Mechanical Ventilation of Obese patient in the Perioperative Period Department of Surgical Sciences and Integrated Diagnostics (DISC) University of Genoa, Italy [email protected] JRUR, Marseille, France, 2012 Body mass index (BMI) and Waist measurement The most common indicators of Obesity BMI = Weight (Kg)/Height 2 (m2) Underweight < 20 Normal > 20 - < 27 Overweight > 27 - < 30 Obese > 30 - < 40 Morbidly Obese > 40 Peate I et al. (2005) BJN 2005 5: 134-138 Agenda (cid:2) (cid:1) Effects of Anesthesia on the Respiratory Function -I(cid:1) ntraoperatively -P(cid:1) ostoperatively (cid:2)E(cid:1) ffects on Morbidity and Mortality (cid:2) (cid:1) Mechanical ventilation: - (cid:1) Optimizing pre-oxygenation - PEEP and recruitment (cid:2) (cid:1) Postoperative period - (cid:1) Prediction of PPCs -P(cid:1) ositioning and Physiotherapy - Non invasive respiratory support Obese’s Grave (III sec. B.C.) Son of Velthur (“The Rich Man”) Peri-operative respiratory modifications : Lung volume reduction and atelectasis Pelosi P and Gregoretti C. Eur Crit Care 2010; 1: 1-8 Pelosi P, Gregoretti C. Best Pract Res Clin Anaesthesiol. 2010 Jun;24(2):211-25 Effects of anesthesia on lung morphology in obese patients PelosiP, Gregoretti C. Best Pract Res Clin Anaesthesiol. 2010 Jun;24(2):211-25 Lung volume as a function of obesity IAP is the main determinant of lung volume Damia, Br J Anaesth 1988; 60:574-578; Pelosi, Anesthesiology 1999; 91: 1221-1231 IAP: Normals 7 cmH2O - Obese 18 cmH2O 3000 2500 L) * p < 0.01 vs Before induction m ( 2000 E M U * L O 1500 V * G N U 1000 L 500 0 Before After After After Skin Induction Induction Laparotomy Incision Closure Lung volume as a function of obesity Cst,rs as a function of BMI