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