Clinical approach to the critically ill, morbidly obese patient.

In the absence of a national registry, the prevalence of critically ill, morbidly obese patients in the United States is not known. On the basis of a retrospective study spanning 7 years of intensive care unit (ICU) data (1994–2000), it is estimated that the incidence of morbidly obese patients requiring intensive care treatment approaches 14 cases per 1,000 ICU admissions per year (1). However, this figure is likely to underestimate the true incidence because the database was restricted to nonsurgical patients. The growing interest in gastric bypass underlines the increased public awareness of the medical and economic consequences of this epidemic. The latest numbers released by the American Society for Bariatric Surgery indicate that the rate of bariatric surgeries has risen in the United States alone from 37,000 cases in the year 2000 to 62,400 cases in 2001 and it is expected that the total number of cases may exceed 100,000 by the end of 2003 (2). Most of the reviews that have provided data on morbidly obese patients have focused on the impact of obesity on individual organ function. Yet, clinical investigations addressing the care of the critically ill, morbidly obese patient are scarce. A recent review published in the AJRCCM detailed the principles and approach to outpatient treatment of obesity (3). The present commentary is aimed at (1) describing the common challenges of treating morbidly obese patients in critical care settings and (2) reviewing the current concepts and suggestions for therapy.