Table 1.

Management Considerations in Specific Clinical Scenarios for Patients With Obesity

Clinical Scenario	Management Considerations in Patients With Obesity	Key References
Intubation	•Reverse Trendelenburg or HOB elevated •Consider preoxygenation with NIV, apneic oxygenation with high flow nasal cannula •Consider recruitment maneuver after intubation	Dixon et al20 Futier et al21 Cabrini et al23
ARDS	•Use predicted body weight for calculating tidal volume •Consider high PEEP strategy •Use prone positioning when indicated •Review sedative doses and goals with pharmacist	Brower et al25 De Jong et al34Erstad and Barletta65
Refractory hypoxemia	•Consider VV-ECMO support •May require additional drainage cannula with ECMO •Monitor for cannula-associated clots and infections	Salna et al38 Schmidt et al105
OHS + respiratory failure	•Place patient in seated position •Consider NIV at higher pressures	Bahammam106
Extubation	•Review for any underlying cardiac disease •Consider extubation to NIV if hypercapnic, high-risk	El Solh et al107 Ouellette et al46
Hypotension	•Ensure appropriate BP cuff size •Account for possible LV and RV dysfunction, increased blood volume	Stelfox et al108 Lemmens et al51
Pressure ulcer	•Bariatric bed to facilitate frequent turning •Nutrition evaluation	Wiggerman et al72
Hospital-acquired infection	•Remove indwelling catheters as soon as able •Review antibiotic dosing with pharmacist to ensure appropriate loading and maintenance doses	Bochicchio et al74 Dossett et al73
DVT	•Review anticoagulant dosing with pharmacist •Radiologist review if ultrasound inconsistent with clinical impression	Sebaaly and Covert69 Cascio et al70

ECMO = extracorporeal membrane oxygenation; HOB = head of bed; LV = left ventricular; NIV = noninvasive ventilation; OHS = obesity hypoventilation syndrome; PEEP = positive end-expiratory pressure; RV = right ventricular; VV-ECMO = venovenous extracorporeal membrane oxygenation.