Perioperative and Intensive Care Management of the Obese Surgical Patient

Abstract

The prevalence of morbid obesity is increasing worldwide, and this is posing several management challenges across medical and surgical care units. The adverse impact related to overweight status on multiple organs, particularly on pulmonary and cardiovascular function, may predispose to increasing perioperative and intensive care complications. However, while obesity is associated with higher all-cause mortality, many studies described an obesity paradox: higher body mass index (BMI) is associated with increased morbidity compared with normal BMI, with no effect on intensive care mortality. Further studies need to define whether this phenomenon is due to real beneficial effects of obesity upon survival for intensive care unit patients or it is reflective of selection biases in the studies design. Nowadays, little evidence exists to guide clinical practice in the perioperative and intensive care management of obese patients, especially in the area of invasive mechanical ventilation, weaning protocols, hemodynamic monitoring and other specific strategies in preoperative and critically ill obese patients. In this chapter, the current knowledge about perioperative and intensive care management of the obese patients is summarized.