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Erschienen in: European Journal of Trauma and Emergency Surgery 1/2014

01.02.2014 | Original Article

The impact of body mass index on treatment outcomes among traumatic brain injury patients in intensive care units

verfasst von: S. Y. Chabok, H. Yazdanshenas, A. F. Naeeni, A. Ziabakhsh, S. S. Bidar, A. Reihanian, S. Bazargan-Hejazi

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 1/2014

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Abstract

Purpose

Obesity is a risk factor in treatment outcomes of critically ill patients. This study was conducted to determine the impact of obesity on the likelihood of recovery from traumatic brain injury (TBI) in intensive care unit (ICU) patients.

Methods

We carried out a prospective study on 115 head injury patients who were admitted to the ICU of Poursina Hospital, Rasht, in the one-year period between July 2006 and June 2007. Obese patients (body mass index [BMI] ≥ 30 kg/m2) were compared with non-obese patients (BMI < 30 kg/m2). Demographic information, acute physiology and chronic health evaluation scores, Injury Severity Scores (ISS), Glasgow Coma Scale scores, and ICU mortality incidences were recorded.

Results

Obese patients had significantly higher ICU mortality rates compared to non-obese patients (p = 0.02). Furthermore, we observed a trend towards a higher ICU mortality rate in obese patients with ISS > 25 (p = 0.04). Moreover, obesity was associated with prolonged mechanical ventilation, ICU length of stay (ILOS), and hospital length of stay (HLOS) (p < 0.001).

Conclusions

Obesity was associated with increased ICU mortality and prolonged dependency on mechanical ventilation, ILOS, and HLOS in patients with TBI. However, further prospective studies with larger sample sizes are needed to substantiate these findings.
Literatur
2.
Zurück zum Zitat Margot S, Carroll M, Ogden Cynthia L. Adult obesity prevalence in Canada and the United States. In: NCHS Data Brief 2011. Atlanta: Centers for Disease Control and Prevention; 2011. Margot S, Carroll M, Ogden Cynthia L. Adult obesity prevalence in Canada and the United States. In: NCHS Data Brief 2011. Atlanta: Centers for Disease Control and Prevention; 2011.
3.
Zurück zum Zitat Frezza EE, Chiriva-Internati M. Venous thromboembolism in morbid obesity and trauma. A review of literature. Minerva Chir. 2005;60(5):391–9.PubMed Frezza EE, Chiriva-Internati M. Venous thromboembolism in morbid obesity and trauma. A review of literature. Minerva Chir. 2005;60(5):391–9.PubMed
4.
Zurück zum Zitat Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635–43.PubMed Kopelman PG. Obesity as a medical problem. Nature. 2000;404(6778):635–43.PubMed
6.
Zurück zum Zitat Marik PE. The paradoxical effect of obesity on outcome in critically ill patients. Crit Care Med. 2006;34(4):1251–3.PubMedCrossRef Marik PE. The paradoxical effect of obesity on outcome in critically ill patients. Crit Care Med. 2006;34(4):1251–3.PubMedCrossRef
7.
Zurück zum Zitat Evans DC, Stawicki SP, Davido HT, Eiferman D. Obesity in trauma patients: correlations of body mass index with outcomes, injury patterns, and complications. Am Surg. 2011;77(8):1003–8. Evans DC, Stawicki SP, Davido HT, Eiferman D. Obesity in trauma patients: correlations of body mass index with outcomes, injury patterns, and complications. Am Surg. 2011;77(8):1003–8.
8.
Zurück zum Zitat Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM. Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg. 2006;203(4):533–8. Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM. Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg. 2006;203(4):533–8.
9.
Zurück zum Zitat Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–7. Neville AL, Brown CV, Weng J, Demetriades D, Velmahos GC. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–7.
10.
Zurück zum Zitat Livingston DH, Lavery RF, N’Kanza A, Anjaria D, Sifri ZC, Mohr AM, et al. Obesity does not increase morbidity and mortality after laparotomy for trauma. Am Surg. 2013;79(3):247–52. Livingston DH, Lavery RF, N’Kanza A, Anjaria D, Sifri ZC, Mohr AM, et al. Obesity does not increase morbidity and mortality after laparotomy for trauma. Am Surg. 2013;79(3):247–52.
11.
Zurück zum Zitat Liu T, Chen JJ, Bai XJ, Zheng GS, Gao W. The effect of obesity on outcomes in trauma patients: a meta-analysis. Injury, 2012. Liu T, Chen JJ, Bai XJ, Zheng GS, Gao W. The effect of obesity on outcomes in trauma patients: a meta-analysis. Injury, 2012.
12.
Zurück zum Zitat Newell MA, Bard MR, Goettler CE, Toschlog EA, Schenarts PJ, Sagraves SG, et al. Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg. 2007;204(5):1056–61. Newell MA, Bard MR, Goettler CE, Toschlog EA, Schenarts PJ, Sagraves SG, et al. Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg. 2007;204(5):1056–61.
13.
Zurück zum Zitat Brown CV, Rhee P, Neville AL, Sangthong B, Salim A, Demetriades D. Obesity and traumatic brain injury. J Trauma. 2006;61(3):572–6. Brown CV, Rhee P, Neville AL, Sangthong B, Salim A, Demetriades D. Obesity and traumatic brain injury. J Trauma. 2006;61(3):572–6.
14.
Zurück zum Zitat Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med. 2004;32(4):998–1003. Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I, Fleury JC. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med. 2004;32(4):998–1003.
15.
Zurück zum Zitat Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A. Influence of overweight on ICU mortality: a prospective study. Chest. 2004;125(4):1441–5. Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A. Influence of overweight on ICU mortality: a prospective study. Chest. 2004;125(4):1441–5.
16.
Zurück zum Zitat Byrnes MC, McDaniel MD, Moore MB, Helmer SD, Smith RS. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7. Byrnes MC, McDaniel MD, Moore MB, Helmer SD, Smith RS. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7.
17.
Zurück zum Zitat El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120(6):1989–97. El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120(6):1989–97.
18.
Zurück zum Zitat O’Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S. Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med. 2006;34(3):738–44. O’Brien JM Jr, Phillips GS, Ali NA, Lucarelli M, Marsh CB, Lemeshow S. Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med. 2006;34(3):738–44.
19.
Zurück zum Zitat Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003;123(4):1202–7.PubMedCrossRef Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003;123(4):1202–7.PubMedCrossRef
20.
Zurück zum Zitat Garrouste-Orgeas M, Troche G, Azoulay E, Caubel A, de Lassence A, Cheval C, et al. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med. 2004;30(3):437–43. Garrouste-Orgeas M, Troche G, Azoulay E, Caubel A, de Lassence A, Cheval C, et al. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med. 2004;30(3):437–43.
21.
Zurück zum Zitat Duane TM, Dechert T, Aboutanos MB, Malhotra AK, Ivatury RR. Obesity and outcomes after blunt trauma. J Trauma. 2006;61(5):1218–21. Duane TM, Dechert T, Aboutanos MB, Malhotra AK, Ivatury RR. Obesity and outcomes after blunt trauma. J Trauma. 2006;61(5):1218–21.
22.
Zurück zum Zitat Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. Obesity increases risk of organ failure after severe trauma. J Am Coll Surg. 2006;203(4):539–45. Ciesla DJ, Moore EE, Johnson JL, Burch JM, Cothren CC, Sauaia A. Obesity increases risk of organ failure after severe trauma. J Am Coll Surg. 2006;203(4):539–45.
23.
Zurück zum Zitat Anzueto A, Frutos-Vivar F, Esteban A, Bensalami N, Marks D, Raymondos K, et al. Influence of body mass index on outcome of the mechanically ventilated patients. Thorax. 2011;66(1):66–73. Anzueto A, Frutos-Vivar F, Esteban A, Bensalami N, Marks D, Raymondos K, et al. Influence of body mass index on outcome of the mechanically ventilated patients. Thorax. 2011;66(1):66–73.
24.
Zurück zum Zitat Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36(1):151–8.PubMedCrossRef Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36(1):151–8.PubMedCrossRef
25.
Zurück zum Zitat Alban RF, Lyass S, Margulies DR, Shabot MM. Obesity does not affect mortality after trauma. Am Surg. 2006;72(10):966–9. Alban RF, Lyass S, Margulies DR, Shabot MM. Obesity does not affect mortality after trauma. Am Surg. 2006;72(10):966–9.
26.
Zurück zum Zitat Zimmerman DW. A note on preliminary tests of equality of variances. Br J Math Stat Psychol. 2004;57(1):173–81.PubMedCrossRef Zimmerman DW. A note on preliminary tests of equality of variances. Br J Math Stat Psychol. 2004;57(1):173–81.PubMedCrossRef
27.
Zurück zum Zitat Choban PS, Weireter LJ Jr, Maynes C. Obesity and increased mortality in blunt trauma. J Trauma. 1991;31(9):1253–7.PubMedCrossRef Choban PS, Weireter LJ Jr, Maynes C. Obesity and increased mortality in blunt trauma. J Trauma. 1991;31(9):1253–7.PubMedCrossRef
28.
Zurück zum Zitat Sifri ZC, Kim H, Lavery R, Mohr A, Livingston DH. The impact of obesity on the outcome of emergency intubation in trauma patients. J Trauma. 2008;65(2):396–400. Sifri ZC, Kim H, Lavery R, Mohr A, Livingston DH. The impact of obesity on the outcome of emergency intubation in trauma patients. J Trauma. 2008;65(2):396–400.
29.
Zurück zum Zitat Sampalis JS, Nathanson R, Vaillancourt J, Nikolis A, Liberman M, Angelopoulos J, et al. Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers. Ann Surg. 2009;249(3):488–95. Sampalis JS, Nathanson R, Vaillancourt J, Nikolis A, Liberman M, Angelopoulos J, et al. Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers. Ann Surg. 2009;249(3):488–95.
30.
Zurück zum Zitat Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ. The total work of breathing in normal and obese men. J Clin Invest. 1964;43:728–39. Sharp JT, Henry JP, Sweany SK, Meadows WR, Pietras RJ. The total work of breathing in normal and obese men. J Clin Invest. 1964;43:728–39.
31.
Zurück zum Zitat Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51. Pelosi P, Croci M, Ravagnan I, Vicardi P, Gattinoni L. Total respiratory system, lung, and chest wall mechanics in sedated-paralyzed postoperative morbidly obese patients. Chest. 1996;109(1):144–51.
32.
Zurück zum Zitat Frat JP, Gissot V, Ragot S, Desachy A, Runge I, Lebert C, et al. Impact of obesity in mechanically ventilated patients: a prospective study. Intensive Care Med. 2008;34(11):1991–8. Frat JP, Gissot V, Ragot S, Desachy A, Runge I, Lebert C, et al. Impact of obesity in mechanically ventilated patients: a prospective study. Intensive Care Med. 2008;34(11):1991–8.
33.
Zurück zum Zitat Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128(3):501–6. Ray CS, Sue DY, Bray G, Hansen JE, Wasserman K. Effects of obesity on respiratory function. Am Rev Respir Dis. 1983;128(3):501–6.
34.
Zurück zum Zitat Thomas PS, Cowen ER, Hulands G, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44(5):382–6. Thomas PS, Cowen ER, Hulands G, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44(5):382–6.
35.
Zurück zum Zitat Varon J, Marik P. Management of the obese critically ill patient. Crit Care Clin. 2001;17(1):187–200.PubMedCrossRef Varon J, Marik P. Management of the obese critically ill patient. Crit Care Clin. 2001;17(1):187–200.PubMedCrossRef
36.
Zurück zum Zitat Lown DJ, Knott J, Rechnitzer T, Maclsaac C. Predicting short-term and long-term mortality in elderly emergency patients admitted for intensive care. Crit Care Resusc. 2013;15(1):49–55. Lown DJ, Knott J, Rechnitzer T, Maclsaac C. Predicting short-term and long-term mortality in elderly emergency patients admitted for intensive care. Crit Care Resusc. 2013;15(1):49–55.
37.
Zurück zum Zitat Zali AR, Seddighi AS, Seddighi A, Ashrafi F. Comparison of the acute physiology and chronic health evaluation score (APACHE) II with GCS in predicting hospital mortality of neurosurgical intensive care unit patients. Glob J Health Sci. 2012;4(3):179–84. Zali AR, Seddighi AS, Seddighi A, Ashrafi F. Comparison of the acute physiology and chronic health evaluation score (APACHE) II with GCS in predicting hospital mortality of neurosurgical intensive care unit patients. Glob J Health Sci. 2012;4(3):179–84.
38.
Zurück zum Zitat Stocchetti N, Paterno R, Citerio G, Beretta L, Colombo A. Traumatic brain injury in an aging population. J Neurotrauma. 2012;29(6):1119–25. Stocchetti N, Paterno R, Citerio G, Beretta L, Colombo A. Traumatic brain injury in an aging population. J Neurotrauma. 2012;29(6):1119–25.
39.
Zurück zum Zitat Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma. 2004;56(5):1084–9. Udekwu P, Kromhout-Schiro S, Vaslef S, Baker C, Oller D. Glasgow Coma Scale score, mortality, and functional outcome in head-injured patients. J Trauma. 2004;56(5):1084–9.
40.
Zurück zum Zitat Farshchian N, Farshchian F, Rezaei M. Correlation between Glasgow coma scale and brain CT-scan findings in traumatic patients. J Inj Violence Res. 2012;4:44. Farshchian N, Farshchian F, Rezaei M. Correlation between Glasgow coma scale and brain CT-scan findings in traumatic patients. J Inj Violence Res. 2012;4:44.
41.
Zurück zum Zitat Shakeri M, Meshkini A, Shokouhi G, Asghari M, Salehpoor F, Mahdkhah A, et al. S100B protein as abiomarker for prediction of brain death following head trauma. J Inj Violence Res. 2012;4:11. Shakeri M, Meshkini A, Shokouhi G, Asghari M, Salehpoor F, Mahdkhah A, et al. S100B protein as abiomarker for prediction of brain death following head trauma. J Inj Violence Res. 2012;4:11.
42.
Zurück zum Zitat Teoh LS, Gowardman JR, Larsen PD, Green R, Galletly DC. Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med. 2000;26(2):157–61. Teoh LS, Gowardman JR, Larsen PD, Green R, Galletly DC. Glasgow Coma Scale: variation in mortality among permutations of specific total scores. Intensive Care Med. 2000;26(2):157–61.
43.
Zurück zum Zitat Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R. Body mass index and mortality among hospitalized patients. Arch Intern Med. 2000;160(17):2641–4. Landi F, Onder G, Gambassi G, Pedone C, Carbonin P, Bernabei R. Body mass index and mortality among hospitalized patients. Arch Intern Med. 2000;160(17):2641–4.
Metadaten
Titel
The impact of body mass index on treatment outcomes among traumatic brain injury patients in intensive care units
verfasst von
S. Y. Chabok
H. Yazdanshenas
A. F. Naeeni
A. Ziabakhsh
S. S. Bidar
A. Reihanian
S. Bazargan-Hejazi
Publikationsdatum
01.02.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 1/2014
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-013-0314-2

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