title: Influence of abdominal obesity on multiorgan dysfunction and mortality in acute respiratory distress syndrome patients treated with prone positioning.
abstract: OBJECTIVE
  Obesity is a worldwide pandemic, and obese patients face an increased risk of developing acute respiratory distress syndrome (ARDS). Prone positioning (PP) is a frequently used intervention in the treatment of ARDS. There are no data describing the impact of PP on morbidity and mortality in abdominally obese patients. We report our observations in abdominally obese ARDS patients treated with PP.
  
  
  METHODS
  Patients with ARDS (n=82) were retrospectively divided into 2 groups characterized by presence (n=41) or absence (n=41) of abdominal obesity as defined by a sagittal abdominal diameter of 26 cm or more.
  
  
  RESULTS
  There was no difference in cumulative time abdominally obese patients were placed in prone position from admission to day 7 (41.0 hours [interquartile range, 50.5 hours] vs 39.5 hours [interquartile range, 61.5 hours]; P=.65) or in overall intensive care unit mortality (34% vs 34%; P=1). However, abdominally obese patients developed renal failure (83% vs 35%; P<.001) and hypoxic hepatitis (22% vs 2%; P=.015) more frequently. A significant interaction effect between abdominal obesity and prone position with respect to mortality risk (likelihood ratio, P=.0004) was seen if abdominally obese patients were treated with prolonged cumulative PP.
  
  
  CONCLUSIONS
  A cautious approach to PP should be considered in abdominally obese patients.
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany. Electronic address: tweig@med.lmu.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weig
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Janitza
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Zoller
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Dolch
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Miller
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.affiliation: Department of Internal Medicine V, Comprehensive Pulmonary Center, Member of the German Center for Lung Research, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Kneidinger
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Johnson
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Schubert
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilians-University, 81377 Munich, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Irlbeck
mesh_terms: D000328:Adult; D005260:Female; D006505:Hepatitis / Q000209:etiology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications* / Q000401:mortality; D056888:Patient Positioning; D016684:Prone Position; D051437:Renal Insufficiency / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors
keywords: ARDS; Abdominal obesity; Anthropometry; Central obesity; Liver failure; Obesity; Prone position; SAD; Sagittal abdominal diameter