Bariatric Patient Hot Case

GENERAL APPROACH

• underlying cause of critical illness?
• specific complications of obesity or bariatric surgery?
• how does obesity complicate management?

INTRODUCTION

CUBICLE

INFUSIONS

• insulin infusion (diabetes mellitus)

VENTILATOR

• VT mL/kg based on predicted body weight not actual body weight
• high PEEP (improve FRC and compliance, decrease atelectasis)

MONITOR

• non-invasive BP monitoring (cuff size, accuracy)

EQUIPMENT

• bariatric equipment (e.g. beds, chairs, hoists)
• TEDS + IPCs
• home CPAP device

QUESTION SPECIFIC EXAMINATION

• often need to examine from both sides of bed
• may need assistance
• airway assessment
• heart failure
• DVT
• IV access attempts
• intertrigo in skin folds and skin care problems

RELEVANT INVESTIGATIONS

• guided by examination

OPENING STATEMENT

• “This patient is critically ill due to X. This is complicated by severe obesity causing/ putting them at risk of…”

DISCUSSION

• obesity paradox
• obesity bias
• difficult intubation and IV access in obese patients
• drug dosing
• reasons for left and right heart failure in obesity
• difficulties with diagnosis — examination and investigations

References And Links

LITFL

• CCC – Obesity and trauma
• CCC – Obesity and Critical Illness
• CCC – Complications of Obesity
• CCC – Obesity and Pharmacokinetics
• CCC – Nutrition of the Critically Ill Obese Patient
• CCC – Bariatric patient hot case