Clinics in chest medicine
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Clinics in chest medicine · Sep 2009
ReviewRole of obesity in cardiomyopathy and pulmonary hypertension.
Obesity is becoming a worldwide problem of epidemic proportions, and its effect on the heart is increasingly being recognized. Obesity is often associated with an increased risk for heart failure. ⋯ The authors also briefly explore whether obesity plays a role in the development of pulmonary hypertension. Better recognition and understanding of both obesity cardiomyopathy and pulmonary hypertension are needed in the obese patient population.
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Acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) are common indications for ICU admission and mechanical ventilation. ALI/ARDS also consumes significant health care resources and is a common cause of death in ICU patients. ⋯ The few studies that have examined the influence of obesity on the outcomes from ALI/ARDS are inconclusive. Furthermore, observed results could be biased by disparities in provided care.
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Clinics in chest medicine · Sep 2009
ReviewAnesthetic management of patients with obesity with and without sleep apnea.
The global obesity epidemic presents anesthesia providers with unique and complex challenges as an increasing number of patients with elevated body mass index present for medical care. Pharmacokinetics, respiratory and cardiac physiology, positioning, regional anesthetic techniques, monitoring, and postoperative care are all profoundly affected by increased body mass. In recent years, the occult impact of undiagnosed obstructive sleep apnea on perioperative morbidity and mortality has marshaled increased attention from both patients and practitioners. A summary and discussion of the Practice Guidelines developed by the American Society of Anesthesiologists regarding the care of patients with obstructive sleep apnea is provided.
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Clinics in chest medicine · Sep 2009
ReviewThe relationship of obesity and obstructive sleep apnea.
Obstructive sleep apnea is a common disorder, and obesity is a known risk factor for its development. The prevalence of obesity is increasing worldwide, and a corresponding increase in the prevalence of obstructive sleep apnea and its cardiovascular and noncardiovascular consequences is likely. ⋯ There is evidence that treating obesity reduces the severity of obstructive sleep apnea and that treating obstructive sleep apnea decreases obesity. However, the evidence does not support a sustained correlation between weight loss and improvement in sleep-disordered breathing.
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The exact prevalence of obesity among critically ill patients is not known, but some evidence suggests that in the United States one in four patients in the intensive care unit is obese. The authors review the physiologic alterations in obesity that are relevant in critical illness and highlight some common diseases associated with obesity. Various practical challenges in the care of the critically ill obese patient, including drug dosing, are also reviewed.