Mechanical Ventilation in the Obese Critically Ill

• Rates of obesity have steadily risen over the past three decades.  In fact, the prevalance of obesity in the ICU is now estimated at 20%.
• Obesity affects numerous organ systems and impacts the resuscitation and management of these patients.
• The pulmonary systems undergoes several changes that include decreased lung compliance, decreased chest wall compliance, increased O2 consumption, increased CO2 production, and increased work of breathing.
• When initiating mechanical ventilation in the obese patient without ARDS, consider the following initial settings:
  • Tidal volume 6 ml/kg ideal body weight
  • PEEP of 10-12 cm H2O
  • RR to achieve a PaCO2 35-45 mmHg
  • FiO2 to maintain SpO2 92-95%
  • Driving pressure < 15 cm H2O

References

Schetz M, et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019 [epub ahead of print].