How I ventilate an obese patient

Excerpt

An increasing number of patients admitted to the intensive care unit are obese [1]. Many of them require mechanical ventilation, which may promote ventilator-induced lung injury (VILI) when applied to both injured and healthy lungs. Obesity induces functional changes in the respiratory system, resulting in a reduction of the end-expiratory lung volume, increased incidence of airway closure and formation of atelectasis, and alterations in lung and chest wall mechanics [2]. These alterations explain the high occurrence of gas exchange impairment, respiratory mechanics alterations, and hemodynamic compromise. To approach to the obese patient requiring mechanical ventilation, we propose a schematic algorithm (i-STAR, Fig. 1) as follows: (1) induction and intubation, (2) setting up initial mechanical ventilation, (3) titrating mechanical ventilation parameters, (4) assessing harmfulness of mechanical ventilation, and (5) rescue strategies.

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