Elsevier

Clinics in Chest Medicine

Volume 30, Issue 3, September 2009, Pages 495-508
Clinics in Chest Medicine

Obesity and Acute Lung Injury

https://doi.org/10.1016/j.ccm.2009.05.008Get rights and content

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Pulmonary physiology in obesity and implications for patients with acute lung injury

The most significant change in pulmonary mechanics seen in obesity is a decrease in pulmonary compliance,6 which has been attributed to one of several factors: fatty infiltration of the chest wall, increased pulmonary blood volume, and extrinsic compression of the thoracic cage by weight from excess soft tissue.6, 7, 8, 9 As a result, obese subjects exhibit an increased work of breathing6, 10 and may note a subjective increase in dyspnea.11 In addition, respiratory resistance has been shown to

Pathophysiology of acute lung injury and the possible role of obesity

A full description of the pathophysiology of ALI/ARDS is beyond the scope of the current review and the reader is directed to recent reviews for further details.2, 39 In brief, in ALI/ARDS imbalances occur between pro- and anti-inflammatory cytokines, oxidants and antioxidants, and coagulation factors. Alterations in neutrophil activation, recruitment, and clearance and release of proteases also are important. The net result of these changes is alveolar filling with proteinaceous fluid,

Adipocytokines and acute lung injury/acute respiratory distress syndrome

In addition to classic cytokines, adipose tissue releases adipocytokines that act as mediators of subsequent proinflammatory and anti-inflammatory pathways.54 Although there are a number of known adipocytokines, of primary importance are leptin and adiponectin.54 Leptin is a polypeptide hormone secreted by adipocytes that is elevated in states of obesity and functions as a mediator of energy balance.61 It is secreted mainly by adipose tissue and meant to signal adequate stores of energy and

Obesity and outcomes from acute lung injury

Although a number of studies explore the association between obesity and outcome for critically ill adults (see article in this issue by Honiden and McArdle), few articles have focused specifically on patients with ALI/ARDS (Table 2). The first such study77 reported a secondary analysis of patients enrolled in the National Heart, Lung and Blood Institute's (NHLBI) multicenter, randomized trials of the Acute Respiratory Distress Syndrome Network.80, 81, 82 These studies included comparisons of

Obesity as a risk factor for acute lung injury and multiorgan failure in at-risk patients

Because of changes in physiology and inflammation associated with excess weight, it is conceivable that obese patients might be at greater risk for ALI/ARDS when suffering a predisposing acute event, such as sepsis or trauma. One of the earliest studies exploring an association between obesity and outcome among the critically ill reviewed data from 184 patients admitted to a trauma service over 6 months.84 In this study, mortality was significantly higher in patients with a BMI greater than 31

Measures of Excess Weight and the Heterogeneity of Obesity

Existing studies of excess weight and ALI have examined BMI as the only measure of excess weight. Although this measure is highly reliable and associated with adult body fat in ambulatory patients,87 BMI might not be the best representation of risk (or benefit) for critically ill patients. For example, the distribution of excess weight may have particular relevance for mechanically ventilated patients kept in a supine or semi-supine position.88 In selected epidemiologic studies, waist

Summary

ALI/ARDS is a common cause of acute respiratory failure with a high mortality rate. Although current data are premature, obesity and ALI/ARDS appear to share alterations in inflammation, endothelial dysfunction, and oxidative stress. This raises the possibility that obese patients may be at higher risk of developing ALI/ARDS and have poorer outcomes from ALI/ARDS. However, data supporting such an association are inconclusive. Additionally, obese ALI/ARDS patients may receive different care than

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References (105)

  • G.A. Zimmerman et al.

    Endothelial activation in ARDS

    Chest

    (1999)
  • M. Bachofen et al.

    Structural alterations of lung parenchyma in the adult respiratory distress syndrome

    Clin Chest Med

    (1982)
  • R.B. Goodman et al.

    Cytokine-mediated inflammation in acute lung injury

    Cytokine Growth Factor Rev

    (2003)
  • G. Fantuzzi

    Adipose tissue, adipokines, and inflammation

    J Allergy Clin Immunol

    (2005)
  • A. Avogaro et al.

    Mechanisms of endothelial dysfunction in obesity

    Clin Chim Acta

    (2005)
  • L.C. Lopez et al.

    Identification of an inducible nitric oxide synthase in diaphragm mitochondria from septic mice: its relation with mitochondrial dysfunction and prevention by melatonin

    Int J Biochem Cell Biol

    (2006)
  • Y. Arita et al.

    Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity

    Biochem Biophys Res Commun

    (1999)
  • A.M. Wolf et al.

    Adiponectin induces the anti-inflammatory cytokines IL-10 and IL-1RA in human leukocytes

    Biochem Biophys Res Commun

    (2004)
  • A.E. Morris et al.

    The association between body mass index and clinical outcomes in acute lung injury

    Chest

    (2007)
  • L.A. Dossett et al.

    Obesity and pulmonary complications in critically injured adults

    Chest

    (2008)
  • R.M. Otero et al.

    Early goal-directed therapy in severe sepsis and septic shock revisited: concepts, controversies, and contemporary findings

    Chest

    (2006)
  • M.A. Alpert et al.

    Relation of duration of morbid obesity to left ventricular mass, systolic function, and diastolic filling, and effect of weight loss

    Am J Cardiol

    (1995)
  • M.A. Alpert et al.

    Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss

    Am J Cardiol

    (1997)
  • W.H. Geerts et al.

    Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)

    Chest

    (2008)
  • T.D. Girard et al.

    Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial

    Lancet

    (2008)
  • A. Casati et al.

    Anesthesia in the obese patient: pharmacokinetic considerations

    J Clin Anesth

    (2005)
  • G.R. Bernard et al.

    The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination

    Am J Respir Crit Care Med

    (1994)
  • L.B. Ware et al.

    The acute respiratory distress syndrome

    N Engl J Med

    (2000)
  • G.D. Rubenfeld et al.

    Incidence and outcomes of acute lung injury

    N Engl J Med

    (2005)
  • M.R. Hebl et al.

    Weighing the care: physicians' reactions to the size of a patient

    Int J Obes Relat Metab Disord

    (2001)
  • C.H. Adams et al.

    The relationship of obesity to the frequency of pelvic examinations: do physician and patient attitudes make a difference?

    Women Health

    (1993)
  • A. Naimark et al.

    Compliance of the respiratory system and its components in health and obesity

    J Appl Physiol

    (1960)
  • F. Barrera et al.

    The distribution of ventilation, diffusion, and blood flow in obese patients with normal and abnormal blood gases

    Am Rev Respir Dis

    (1973)
  • E.J. Fadell et al.

    Fatty infiltration of respiratory muscles in the Pick-wickian syndrome

    N Engl J Med

    (1962)
  • P. Pelosi et al.

    The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia

    Anesth Analg

    (1998)
  • D.D. Sin et al.

    Obesity is a risk factor for dyspnea but not for airflow obstruction

    Arch Intern Med

    (2002)
  • C.S. Ray et al.

    Effects of obesity on respiratory function

    Am Rev Respir Dis

    (1983)
  • G.N. Bedell et al.

    Pulmonary function in obese persons

    J Clin Invest

    (1958)
  • P.S. Thomas et al.

    Respiratory function in the morbidly obese before and after weight loss

    Thorax

    (1989)
  • H.E. Refsum et al.

    Pulmonary function and energy expenditure after marked weight loss in obese women: observations before and one year after gastric banding

    Int J Obes

    (1990)
  • C. Wadstrom et al.

    Influence of excessive weight loss on respiratory function. A study of obese patients following gastroplasty

    Eur J Surg

    (1991)
  • R.O. Crapo et al.

    Spirometry as a preoperative screening test in morbidly obese patients

    Surgery

    (1986)
  • J. Kollias et al.

    Pulmonary function and physical conditioning in lean and obese subjects

    Arch Environ Health

    (1972)
  • I. Rubinstein et al.

    Airflow limitation in morbidly obese, nonsmoking men

    Ann Intern Med

    (1990)
  • W. Pankow et al.

    Expiratory flow limitation and intrinsic positive end-expiratory pressure in obesity

    J Appl Physiol

    (1998)
  • G. Licata et al.

    Effect of obesity on left ventricular function studied by radionuclide angiocardiography

    Int J Obes

    (1991)
  • K. Karason et al.

    Effects of obesity and weight loss on cardiac function and valvular performance

    Obes Res

    (1998)
  • H.S. Holley et al.

    Regional distribution of pulmonary ventilation and perfusion in obesity

    J Clin Invest

    (1967)
  • D.H. Tucker et al.

    The effect of change in body position on lung volumes and intrapulmonary gas mixing in patients with obesity, heart failure, and emphysema

    Am Rev Respir Dis

    (1960)
  • M.R. Salem et al.

    Does PEEP improve intraoperative arterial oxygenation in grossly obese patients?

    Anesthesiology

    (1978)
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