sábado, 19 de octubre de 2013

Obesidad en UCI

Inquietudes en el cuidado clínico y crítico en los pacientes obesos con enfermedades graves.
Clinical and critical care concerns in severely ill obese patient.
Bajwa SJ, Sehgal V, Bajwa SK.
Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India.
Indian J Endocrinol Metab. 2012 Sep;16(5):740-8. doi: 10.4103/2230-8210.100667.
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical careconcerns in critically ill obese patients.
KEYWORDS: Body mass index, critically ill, obesity, sleep apnea syndrome 

Efecto de la obesidad y laparotomía descompresiva sobre la mortalidad de la pancreatitis aguda que requiere admisión en UCI      
Effect of obesity and decompressive laparotomy on mortality in acute pancreatitis requiring intensive care unit admission.
Davis PJ, Eltawil KM, Abu-Wasel B, Walsh MJ, Topp T, Molinari M.
Division of General Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Room 6-302 Victoria Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
World J Surg. 2013 Feb;37(2):318-32. doi: 10.1007/s00268-012-1821-8.
BACKGROUND: Controversy still exists on the effect that obesity has on the morbidity and mortality in severe acute pancreatitis (SAP). The primary purpose of this study was to compare the mortality rate of obese versus nonobese patients admitted to the ICU for SAP. Secondary goals were to assess the potential risk factors for abdominal compartment syndrome (ACS) and to investigate the performance of validated scoring systems to predict ACS and in-hospital mortality. METHODS:A retrospective cohort of adults admitted to the ICU for SAP was stratified by their body mass index (BMI) as obese and nonobese. The rates of morbidity, mortality, and ACS were compared by univariate and multivariate regression analyses. Areas under the curve (AUC) were used to evaluate the discriminating performance of severity scores and other selected variables to predict mortality and the risk of ACS. RESULT: Forty-five patients satisfied the inclusion criteria and 24 (53 %) were obese with similar characteristics to nonobese patients. Among all the subjects, 11 (24 %) died and 16 (35 %) developed ACS. In-hospital mortality was significantly lower for obese patients (12.5 vs. 38 %; P = 0.046) even though they seemed to develop ACS more frequently (41 vs. 28 %; P = 0.533). At multivariable analysis, age was the most significant factor associated with in-hospital mortality (odds ratio (OR) = 1.273; 95 % confidence interval (CI) 1.052-1.541; P = 0.013) and APACHE II and Glasgow-Imrie for the development of ACS (OR = 1.143; 95 % CI 1.012-1.292; P = 0.032 and OR = 1.221; 95 % CI 1.000-1.493; P = 0.05) respectively. Good discrimination for in-hospital mortality was observed for patients' age (AUC = 0.846) and number of comorbidities (AUC = 0.801). ACS was not adequately predicted by any of the clinical severity scores (AUC = 0.548-0.661). CONCLUSIONS: Patients' age was the most significant factor associated with mortality in patients affected by SAP. Higher APACHE II and Glasgow-Imrie scores were associated with the development of ACS, but their discrimination performance was unsatisfactory.
 Respuesta respiratoria y hemodinámica a la movilización de obesos graves             
Respiratory and hemodynamic responses to mobilization of critically ill obese patients.
Genc A, Ozyurek S, Koca U, Gunerli A.
School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.
Cardiopulm Phys Ther J. 2012 Mar;23(1):14-8.
PURPOSE: The aim of this study was to investigate the effects of mobilization on respiratory and hemodynamic parameters in critically ill obese patients. METHODS:
Critically ill obese patients (n = 31) were included in this retrospective study. Data were collected from patients' files and physiotherapy records of mobilization sessions. Heart rate (HR), systolic/diastolic/mean blood pressure, respiratory rate (RR), and percutaneous oxygen saturation (SpO(2)) were recorded. Cardiorespiratory parameters were collected just prior to the mobilization, just after the completion of the mobilization and after 5 minutes recovery period. Respiratory reserve was calculated before and after the mobilization. RESULTS: A total of 37 mobilization sessions in 31 obese patients (mean age: 63.3 years, mean BMI: 32.2 kg/m(2)) who received physiotherapy were analyzed. Respiratory rate increased significantly after the completion of the mobilization compared to initial values (p < 0.05). SpO(2) significantly increased (p < 0.05) and all other parameters remained similar (p > 0.05) compared to initial values after the recovery period. Mobilization resulted in a significant increase in respiratory reserve (p < 0.05). CONCLUSION: Early mobilization in intensive care unit promotes respiratory reserve in obese patients. We found that mobilization can be performed safely in critically ill obese patients if cardiorespiratory parameters are continuously monitored.
KEYWORDS: critically ill patients, mobilization, obesity, physiotherapy
Dr. Juan Carlos Flores-Carrillo
Anestesiología y Medicina del Dolor
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