Problems during hospitalisation of morbidly obese patients in intensive care units: a narrative review
Problems during hospitalisation of morbidly obese patients in intensive care units: a narrative review

Summary/Abstract: Background: The frequency of hospitalization of patients with morbid obesity (Body Mass Index - BMI ≥ 40 kg/m2) is constantly increasing. When these patients are hospitalized in the Intensive Care Units (ICUs), in addition to the common problems in care and treatment encountered in the rest of the hospital wards, it brings distinct challenges to be faced by the staff. Aim of the study: This review aims to clarify the distinctive physiological characteristics of morbidly obese patients and the resulting challenges during ICU hospitalization while presenting appropriate therapeutic approaches and interventions. Material and methods: Based on the available medical literature and the authors’ clinical experience, we have selected articles and guidelines using PubMed, National Institutes of Health (NIH), SpringerMedizin, Semantic Scholar, the Medycyna Praktyczna website, WHO data, and book sources. We reviewed 693 articles, 3 books, and the websites of WHO and Medycyna Praktyczna. The final selection comprised 34 articles (32 in English, 1 in German, 1 in Polish), published between 2004 and 2023, with 12 published after 2020. Results: Morbid obesity disrupts the physiological homeostasis of the body. It most noticeably affecting the respiratory, cardiovascular, or gastrointestinal systems while being associated with multiple diseases. This necessitates specific distinctions in the intubation procedure, mechanical ventilation strategy, and drug dosing. In addition, life-threatening conditions such as acute respiratory distress syndrome (ARDS) or sepsis occur among patients hospitalized in the ICU, requiring additional modifications to therapy. Conclusions: Morbidly obese ICU patients, due to their anatomical and physiological characteristics, belong to individuals at risk of difficult intubation requiring specific positioning, preoxygenation, the use of video laryngoscopes, and implementation of an appropriate mechanical ventilation strategy. Additionally, altered drug metabolism and distribution in these patients necessitate distinct dosing protocols for effective treatment

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