Revue des maladies respiratoires
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The obese patient is at an increased risk of perioperative complications. Most importantly, these include difficult access to the airways (intubation, difficult or impossible ventilation), and post-extubation respiratory distress secondary to the development of atelectasis or obstruction of the airways, sometimes associated with the use of morphine derivatives. The association of obstructive sleep apnea syndrome (OSA) with obesity is very common, and induces a high risk of peri- and postoperative complications. ⋯ Appropriate prophylaxis against venous thromboembolic disease and early mobilization are recommended, as thromboembolic disease is increased in the obese patient. The use of non-invasive ventilation to prevent the occurrence of acute post-operative respiratory failure and for its treatment is particularly effective in obese patients. In case of admission to ICU, an individualized ventilatory management based on pathophysiology and careful monitoring should be initiated.
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We are at a "post-trust" period, characterised by vaccine hesitancy which is being widely diffused by the media and social networks. The consequences of this include: measles, whooping cough epidemics, vaccine coverage decreasing for the youngest, and remaining at low levels in adults. Mandatory vaccination has been extended for children less than two years in France, with the objective to increase vaccination rates during this period. ⋯ Anti-vaccine ideas were born with vaccines; they are abundantly spread through the Internet and social networks and can give a false impression of their basis in reality. It is time for positive action not merely a defensive approach.