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Review
. 2024 Feb 21:11:1321692.
doi: 10.3389/fmed.2024.1321692. eCollection 2024.

Physical and respiratory therapy in the critically ill patient with obesity: a narrative review

Miguel Ángel Martínez-Camacho  1   2 , Robert Alexander Jones-Baro  1   3 , Alberto Gómez-González  1 , Diego Morales-Hernández  1 , Dalia Sahian Lugo-García  1 , Andrea Melo-Villalobos  1 , Carlos Alberto Navarrete-Rodríguez  1 , Josué Delgado-Camacho  1
Affiliations
Review

Physical and respiratory therapy in the critically ill patient with obesity: a narrative review

Miguel Ángel Martínez-Camacho et al. Front Med (Lausanne). .

Abstract

Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.

Keywords: critical care; early mobilization; obesity; physical therapy; rehabilitation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Key management and interventions for achieving better outcomes in critically ill patients with obesity. NIV: non-invasive ventilation; HFNC: high-flow nasal cannula; TV: tidal volume; PBW: predicted body weight; IBW: ideal body weight; PEEP: positive-end expiratory pressure; ARDS: acute respiratory distress syndrome; PS: pressure support; SAT: spontaneous awakening trial; SBT: spontaneous breathing trial; IMS: ICU Mobility Scale; MRC-SS: Medical Research Council Sum-Score.
FIGURE 2
FIGURE 2
Safety criteria for EM. SpO2, partial oxygen saturation; RR, respiratory rate; FiO2, fraction of inspired oxygen; PEEP, positive end-expiratory pressure; PaO2, arterial oxygen pressure; PaCO2, arterial carbon dioxide pressure; HR, heart rate; MAP, mean arterial pressure; SBP, systolic blood pressure; RASS, Richmond Agitation-Sedation Scale; ICP, intracranial pressure.
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