Obesity can result in decreased lung volumes, decreased lung and chest wall compliance, and increased work of breathing.
Unfortunately, there is very little literature to guide the emergency physician on mechanical ventilation in obese patients.
A recent study of intubated ED patients by Goyal, et al found that over 1 in 5 patients were ventilated with potentially injurious tidal volumes.
Importantly, obesity increased the odds of inappropriate ventilator settings.
In the intubated obese patient, be sure to set tidal volume based on ideal body weight and consider starting with a higher PEEP setting (i.e., 10 to 15 cm H2O).
References
Goyal M, et al. Body mass index is associated with inappropriate tidal volumes in adults intubated in the ED. Am J Emerg Med 2016; 34:1682-3.
