Obesity

Mask ventilation obese women – Mechanical ventilation in obese ICU patients: from intubation to extubation

If CPAP or NIV were used prior to surgery, they should be pursued throughout the perioperative period, including the postoperative period.

Likewise, special attention should be given to airway management for the obese, morbidly obese, or very large patient [ 14 ]. Licensee IntechOpen. Troop elevation pillow TEP with standard head cradle note the elevated arm board pads. Recruitment maneuvers To open alveoli once they are closed, recruitment maneuvers should be used, transitorily increasing the transpulmonary pressure. The impact of obesity on outcomes after critical illness: a meta-analysis. A sitting position should therefore be privilegied in case of respiratory failure.

  • Article PubMed Google Scholar 9. Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed.

  • Conclusion Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients.

  • However, it is necessary to remain on guard and always assess the hemodynamic effects of high PEEP: risk of decreased oxygenation because of an impact on cardiac flow and of hypotension because of compromised venous drainage.

Associated Data

In obese patients with obstructive apnea syndrome, nocturnal CPAP should be initiated before surgery, especially if the apnea hypopnea index Obese women is more than 30 events per hour or if there is severe cardiovascular comorbidity. Morbid obesity and tracheal intubation. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. It is well accepted that surgical positioning is adjusted or modified depending on the type of surgery. Troop November 5th

  • Results Of 45, analyzed cases, 4. Moreover, in obese hypercapnic patients, the use of NIV following extubation is associated with decreased mortality [ 46 ].

  • Uptake of Halothane by the Human Body. Uptake of Halothane by the Human Body.

  • Effect of obesity on intensive care morbidity and mortality: a meta-analysis. J Anesth.

  • De Jong, A.

Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. Receiver operating curve ROC showing the relationship between sensitivity true ventklation and 1-specificity true negative in determining the predictive value of the number of criteria 1 to 5 for difficult mask ventilation. Intubation difficulty scale: anticipated best use. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. J Anesth. Patients with a history of gastroesophageal reflux or with known pathologic airway abnormalities were not included in the study.

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Airway axes misaligned. Mask ventilation obese women of steroids on reintubation and post-extubation stridor in adults: meta-analysis of randomised controlled trials. When caring for the airway of normal-size nonobese patients, the concept of aligning the three airway axes in preparation for intubation has been taught at all anesthesia teaching colleges. The effect of leaving dentures in place on bag-mask ventilation at induction of general anesthesia. Eighty-eight patients were women and 16 were men. Figure 4 shows the white imaginary line as an acute angle and the airway axes misaligned. You can also search for this author in PubMed Google Scholar.

  • Anaesth Intensive Care. However, it is necessary to remain on guard and always assess the hemodynamic effects of high PEEP: risk of decreased oxygenation because of an impact on cardiac flow and of hypotension because of compromised venous drainage.

  • Anesthesiology MayVol.

  • Lung protective ventilation strategy for the acute respiratory distress syndrome.

  • Main outcome measures: The primary outcome of the study was difficult tracheal intubation.

  • In the supine position, positional flow limitation and air trapping impedes respiratory management particularly in obese patients [ 43 ]. Public Health.

Difficult mask ventilation. A recent physiological study specifically investigated the inspiratory effort during weaning of mechanical ventilation in a population of critically ill, morbidly obese patients [ 44 ]. This is a preview of subscription content, access via your institution. Bertrand Leroux, M.

Article PubMed Google Scholar 9. Unfortunately, the factors predicting for DMV remain unknown obede have not been defined in practice guidelines for management of the difficult airway. As confirmed by adequate ventilation obtained in all patients, the safety of the ILMA was similar in both groups. J Anesth. Surg Obes Relat Dis. Categorical data were analyzed with the chi-square test and the Fisher exact test as required.

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Many complications of respiratory care are directly related to the obstructive apnea syndrome: difficult airway management including difficult mask ventilation, difficult intubation and obstruction of the upper airway. Google Scholar. Download references. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study.

  • A sitting position should therefore be privilegied in case of respiratory failure. A partial list of these concerns includes cardiovascular disease increased cardiac workload, arrhythmiashypertension, obstructive sleep apnea OSA [ 13 ], restrictive and reactive lung disease asthma, chronic hypoxemia, and hypercarbiaand abnormal pulmonary mechanics.

  • The anesthesiologist was asked to rate mask ventilation as impossible when it completely failed, and an alternative to face mask ventilation was required in emergency conditions.

  • Respiratory maxk and patient education of exercises, such as incentive spirometry or high volume respiration, also limit the reduction in lung volume induced by surgery. The head-elevated laryngoscopy position HELP has been presented as the best starting point to improve patient safety, lower risk, and facilitate a successful first attempt at intubation.

  • The Australian incident monitoring study. Bruno Riou, M.

  • Third, the incidence of impossible ventilation was very low, and consequently this phenomenon could not be analyzed and its risk factors could not be identified.

Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia: a single-center analysis ofmask ventilation obese women. Article PubMed Google Scholar 4. Airway axes. Moon View author publications. Protective ventilation enabled a decrease in the global rate of complications from Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support.

Leoni, A. In practice, the advantages and inconveniences of each mode must be known and the ventilatory mode that the physician prefers used. Postoperative noninvasive ventilation. Article Navigation.

Effect of noninvasive ventilation on tracheal reintubation among patients with hypoxemic respiratory failure following abdominal surgery: a randomized clinical trial. Published : 08 January SpO2 an indirect noninvasive measurement of the oxygen level oxygen saturation of the blood. Subscription will auto renew annually. This article has been cited by other articles in PMC.

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Eur J Anaesthesiol. PY - Y1 - N2 - Background. Ghisi, M. Together they form a unique fingerprint.

  • Of 37, cases in which mask ventilation was attempted, 2.

  • Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study.

  • Difficult endotracheal intubation in patients with sleep apnea syndrome. Oxygenation decreases with increase in weight, mostly because oxygen consumption and work of breathing are increased in obese patients [ 12 ].

  • Respir Physiol Neurobiol. Eur Respir J.

  • Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. The TEP has been offered by several medical distribution companies around the world since

  • Weaning from mechanical ventilation A recent physiological study specifically investigated the inspiratory effort during weaning of mechanical ventilation in a population of critically ill, morbidly obese patients [ 44 ]. If possible, the supine position should be avoided in patients with an obstructive apnea syndrome at risk of postoperative pulmonary complications, and a sitting position adopted.

This entire mask ventilation obese women prediction had a sensitivity of 0. The best recruitment maneuver has not been determined in the obese patient. Article Google Scholar. Methods Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed. Development of a new device for intubation of the trachea. Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days [ 48 ]. Lastly, a subjective assessment of anticipated DMV by the anesthesiologist was also requested.

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Mechanical ventilation in obese Domen patients: from intubation to extubation. Statistical analysis was mask ventilation obese women on a computer using NCSS 6. Obesity has become a worldwide health concern. DMV prediction score is easy to perform and is established with objective criteria that are probably not operator-dependent. Citing articles via Web Of Science Increases in morbid obesity in the USA: —

Laryngoscopy and morbid obesity [ 1 ]. Sturm Mask ventilation obese women. Post-extubation stridor in intensive care unit patients. Each intubation in a morbidly obese patient should be considered as difficult, and adequate preparation following an algorithm for difficult intubation performed Fig. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial.

chapter and author info

J Anesth 33, 96— Rights and permissions Reprints and Permissions. These findings support the use of NIV in this setting. Naimark A, Cherniack RM.

Obede, V. Article PubMed Google Scholar. Impact of obesity in mechanically ventilated patients: a prospective study. In case of increase in airway resistance bronchospasm, obstructed tube or decrease in compliance of the respiratory system obesity, atelectasis, selective intubation, surgical pneumoperitoneum, pneumothorax …the tidal volume decreases, leading to hypercapnia acidosis if alveolar ventilation is too low. Difficult intubation in obese patients: incidence, risk factors, and complications in the operating theatre and in intensive care units.

Br J Anaesth. Gerald Chanques, Email: rf. Risk factors evaluation and importance of the cuff-leak test. Physiology Oxygenation decreases with increase in weight, mostly because oxygen consumption and work of breathing are increased in obese patients [ 12 ]. Obese patient.

Patients and Methods

Respiratory rate Concerning the setting or respiratory rate, obese patients have an excess production of CO 2 and body, because of their increased oxygen consumption and increased work of breathing, especially when there is an associated obesity hypoventilation syndrome, with a decreased respiratory drive [ 13 ]. Surg Obes Relat Dis. Gonzales, Taylor J. Videolaryngoscopes are of particular interest in obese patients [ 28 ] and their use should be particularly emphasized when additional risk factors for difficult intubation are present. Post-extubation stridor in intensive care unit patients.

Eight senior anesthetists with substantial expertise in laryngeal mask airway but with no experience with the ILMA participated in this study. Predicting difficult intubation in women normal patients: a meta-analysis of bedside screening test performance. Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease. Link to citation list in Scopus. Online First Alert. Finally, as mentioned earlier, obesity is a major risk factor for obstructive apnea syndrome.

The importance of increased neck circumference to intubation difficulties in obese patients. The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. In obese patients, some teams recommend the pressure controlled mode because the decelerating flow should allow a better distribution of the flow in the alveoli. It is not the intent of this chapter to address the etiology or reasons for this current clinical issue. Oxygen supplementation should be administered continuously to all patients with obstructive apnea syndrome at increased perioperative risk until they are able to maintain their baseline oxygen saturation on ambient air; oxygen saturations should be monitored after leaving the recovery room [ 49 ]. Moreover, in this study, elevated Mallampati score, limited mouth opening, reduced cervical mobility, presence of an obstructive apnea syndrome, coma and severe hypoxemia risk factors included in the MACOCHA score [ 27 ] were associated with difficult intubation in obese patients. LMA laryngeal mask airway.

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Intensive Care Med. J Mask ventilation obese women Physiol. The anesthesia provider must initiate breathing for the patient to womeen a crisis. Improved line of sight facilitates successful first-pass intubation [direct laryngoscopy DL or video laryngoscopy VL ]. The ventilatory setting during mechanical ventilation, especially in obese patients, should be set to minimize driving pressure.

Results Of 45, analyzed cases, ventilaation. Recruitment maneuvers are mandatory to fully reopen the lung after anesthesia induction and a PEEP must be applied to prevent the progressive closing of the lung leading to atelectasis. Predicting difficult intubation—worthwhile exercise or pointless ritual? Practice guidelines for management of the difficult airway. NIV is as efficient in patients with obesity hypoventilation syndrome as in patients with chronic obstructive pulmonary disease COPDin case of acute hypercapnic respiratory failure [ 17 ]. Crit Care.

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In several studies specifically lbese in obese patients, respiratory mechanics and alveolar recruitment have been shown to be significantly improved by application of PEEP improvement in compliance and decreased inspiratory resistanceas has gas exchange [ 36 ]. Clinics Sao Paulo. Lower levels of driving pressure have been found to be associated with increased survival in ICU patients [ 39 ]. Morbidly obese patients do not have a higher incidence of difficult intubation compared to non-morbidly obese patients. The anesthesia provider must initiate breathing for the patient to avoid a crisis. Moreover, obese patients often present comorbidities, such as obstructive apnea syndrome or obesity hypoventilation syndrome.

Conclusion Obese patients admitted to the ICU are at risk of atelectasis, mask ventilation obese women is associated with pulmonary complications. Try out PMC Labs and tell us what you think. Incidences and predictors of difficult laryngoscopy in adult patients undergoing general anesthesia: a single-center analysis ofcases. Published : 08 January

Article PubMed Google Scholar 6. PubMed Google Scholar Table 1 Pathophysiological specificities of the obese patient.

The DMV prediction score is an indicator of a high risk of difficult airway and may lead to a better anticipation of difficult airway management, potentially decreasing the morbidity and mortality resulting from hypoxia or anoxia associated with a failed ventilation. AU - Cappelleri, G. Perioperative management In obese patients with obstructive apnea syndrome, nocturnal CPAP should be initiated before surgery, especially if the apnea hypopnea index AHI is more than 30 events per hour or if there is severe cardiovascular comorbidity. Table 1.

Patients were asked if they were habitual almost every night or every night snorers or not. Article PubMed Google Scholar Moon View author publications. Uptake of Halothane by the Human Body. View author publications. A moderate level of PEEP has been measured with this device [ 18 ] when the patient breaths with a closed mouth.

Eva Masso, M. In the scenario of unanticipated difficult airway management, several alternative or rescue techniques have been proposed, but few are able to overcome the problem of simultaneous difficult ventilation and intubation. Cite this article Moon, T. Bruno Riou, M.

At rest, oxygen consumption is 1. Cochrane Database Syst Rev. A preliminary clinical report of a new means of intubating the trachea.

Crit Care Med. The effect of leaving dentures in place on bag-mask ventilation at induction of general anesthesia. DL direct laryngoscopy. Practice guidelines for management of the difficult airway. The concept of driving pressure assumes that functional lung size is better quantified by compliance than by predicted body weight. J Anesth 33, 96—

Suggested airway and ventilation management algorithm in the obese patient in the intensive care unit. Pressure support improves oxygenation and lung protection compared to pressure-controlled ventilation and is further improved by random variation of pressure support. View large. Cappelleri and V.

Background

Ventilatory mode Which ventilator mode is better in obese patients? Obesity hypoventilation syndrome: an underdiagnosed and undertreated condition. However, studies comparing the two ventilatory modes report contradictory data: discordances can be explained by the different inclusion criteria and the methodological limitations of the studies [ 40 ].

When caring nask the airway of normal-size nonobese patients, the concept of aligning the three airway axes in preparation for intubation has been taught at all anesthesia teaching colleges. Naimark A, Cherniack RM. Moreover, abdominal pressure is increased because of increased abdominal and visceral adipose tissue deposition. Respiratory rate Concerning the setting or respiratory rate, obese patients have an excess production of CO 2because of their increased oxygen consumption and increased work of breathing, especially when there is an associated obesity hypoventilation syndrome, with a decreased respiratory drive [ 13 ].

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However, it is necessary to ventilatikn on guard and always assess the hemodynamic effects of high PEEP: risk of decreased oxygenation because of an impact on cardiac flow and of hypotension because of compromised venous drainage. These findings support the use of NIV in this setting. Obes Surg. Perioperative management In obese patients with obstructive apnea syndrome, nocturnal CPAP should be initiated before surgery, especially if the apnea hypopnea index AHI is more than 30 events per hour or if there is severe cardiovascular comorbidity. N Engl J Med. Such patients understandably are anxious when lying fully supine as the work of breathing increases.

The effectiveness of noninvasive positive pressure ventilation to enhance preoxygenation in morbidly obese obesr mask ventilation obese women randomized controlled study. Asai et al. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Because the incidence of difficult mask ventilation DMV and the factors associated with it are not well known, we undertook this prospective study.

J Appl Physiol. Respir Physiol Neurobiol. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.

AB - Background. Trends in adult body-mass index in countries from to a pooled analysis of population-based measurement studies mask ventilation obese women Br J Anaesth ; —4. Anaesthesia ; —9. Table 4. Uptake of Halothane by the Human Body. Patients with a history of gastroesophageal reflux or with known pathologic airway abnormalities were not included in the study.

Anesth Analg ; —5. Statistical analysis was performed on a computer using NCSS 6. Macintosh direct laryngoscope for intubation of morbidly obese patients: a randomized trial. Close Modal. Education May

Surprisingly, we observed with the ILMA a trend toward simpler airway management of obese as compared with lean ventilatioon. Minerva Anestesiol. Difficult intubation was defined as a proper insertion of the endotracheal tube with conventional laryngoscopy requiring more than two attempts or more than 10 min. High flow nasal cannula oxygen HFNC could be particularly interesting in obese patients.

Anesthesiology August This site uses cookies. Search all BMC articles Search. The areas under the ROC curve were 0.

  • Obese patients have an excess production of carbon dioxide CO 2because of their increased oxygen consumption and increased work of breathing, especially when there is an associated obesity hypoventilation syndrome, including a decreased respiratory drive [ 13 ].

  • In our study, the use of muscle relaxants was equally reported when ventilation was easy or difficult table 2as previously reported by Rose and Cohen.

  • The effect of leaving dentures in place on bag-mask ventilation at induction of general anesthesia. In addition, the cut-off neck circumference related to difficult intubation has not been clearly identified.

  • AU - Cappelleri, G.

  • Troop elevation pillow TEP with standard head cradle note the elevated arm board pads.

Moon, T. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance. Exclusions were known difficult airway and emergency surgery. Benefits of the ramped position. Article PubMed Google Scholar 6. These two large randomized studies are complementary: while the first showed the usefulness of protective ventilation to decrease pulmonary and extrapulmonary postoperative complications, the second warns against the hemodynamic dangers of excessively high levels of PEEP for all patients, in particular when high PEEP levels are not associated with low tidal volume.

Compliance of the respiratory system and its components in health and obesity. The relationship between womem predictors of obstructive mask ventilation obese women apnea and difficult intubation. These atelectases are further exacerbated by a supine position and further worsened after general anesthesia and mechanical ventilation. Br J Anaesth ; —6. Among patients with hypoxemic respiratory failure following abdominal surgery, use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation within 7 days [ 48 ]. VolumeIssue 6. Sex differences in human adipose tissues—the biology of pear shape.

Materials and Methods

Fourth, the DMV prediction score provides an initial assessment of mask ventilation without any previous attempts of intubation. J Emerg Med ; —4. Risk factors evaluation and importance of the cuff-leak test. Can J Anaesth ; —4.

Categorical data were analyzed with the chi-square test and the Fisher exact test as required. Eur J Anaesthesiol. Marc Dumerat, M. The reliability and validity of the upper lip bite test compared w ith the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation.

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Of 37, cases in which mask ventilation was attempted, 2. Design: A obese women, noninterventional study. The position facilitates a successful first attempt at intubation. Numerous formal studies also confirm that HELP ramping or stacking the obese patient is of clinical benefit. Anaesth Intensive Care. The pressure modes deliver a constant pressure in the airway, decreasing the risk of barotrauma, with an insufflating pressure set at less than 30 cmH 2 O.

The objective of this chapter can be stated in one sentence. Article PubMed Google Scholar 5. Article PubMed Google Scholar 9. Licensee IntechOpen. J Appl Physiol. The best recruitment maneuver has not been determined in the obese patient.

  • It is well accepted that surgical positioning is adjusted or modified depending on the type of surgery.

  • The two parts preoperative visit and induction of anesthesia were provided on separate sheets and have been reassembled. Univariate comparison between patients with or without DMV was performed using the unpaired Student t test or Fisher exact method when appropriate.

  • Grading scale for mask ventilation.

  • Exclusions were known difficult airway and emergency surgery.

  • Public Health.

Moreover, abdominal pressure is increased because of increased mask ventilation obese women and visceral adipose tissue deposition. Comorbidities — Obstructive apnea syndrome — Obesity hypoventilation syndrome. Obesity hypoventilation syndrome: an underdiagnosed and undertreated condition. Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients. In spite of these recommendations, a recent study showed that obese patients were still ventilated in the perioperative period with tidal volumes that were too high [ 35 ].

In this study, all mask ventilations and endotracheal intubations were performed by a staff anesthesiologist. We hypothesized that body mass index would not influence airway management characteristics using the ILMA. If any resistance or evidence of esophageal intubation occurred, the tube was removed, and tracheal intubation was reattempted after the recommended adjustment maneuvers were performed. Driving pressure and survival in the acute respiratory distress syndrome.

More About Us. Cochrane Database Syst Rev. In the obese patient, postoperative pulmonary complications were decreased by the use of PSV compared to pressure controlled ventilation [ 42 ].

In obese patients, some teams recommend the mask ventilation obese women controlled mode because the decelerating flow should allow a better distribution of the flow in the alveoli. Ventilation strategies in obese patients undergoing surgery: a quantitative systematic review and meta-analysis. Article PubMed Google Scholar BMI, age, Mallampati class, thyromental distance, macroglossia, lack of teeth, beard, and snoring history were significantly different between the two groups, with or without DMV table 2. Moreover, we observed that airway management with the ILMA was simpler in morbidly obese patients as compared with lean patients. Anaesthesia ; —5. Table 1.

Article PubMed Google Scholar. Preoxygenation: prior to the administration of anesthesia, the surgical patient ventliation on a mask and circuit of oxygen to increase the O2 content in the lungs and in the circulation. Ventilatory mode Which ventilator mode is better in obese patients? Recruitment maneuvers are mandatory to fully reopen the lung after anesthesia induction and a PEEP must be applied to prevent the progressive closing of the lung leading to atelectasis. Prevention and care of respiratory failure in obese patients. There was no significant difference between the two groups for the main endpoint, which was a composite of postoperative pulmonary complications in the five first days following surgery. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study.

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The reliability and wommen of the upper lip bite test compared w ith the Mallampati classification to predict mask ventilation obese women laryngoscopy: an external prospective evaluation. A recent study reported an increase in the incidence of difficult intubation in obese patients [ 3 ]. External link. The TEP has been offered by several medical distribution companies around the world since Over 21, IntechOpen readers like this topic Help us write another book on this subject and reach those readers Suggest a book topic Books open for submissions.

The old saying that a picture ventilatiom a thousand words is captured in Figure 10a side-by-side comparison of bad and good positioning. Some obese patients may benefit from higher levels of PEEP than others. Over a 6-year period, all tracheal intubations in the operating room of a large tertiary teaching hospital were analyzed. J Appl Physiol.

The ventilatory setting during mechanical ventilation, especially in obese patients, should be set to minimize driving pressure. Eur J Anaesthesiol. Korean J Anesthesiol. A moderate level of PEEP has been measured with this device [ 18 ] when the patient breaths with a closed mouth. Correspondence to Tiffany S.

A sitting position during mechanical ventilation is therefore advised. Download citation. Pocar, V. This sequence of steps—first, reporting a case of DMV by the anesthesiologist, and second, retrospectively classifying the type of difficulties encountered during mask ventilation—may have underestimated the incidence of reported DMV. Obesity hypoventilation syndrome: an underdiagnosed and undertreated condition. Perioperative management In obese patients with obstructive apnea syndrome, nocturnal CPAP should be initiated before surgery, especially if the apnea hypopnea index AHI is more than 30 events per hour or if there is severe cardiovascular comorbidity.

MeSH terms

How to cite and reference Link to this chapter Copy to clipboard. This simple and easy step or adjustment when caring for the airway of obese and morbidly obese patients has significant clinical benefits Table 1. The optimal level of PEEP during protective ventilation remains to be determined, but many physiological studies suggest that PEEP levels of at least 5 cmH 2 O are necessary, in particular in obese patients. Audrey De Jong, Email: rf.

Two studies are most noteworthy: Collins et al. In the mask ventilation obese women position, positional flow limitation and air trapping impedes respiratory management obdse in obese patients [ 43 ]. The anesthesia clinician will benefit as HELP will facilitate easier mask ventilation [ 17 ]. Videolaryngoscopes are of particular interest in obese patients [ 28 ] and their use should be particularly emphasized when additional risk factors for difficult intubation are present. Crit Care Med. Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients.

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Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. Subscription will auto renew annually. Women readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. ADJ, GC and SJ contributed to drafting the submitted article, and to provide final approval of the version to be published. Can J Anaesth. Over 21, IntechOpen readers like this topic Help us write another book on this subject and reach those readers Suggest a book topic Books open for submissions.

Yentis SM. Prediction of difficult women ventilation. Lancet Respir Med. Bariatric surgery and complications associated with bariatric surgery are becoming increasingly frequent [ 2 ]. More Print chapter. Weaning from mechanical ventilation A recent physiological study specifically investigated the inspiratory effort during weaning of mechanical ventilation in a population of critically ill, morbidly obese patients [ 44 ].

  • Yentis SM. Predicting difficult intubation in apparently normal patients: a meta-analysis of bedside screening test performance.

  • View author publications. Eur J Anaesthesiol.

  • Login to your personal dashboard for more detailed statistics on your publications. Effect of obesity on intensive care morbidity and mortality: a meta-analysis.

  • Anaesthesia ; —5. At rest, oxygen consumption is 1.

  • Pressure support ventilation PSV seems very interesting in obese patients.

Clinics Sao Paulo. Asai et al. Respiratory rate Concerning the setting or respiratory rate, mask ventilation obese women patients have an excess production of CO 2because of their increased oxygen consumption and increased work of breathing, especially when there is an associated obesity hypoventilation syndrome, with a decreased respiratory drive [ 13 ]. Effect of intra-operative pressure support vs pressure controlled ventilation on oxygenation and lung function in moderately obese adults. View large. The authors thank Dr.

At rest, oxygen consumption is 1. Difficult tracheal intubation is more common in obese than in lean patients. Noninvasive ventilation for prevention of post-extubation respiratory failure in obese patients. Br J Anaesth.

High flow nasal cannula oxygen HFNC could be particularly interesting in obese patients. Published : women March Then, all dichotomous variables were analyzed using a stepwise forward logistic regression. Measuring transdiaphragmatic pressure seems crucial to determine the maximum pressure minimizing alveolar damage, taking into account that the plateau pressure is related to both transthoracic and transalveolar pressures. Increased body mass index per se is not a predictor of difficult laryngoscopy.

By continuing to use our website, you are agreeing to our privacy policy. There were significantly woken cases low body hemodynamic failure in the group with high PEEP. Table 1 Pathophysiological specificities of the obese patient Full size table. In the supine position, positional flow limitation and air trapping impedes respiratory management particularly in obese patients [ 43 ]. Second, we performed this study in a general adult population with various types of scheduled surgery. Article PubMed Google Scholar 5. The authors compared airway management quality in morbidly obese and lean patients with use of the ILMA.

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Difficulties Encountered during Mask Ventilation in 75 Patients. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Difficulties with mask ventilation and intubation cause swelling obese women makes ventilation and intubation more difficult with repeated attempts and may increase the incidence of the difficult ventilation—intubation scenario. Some case reports have described successful tracheal intubation with the ILMA in obese patients, and a large prospective study with this device in morbidly obese patients has been conducted recently. Questions persist regarding the type of recruitment maneuver to recommend.

The discriminating capacity of the model ROC curve area and adjusted weights for the risk factors odds ratios were also determined. In conclusion, we have shown that, although it was not ventilatjon designed for morbidly obese patients, when used by nonexpert anesthesiologists, the ILMA can provide adequate ventilation and allows tracheal intubation in most of these patients. Availability of data and materials Not applicable. In the obese patient, postoperative pulmonary complications were decreased by the use of PSV compared to pressure controlled ventilation [ 42 ]. Crit Care. Article PubMed Google Scholar 6. PubMed Google Scholar

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