Mechanical Ventilation in the Critically Ill Obese Patient

Antonio M. Esquinas, MD, PhD, is a member of staff on the Intensive Care Unit and Non-invasive Ventilatory Unit at Hospital General Universitario Morales Meseguer, Murcia, Spain. Prior to taking up this position in January 2013, he worked in the Departments of Anesthesiology, Critical Care, and Pain Medicine at Sapienza University of Rome, Italy. Dr. Esquinas is a Fellow of the College of Chest Physicians and an International Fellow of the American Association of Respiratory Care. He is Director of the International School of Non-invasive Mechanical Ventilation and President of the International Association of NIV and the Ibero-American Association of Bioethics in NIV. He is the author of well over 700 scientific publications, including almost 400 articles and 32 books. Malcolm Lemzye, MD, is a Specialist in Respiratory and Critical Care Medicine in the Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France. He had previously held a similar position at Broussais Hospital, Saint Malo (2008-9) and was a Clinical Fellow in Critical Care Medicine and Hyperbaric Medicine at Calmette Hospital, Lille (2006-8). Dr. Lemzye obtained his medical degree from 2 University Medical School, Lille in 2001 and subsequently completed his board certification in Critical Care in Pneumonology in 2006 and in Critical Care in 2008. He is the author of more than 40 articles in international peer-reviewed journals.

Part I. Effects of obesity on respiratory physiology.- Effects of obesity on control of breathing.- Effects of obesity on respiratory mechanics and gas exchange.- Effects of obesity on sleep-disordered breathing.- Implications for mechanical ventilation.- Part II. Causes of acute respiratory failure in the obese patient.- Atelectasis.- Acute respiratory distress syndrome.- Community-acquired pneumonia.- Congestive heart failure.- Abdominal compartment syndrome.- Trauma.- Sleep-disordered breathing.- Drugs and medications.- Part III. Invasive mechanical ventilation in the critically ill obese patient.- Pre-oxygenation before intubation.- Difficult airway management.- Analgesia of the obese patient.- Sedation of the obese patient: indications, management, and complications.- Use of paralytics.- Positioning of the patient for mechanical ventilation.- Prevention of lung derecruitment.- Management of complications associated with mechanical ventilation.- Management of ventilator-inducedlung injury.- Management of the obese pregnant patient.- Modes of ventilation.- Weaning from mechanical ventilation.- Tracheostomy: indications and technique.- Decannulation process in the tracheostomised obese patient.- Part IV. Noninvasive ventilation and oxygen delivery in the critically ill obese patient.- The choice of interface.- The choice of ventilator and ventilator setting.- NIV in type 1 (hypoxemic) acute respiratory failure.- High-flow oxygen via nasal cannula.- NIV in type 2 (hypercapnic) acute respiratory failure.- Prevention of post-extubation respiratory failure.- NIV in the obese patient after surgery.- Determinants of NIV success or failure.- Chronic ventilation in obese patients.- Part V. Moving and feeding the critically ill obese patient.- Transportation of obese patients under mechanical ventilation.- Nutritional support in the critically ill obese ventilated patient.- Rehabilitation of obese patients under mechanical ventilation.- Part VI. Ethical issues, outcomeand costs.- Ethical issues regarding mechanical ventilation.- Long-term outcomes after mechanical ventilation.- Healthcare costs.

"This book is a comprehensive, internationally oriented guide for health care providers, managers, and specialists engaged in the care of these challenging patients. It considers the specific demands and peculiarities of this patient population and offers valuable clinical recommendations and guidance on respiratory care." (Anesthesia & Analgesia, Vol. 27 (06), December, 2018)

"Senior trainees, fellows, and attending anesthesiologists, intensivists, and pulmonologists treating morbidly obese patients are an appropriate audience for this book, written by an international cast of contributors. ... Given the international group of authorities and the breadth of topics, this book is an important contribution to our understanding of respiratory management in the obese patient." (David J. Dries, Doody's Book Reviews, February, 2018)