Mechanical Ventilation of the Obese Patient

An increasing number of obese patients are presenting to the ICU with respiratory failure. Respiratory mechanics and gas exchange are altered in the obese patient. Reduction in functional residual capacity is the most prominent change and ventilation strategies aimed at reversing this effect need to be pursued. Obese patients with hypercapnic respiratory failure benefit from early application of noninvasive ventilation on initial presentation. During invasive ventilation, special consideration needs to be given to the mode of ventilation, tidal volume, positive end expiratory pressure, and patient positioning. Extubation failure and the need for reintubation may be decreased by application of noninvasive ventilation post extubation. Obese patients with respiratory failure who require mechanical ventilation have increased morbidity but not mortality when compared to normal-weight patients.