title: Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation.
abstract: The aims of the present investigation, performed in 118 consecutive patients with refractory ARDS treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO), were as follows: (a) to assess ICU mortality in overweight, obese and morbid obese patients in respect to normal weight; (b) to evaluate echocardiographic findings according to BMI subgroups. Echocardiography was performed before VV-ECMO implantation. Forty-five patients (38.1%) showed normal BMI, 37 patients (31.4%) were overweight and the remaining were obese (21.2%), or morbid obese (9.3%). Morbid obese showed the lowest ICU mortality rate (p = 0.003). No differences were detectable among BMI subgroups in echocardiographic findings apart from the fact that obese patients showed the lowest incidence of LV dysfunction (p = 0.015). At stepwise regression analysis the following variables were independent predictor of ICU mortality (when adjusted for age): RV dilatation (OR 4.361, 95 % CI 1.809-10.512, p < 0.001), BMI (OR 0.884, 95% CI 0.821-0.951, p < 0.001). In other terms, the presence of RV dilatation is an independent predictor of ICU mortality. In refractory ARDS treated with VV-ECMO, BMI > 30 kg/m2is common (accounting for one-third of the entire population) but it is not associated with a worse outcome, so that it cannot be considered per se a contraindication to ECMO implantation. The incidence of RV dilatation and failure, which are known to negatively affect prognosis in ARDS patients, were comparable among BMI subgroups.
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. lazzeric@libero.it.
authors: Chiara
authors: C
authors: Lazzeri
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Manuela
authors: M
authors: Bonizzoli
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Giovanni
authors: G
authors: Cianchi
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Stefano
authors: S
authors: Batacchi
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Paolo
authors: P
authors: Terenzi
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Morena
authors: M
authors: Cozzolino
authors: Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy.
authors: Pasquale
authors: P
authors: Bernardo
authors: Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Adriano
authors: A
authors: Peris
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies
keywords: ARDS; BMI; Echocardiography; Prognosis