Obesity remains a challenging public health problem. The anatomic and physiologic complexities of obese patients make their healthcare challenging under routine circumstances, but in the setting of critical illness, these challenges are magnified. This review explores some of the unique difficulties that critical care providers face when caring for the obese patient and highlights areas in which future research is needed to provide optimal care.
HubertHBFeinleibMMcNamaraPMCastelliWP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983;67(5):968-977.
3.
KaltmanAJGoldringRM. Role of circulatory congestion in the cardiorespiratory failure of obesity. Am J Med. 1976;60(5):645-653.
4.
ZhouYTGrayburnPKarimA. Lipotoxic heart disease in obese rats: implications for human obesity. Proc Natl Acad Sci U S A. 2000;97(4):1784-1789.
5.
UmanaEAhmedWFraleyMAAlpertMA. Comparison of oscillometric and intraarterial systolic and diastolic blood pressures in lean, overweight, and obese patients. Angiology. 2006;57(1):41-45.
6.
WinfieldRDDelanoMJLottenbergL. Traditional resuscitative practices fail to resolve metabolic acidosis in morbidly obese patients after severe blunt trauma. J Trauma. 2010;68(2):317-330.
7.
McClaveSAMartindaleRGVanekVW. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
8.
WinfieldRDBochicchioGV. The critically injured obese patient: a review and a look ahead. J Am Coll Surg. 2013;216(6):1193-1206.
9.
AnagnostisPAthyrosVGTziomalosKKaragiannisAMikhailidisDP. Clinical review: the pathogenetic role of cortisol in the metabolic syndrome: a hypothesis. J Clin Endocrinol Metabol. 2009;94(8):2692-2701.
10.
HotamisligilGSShargillNSSpiegelmanBM. Adipose expression of tumor necrosis factor-alpha: direct role in obesity-linked insulin resistance. Science. 1993;259(5091):87-91.
11.
StefanNSunQFritscheA. Impact of the adipokine adiponectin and the hepatokine fetuin-A on the development of type 2 diabetes: prospective cohort- and cross-sectional phenotyping studies. PloS One. 2014;9(3):e92238.
12.
GoossensGH. The renin-angiotensin system in the pathophysiology of type 2 diabetes. Obesity Facts. 2012;5(4):611-624.
13.
IwashitaMNakatsuYSakodaH. Valsartan restores inflammatory response by macrophages in adipose and hepatic tissues of LPS-infused mice. Adipocyte. 2013;2(1):28-32.
14.
GoossensGHMoorsCCvan der ZijlNJ. Valsartan improves adipose tissue function in humans with impaired glucose metabolism: a randomized placebo-controlled double-blind trial. PloS One. 2012;7(6):e39930.
15.
MoweryNTMayAKCollierBC. Glucose metabolism, not obesity, predicts mortality in critically ill surgical patients. Am Surg. 2010;76(12):1377-1383.
16.
NICE-SUGAR Study Investigators, FinferSChittockDR. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297.
17.
SchierenbeckFOwallAFranco-CerecedaALiskaJ. Evaluation of a continuous blood glucose monitoring system using a central venous catheter with an integrated microdialysis function. Diabetes Technol Ther. 2013;15(1):26-31.
18.
YueXYZhengYCaiYHYinNNZhouJX. Real-time continuous glucose monitoring shows high accuracy within 6 hours after sensor calibration: a prospective study. PloS One. 2013;8(3):e60070.
AnfossiGRussoIDoronzoGPomeroATrovatiM. Adipocytokines in atherothrombosis: focus on platelets and vascular smooth muscle cells. Mediators Inflamm. 2010;2010:174341.
21.
KurthTGazianoJMBergerK. Body mass index and the risk of stroke in men. Arch Intern Med. 2002;162(22):2557-2562.
22.
GouldMKGarciaDAWrenSM. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 suppl):e227S-e277S.
23.
HirshJGuyattGAlbersGWHarringtonRSchunemannHJ, American College of Chest Physicians. Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133(6 suppl):110S-112S.
24.
McGuireTRBrusnahanSKBilekLD. Inflammation associated with obesity: relationship with blood and bone marrow endothelial cells. Obesity (Silver Spring). 2011;19(11):2130-2136.
25.
LumengCNBodzinJLSaltielAR. Obesity induces a phenotypic switch in adipose tissue macrophage polarization. J Clin Invest. 2007;117(1):175-184.
26.
SharmaSMalurAMarshallI. Alveolar macrophage activation in obese patients with obstructive sleep apnea. Surgery. 2012;151(1):107-112.
27.
SheridanPAPaichHAHandyJ. Obesity is associated with impaired immune response to influenza vaccination in humans. Int J Obes. 2012;36(8):1072-1077.
28.
WinfieldRDDelanoMJCuencaAG. Obese patients show a depressed cytokine profile following severe blunt injury. Shock. 2012;37(3):253-256.
29.
WatersDLBaumgartnerRN. Sarcopenia and obesity. Clin Geriatr Med. 2011;27(3):401-421.
30.
McClaveSAKushnerRVan WayCWIII. Nutrition therapy of the severely obese, critically ill patient: summation of conclusions and recommendations. JPEN J Parenter Enteral Nutr. 2011;35(5 suppl):88S-96S.
31.
ChobanPDickersonRMaloneA. A.S.P.E.N. Clinical guidelines: nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr. 2013;37(6):714-744.
