Obesity and the lung: 3. Obesity, respiration and intensive care

Abstract

Obesity is a major problem from a public health perspective and a difficult practical matter for intensivists. The obesity pandemic has required treating clinicians to develop an appreciation of the substantial pathophysiological effects of obesity on the various organ systems. The important physiological concepts are illustrated by focusing on obstructive sleep apnoea, obesity hypoventilation syndrome, abdominal compartment syndrome and ventilatory management of the obese patient with acute respiratory distress syndrome.

Figure 1

Obesity-related complications.

Figure 2

Impact of experimental manipulations of intra-abdominal pressure (IAP) on central venous pressure (CVP), pleural pressure and intracranial pressure (ICP). Note that resuscitation does not improve the intracranial pressure but release of the IAP (abdominal decompression) does lower ICP considerably. Failure to recognise increases in IAP could therefore contribute to mistreatment or poor outcome. Reproduced with permission from Citerio and Berra.