Obesity Confers Longer Ventilator Use, Increased Risk for ARDS in Sepsis

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

In patients with sepsis admitted to the intensive care unit (ICU) who were classified as obese experienced longer durations of ventilator use and had a higher risk for acute respiratory distress syndrome (ARDS) compared with patients with a normal body mass index (BMI), according to findings intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

The study authors conducted a retrospective analysis of deidentified patient data from the MIMIC 3 critical care database as well as patients with sepsis who were admitted to the ICU (N=4224). BMI data as well as diagnostic and severity data on ARDS, which were assessed using a standard partial pressure of arterial oxygen (PaO₂) and percentage of inspired oxygen ratio (FiO₂) ratio.

Mild, moderate, and severe ARDS were represented by PaO₂/FiO₂ ratio values of 200 to 300, 100 to 200, and <100, respectively. A regression model adjusted for age, sex, and SOFA (Sequential Organ Failure Assessment) scores was used to analyze the effect of BMI on duration of ventilator use and development of ARDS in this patient population.

Approximately 31% and 26% of patients with sepsis who were admitted to the ICU were overweight and obese, respectively. Another 9% of these patients were categorized as severely obese. A significant association was found between the patients’ BMI and duration of ventilator use (P ≤.001). The duration of ventilator use was significantly longer in patients who were obese (odds ratio [OR], 1.2; 95% CI, 1.03-1.40; P =.02) and severely obese (OR, 1.5; 95% CI, 1.24-1.87; P ≤.001) compared with patients with normal BMI.

Additionally, the study authors found a significant association between BMI and ARDS (P =.01). Based on the PaO₂/FiO₂ ratio, the investigators found a significantly higher risk for mild ARDS in patients categorized as obese (risk ratio [RR], 1.62; 95% CI, 1.18-2.23; P=.002) and severely obese (RR, 2.02; 95% CI, 1.31-3.13; P =.001) vs patients with normal BMI and no ARDS.

A higher risk for moderate ARDS was associated with obesity (RR, 1.71; 95% CI, 1.27-2.23; P ≤.001) and severe obesity (RR, 1.97; 95% CI, 1.30-2.96; P =.001) compared with normal BMI. In addition, only obesity was associated with a higher risk for severe ARDS compared with normal BMI (RR, 1.57; 95% CI, 1.11-2.23; P =.01).

Reference

Rana A, Mansoor K, Abouzid M, et al. Influence of body mass index on the duration of ventilator use and its association with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2020;201:A1146.

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