부산대학교 도서관

Summary Obese patients admitted to the intensive care unit (ICU) are at risk of pulmonary complications, mainly because of their predisposition to atelectasis. Non-invasive ventilation (NIV) has proven its safety and efficacy to treat and/or prevent acute respiratory failure. Use of high-flow nasal cannula oxygen (HFNC) allows warm, humidified oxygen to be administered and provides a moderate level of positive end-expiratory pressure (PEEP). Mask ventilation and intubation are more difficult in obese than in non-obese patients. Then, a protocol of difficult airway management should be applied, using difficult airway devices such as videolaryngoscopes, to prevent complications related to intubation (severe hypoxaemia, arterial hypotension, and cardiac arrest). Preoxygenation optimization in a semi-sitting position using positive-pressure ventilation (continuous positive airway pressure or NIV) may be helpful. Apnoeic oxygenation using HFNC may be considered in obese patients with the aim of preventing desaturation. After securing the airway, a lung-protective ventilation, using low tidal volume (TV), moderate-to-high PEEP, and recruitment manoeuvres should be applied to avoid both baro-volutrauma and atelecto-biotrauma. TV should be set according to ideal body weight (IBW) and not actual body weight as the height of the lung is correlated with the height of the patient. The optimal TV recommended is between 6 and 8 mL/kg IBW. In case of acute respiratory distress syndrome, prone positioning can be used safely, facilitating improvements in oxygenation and respiratory mechanics. Obesity hypoventilation syndrome and obstructive-apnoea syndrome should be sought, and treated, including the use of positive airway pressure at home. These measures can prevent or reduce obesity-associated pulmonary complications.