Intensivtherapie bei Adipositas: Too Big to Fail?

Zusammenfassung

Pathophysiologische Besonderheiten und typische Begleiterkrankungen adipöser Patienten stellen Ärzte und Pflegepersonal auf Intensivtherapiestationen vor große Herausforderungen – und die Prävalenz dieser Patienten steigt. Dieser Beitrag vermittelt pathophysiologische Hintergründe sowie notwendiges Wissen über endotracheale Intubation, Anpassung der maschinellen Ventilation und die Lagerungsbehandlung bei kritisch kranken Adipösen.

Abstract

Worldwide, currently more than 1.9 billion adults are overweight, 650 million of them are obese. Hereby they pose a significant burden on the budget of the health system and on the workload of intensive care units. Mechanical ventilation of critically ill obese patients needs to take into account the characteristic pathologic alterations of their respiratory system. Setting the respirator also requires careful consideration. Cornerstones include judicious preoxygenation, selection of a tidal volume of 6 – 8 ml/kg ideal body weight, a level of positive end-expiratory pressure titrated to compensate for the reduced functional residual capacity and concurrently protect the lung from ventilator associated lung injury. In selected cases recruitment manoeuvres may be required. In light of the recently published ART study that showed an increased mortality and higher incidence of pneumothorax and barotrauma, these need to be performed carefully. Correctly positioning the critical obese is an unrenounceable asset of intensive care. Prone position in mechanically ventilated obese ARDS-patients has been proven to be life-saving. However, specifically the supine position and the Trendelenburg position need to consequently be avoided. Failure to do so may result in obesity supine death syndrome. Finally, latest research documented lower mortality rates in obese individuals who require intensive care. This represents another hard to explain obesity paradox.

Schlüsselwörter

Adipositas - maschinelle Beatmung - Lagerung - Obesity Supine Death Syndrome - Adipositas-Paradoxon

Key words

obesity - mechanical ventilation - positioning - obesity supine death syndrome - obesity paradox

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