and August 2020. All adult patients admitted to the intensive care unit in need of ventilatory support and confirmed to have COVID-19 were included. The outcomes included mortality, time on mechanical ventilation, and mobility at intensive care unit discharge.

    Results

    Four hundred and twenty-nine patients were included, 36.6% of whom were overweight and 43.8% of whom were obese. Compared with normal body mass index patients, overweight and obese patients had lower mortality (p = 0.002) and longer intensive care unit survival (log-rank p < 0.001). Compared with patients with a normal body mass index, overweight patients had a 36% lower risk of death (p = 0.04), while patients with obesity presented a 23% lower risk (p < 0.001). There was no association between obesity and time on mechanical ventilation. The level of mobility at intensive care unit discharge did not differ between groups and showed a moderate inverse correlation with length of stay in the intensive care unit (r = -0.461; p < 0.001).

    Conclusion

    Overweight and obese patients had lower mortality and higher intensive care unit survival rates. The duration of mechanical ventilation and mobility level at intensive care unit discharge did not differ between the groups.

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    Influence of obesity on mortality, mechanical ventilation time and mobility of critical patients with COVID-19
  • Original Articles

    A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients

    Rev Bras Ter Intensiva. 2015;27(2):141-148

    Abstract

    Original Articles

    A gradient-boosted model analysis of the impact of body mass index on the short-term outcomes of critically ill medical patients

    Rev Bras Ter Intensiva. 2015;27(2):141-148

    DOI 10.5935/0103-507X.20150025

    Views2

    ABSTRACT

    Objective:

    To evaluate the impact of body mass index on the short-term prognosis of non-surgical critically ill patients while controlling for performance status and comorbidities.

    Methods:

    We performed a retrospective analysis on a two-year single-center database including 1943 patients. We evaluated the impact of body mass index on hospital mortality using a gradient-boosted model that also included comorbidities and was assessed by Charlson’s comorbidity index, performance status and illness severity, which was measured by the SAPS3 score. The SAPS3 score was adjusted to avoid including the same variable twice in the model. We also assessed the impact of body mass index on the length of stay in the hospital after intensive care unit admission using multiple linear regressions.

    Results:

    A low value (< 20kg/m2) was associated with a sharp increase in hospital mortality. Mortality tended to subsequently decrease as body mass index increased, but the impact of a high body mass index in defining mortality was low. Mortality increased as the burden of comorbidities increased and as the performance status decreased. Body mass index interacted with the impact of SAPS3 on patient outcome, but there was no significant interaction between body mass index, performance status and comorbidities. There was no apparent association between body mass index and the length of stay at the hospital after intensive care unit admission.

    Conclusion:

    Body mass index does appear to influence the shortterm outcomes of critically ill medical patients, who are generally underweight. This association was independent of comorbidities and performance status.

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    A gradient-boosted model analysis of the impact of body mass index on the
               short-term outcomes of critically ill medical patients
  • Original Articles

    Impact of obesity on critical care treatment in adult patients

    Rev Bras Ter Intensiva. 2010;22(2):133-137

    Abstract

    Original Articles

    Impact of obesity on critical care treatment in adult patients

    Rev Bras Ter Intensiva. 2010;22(2):133-137

    DOI 10.1590/S0103-507X2010000200006

    Views2

    STUDY OBJECTIVE: Obese patients seem to have worse outcomes and more complications during intensive care unit (ICU) stay. This study describes the clinical course, complications and prognostic factors of obese patients admitted to an intensive care unit compared to a control group of nonobese patients. DESIGN: Retrospective observational study. SETTING: A 10-bed adult intensive care unit in a university-affiliated hospital. METHODS: All patients admitted to the intensive care unit over 52 months (April 01/2005 to November 30/2008) were included. Obese patients were defined as those with a body mass index (BMI) ≥ 30 Kg/M2. Demographic and intensive care unit related data were also collected. An clinical and demographical matching group of eutrophic patients selected from the data base as comparator for mortality and morbidity outcomes. The Mann-Whitney test was used for numeric data comparisons and the Chi Square test for categorical data comparisons. RESULTS: Two hundred nineteen patients were included. The obese group (n=73) was compared to the eutrophic group (n= 146). Most of this group BMI ranged between 30 - 35 Kg/M2. Only ten patients had body mass index ≥40 Kg/M2. Significant differences between the obese and eutrophic groups were observed in median APACHE II score (16 versus 12, respectively; p<0.05) and median intensive care unit length of stay (7 versus 5 days respectively; p<0,05). No significant differences were seen regarding risk of death, mortality rate, mechanical ventilation needs, days free of mechanical ventilation and tracheostomy rates. The observed mortality was higher than the APACHE II-predicted for both groups, but the larger differences were seen for morbid obese patients (BMI ≥40 Kg/M2). CONCLUSIONS: Obesity did not increase the mortality rate, but improved intensive care unit length of stay. The current prognostic scoring systems do not include BMI, possibly underestimating the risk of death, and other quality of care indexes in obese patients. New studies could be useful to clarify how body mass index impacts the mortality rate.

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  • Original Articles

    Bariatric surgery: is admission to the intensive care unit necessary?

    Rev Bras Ter Intensiva. 2009;21(2):162-168

    Abstract

    Original Articles

    Bariatric surgery: is admission to the intensive care unit necessary?

    Rev Bras Ter Intensiva. 2009;21(2):162-168

    DOI 10.1590/S0103-507X2009000200008

    Views4

    OBJECTIVE: The purpose of this study was to determine the place of stay at postoperative and to verify medical-surgical complications that would justify admission to the intensive care unit, including death. METHODS: Cross-over, prospective, open study that evaluated 120 patients who were submitted to primary bariatric surgery by video laparoscopy from May 2007 to April 2008 in a tertiary hospital. The Aldrete Kroulik index was used for release from the post-anesthesia recovery room and to define where the patient should be routinely referred for postoperative. RESULTS: Among the 120 patients, 83 were women and 37 men with a mean age ranging from 35.4 ± 10.5 years (18 to 66 years), body mass index 45.6 ± 10.5. The time between hospital admission and start of surgery was 140.7 ± 81.8 minutes, surgery time was 105 ± 28.6 minutes, time of post-anesthesia recovery room was between 125 ± 38 minutes and length of hospital stay was 47.7 ± 12.4 hours, with 100% of the patients walking in 24 hours. The Aldrete and Kroulik index in the post-anesthesia recovery room achieved scores of 10 to 120 minutes in all patients, with a 100% survival . CONCLUSION: Using the Aldrete and Kroulik index in the post-anesthesia of gastric bypass by video laparoscopy in primary bariatric surgery, no patient was admitted in intensive care unit and no major complication was observed.

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    Bariatric surgery: is admission to the intensive care unit necessary?

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