jueves, 8 de septiembre de 2016

Obesidad en UCI / Obesity in ICU

Septiembre 1, 2016. No. 2435

Predictores de la evolución clínica después de traqueostomía en obesos graves
Predictors of clinical outcome after tracheotomy in critically ill obese patients.
Laryngoscope. 2014 May;124(5):1118-22. doi: 10.1002/lary.24347. Epub 2014 Mar 1.
OBJECTIVES/HYPOTHESIS: To identify patient factors associated with outcomes in critically ill obese patients requiring tracheotomy. STUDY DESIGN: Single-institution, retrospective cohort study. METHODS: Charts were reviewed for inpatients admitted to an intensive care unit from 2007 to 2010 with International Classification of Diseases, 9th Revision codes of obesity or morbid obesity and tracheotomy. Variables collected in the dataset include subject age, ethnicity, gender, body mass index, tracheotomy type, patient outcome, chief diagnosis, and medical comorbid conditions. The primary outcomes of interest were tracheotomy type and patient outcome at the time of hospital discharge. Logistic regression models were developed for the probability of each patient outcome using univariate and multivariate models. RESULTS: One hundred two patients met inclusion criteria. The most common outcome was tracheostomy dependence (49%). Increased mortality was independently significantly associated with pulmonary hypertension (P = .019) and African American ethnicity (P = .045). Increased tracheostomy dependence was significantly associated with obstructive sleep apnea (P = .030). Increased decannulation was significantly associated with percutaneous tracheotomy (P = .016) and Caucasian ethnicity (P < .001). CONCLUSIONS: Obese patients in the intensive care unit who undergo tracheotomy have a high likelihood of remaining tracheostomy dependent at the time of discharge from the hospital. The factors most commonly found to be significantly associated with poor outcomes were open tracheotomy, African American ethnicity, obstructive sleep apnea, and pulmonary hypertension.
KEYWORDS: Obesity; critically ill; decannulation; intensive care unit; morbid obesity; mortality; outcome; tracheotomy.

Características clínicas y evolución de la peritonitis postoperatoria después de cirugía bariátrica
Clinical features and outcome of postoperative peritonitis following bariatric surgery.
Obes Surg. 2013 Oct;23(10):1536-44. doi: 10.1007/s11695-013-0955-6.
BACKGROUND: We assessed the clinical features and outcome of morbidly obese patients admitted to the intensive care unit (ICU) for management of postoperative peritonitis (POP) following bariatric surgery (BS). CONCLUSIONS: The severity of POP in BS patients resulted in high mortality rates, similar to the results observed in cPOP. Usual empiric antibiotic therapy protocols should be applied to target multidrug-resistant microorganisms, but de-escalation can be performed in most cases.

Pacientes obesos tienen mayor riesgo de shock hipovolémico temprano
Obese trauma patients are at increased risk of early hypovolemic shock: a retrospective cohort analysis of 1,084 severely injured patients.
Crit Care. 2012 May 8;16(3):R77. doi: 10.1186/cc11334.
INTRODUCTION: Morbid obesity and its consequences are considered risk factors for adverse outcome in trauma, although the pathophysiologic mechanisms are incompletely understood. The aim of this study was to compare initial resuscitation, treatment, and short-term outcome of severely injured patients by body mass index (BMI). METHODS: A total of 1,084 severely injured patients with an injury severity score of 16 or greater were enrolled between 1996 and 2009 and grouped according to BMI. Their course of treatment and in-hospital outcome were analyzed by univariate and multivariate comparison. RESULTS: Of these patients, 603 (55.6%) were of normal weight with a BMI between 18.5 and 24.9, 361 (33.3%) had BMI values between 25 and 29.9, and 90 patients (8.3%) were obese (BMI ≥ 30). Thirty patients (2.8%) had BMI levels below 18.5. All groups were comparable with respect to injury severity, initial resuscitation, and time to ICU admission. There was a tendency towards higher mortality in obese patients (mortality 24.4%) and also overweight patients (mortality 18.8%) when compared with patients with a normal BMI (mortality 16.6%). Obese patients showed the highest mortality on day 0 (8.9% vs. 2.8% in the normal-weight group, P = 0.023), mostly due to persistent shock (6.7%). When corrected for BMI, obese patients are provided significantly lower volumes of intravenous fluids during the initial resuscitation period. CONCLUSION: In contrast to the mostly American literature, only a low percentage of trauma patients at a European trauma center are obese. These patients are at risk of higher mortality from persistent hemorrhagic shock in the initial phase after trauma, which may potentially be related to relative hypovolemia during the resuscitation period. In the later course of treatment, no significant differences exist with respect to specific complications, hospital stay, or in-hospital mortality.

XIII Congreso Virtual Mexicano de Anestesiología
Octubre a Diciembre 2016

Información / Information
2017 Winter Anesthesia Conference in Maui
California Society of Anesthesiologists
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