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Ventilator Management of the Obese Patient

Faculty

Dr. Robert Kacmarek, PhD, RRT, FCCM, FCCP, FAARC Dr. Robert Kacmarek, PhD, RRT, FCCM, FCCP, FAARC

Webcast Replay

Originally Recorded   Thursday, March 5, 2020
9 a.m. – 10 a.m. PDT
12 p.m. – 1 p.m. EDT

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No fee is associated with this activity.

Each participant wishing to obtain CRCE credit must preregister individually, even when viewing with a group. In addition, please obtain group viewing instructions, roster and evaluation forms by contacting Salomay_corbaley@nihonkohden.com

Learning Objectives

Upon completion of this Webinar the attendee will be able to:

  1. Discuss the effect of obesity on ventilatory function.
  2. Discuss the concept of transpulmonary pressure and how it is used to set PEEP.
  3. Discuss ventilator setting in general in the obese patient and the use of Lung recruitment maneuver and high PEEP to stabilize the lung of the acutely ill obese patient.

Webcast Summary

Today, obesity is considered epidemic. In the adult, obesity is defined as greater than a body mass index (BMI) of 30 kg/m2. The United States is one of the most affected countries by this epidemic. In the US 40% of adults are considered obese, 20% of adolescents and 14% of children. Obesity has some very negative effects on the individual; diabetes, heart disease and various metabolic issues are caused by obesity. In references to this presentation obesity can have a profound effect of ventilatory function. Because of the increased mass on the chest wall atelectasis and premature airway closure are common. Normally, the lung is maintained open as a result, of a positive end expiratory transpulmonary pressure (alveolar pressure minus pleural pressure). In obesity pleural pressure is increased sometime as high a positive 20 cmH2O as a result, at end expiration the transpulmonary pressure is negative causing alveolar collapse. In obese patients in hypoxemic respiratory failure very high PEEP levels are required to stabilize the lung and avoid collapse, sometimes exceeding 25 cmH2O. It should also be remembered the obese lung is no larger than the normal sized lung. As a result, tidal volumes should be set at 4 to 8 ml/kg similar to someone of lean body mass. These and other topics will be discussed in detail during the Webinar.

References

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