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The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study.
Crit Care Med. 2012 May; 40(5):1456-63.CC

Abstract

OBJECTIVE

To determine the association between excess weight and processes of care and outcomes for critically ill adults.

DESIGN

Prospective cohort study.

SETTING

Three medical intensive care units at two hospitals.

PATIENTS

Five hundred eighty mechanically ventilated adult patients admitted between February 1, 2006 and January 31, 2008.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

After adjusting weight based on the recorded fluid balance before enrollment, 21.9% of subjects were categorized into different body mass index categories than without this adjustment. We used a competing risk analysis with events of interest considered death during hospitalization and successful liberation from mechanical ventilation. We found no statistically significant difference between body mass index categories (<25 kg/m² vs. 25 to <30 kg/m² vs. ≥30 kg/m²) in the competing risks analyses when the results were unadjusted or adjusted for severity of illness and comorbidities. When the analyses were adjusted for the use of continuous infusions of opioids and/or sedatives and ventilator parameters (tidal volume per ideal body weight, positive end-expiratory pressure, and airway pressure), subjects with an overweight fluid-balance-adjusted body mass index had significantly lower hazard ratios for dying while hospitalized (adjusted hazard ratio 0.68 [95% confidence interval 0.47-0.99], p=.044), and those with an obese fluid-adjusted body mass index had significantly higher hazard ratios for successful extubation (adjusted hazard ratio 1.53 [95% confidence interval 1.14-2.06], p=.005). An analysis of longer-term mortality found lower adjusted hazard ratios for subjects with overweight (adjusted hazard ratio 0.74 [95% confidence interval 0.56-0.96]) and obese (adjusted hazard ratio 0.74 [95% confidence interval 0.59-0.94]) fluid-balance-adjusted body mass indices.

CONCLUSIONS

Processes of provided care may affect the observed association between excess weight and outcomes for critically ill adults and should be considered when making inferences about observed results. It is unknown if disparities in processes of care are due to clinically justified reasons for variation, bias against heavier patients, or other reasons.

Authors+Show Affiliations

Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Center for Critical Care, The Ohio State University Medical Center, College of Public Health, The Ohio State University, Columbus, OH, USA. James.OBrien@osumc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

22430246

Citation

O'Brien, James M., et al. "The Association Between Body Mass Index, Processes of Care, and Outcomes From Mechanical Ventilation: a Prospective Cohort Study." Critical Care Medicine, vol. 40, no. 5, 2012, pp. 1456-63.
O'Brien JM, Philips GS, Ali NA, et al. The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. Crit Care Med. 2012;40(5):1456-63.
O'Brien, J. M., Philips, G. S., Ali, N. A., Aberegg, S. K., Marsh, C. B., & Lemeshow, S. (2012). The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. Critical Care Medicine, 40(5), 1456-63. https://doi.org/10.1097/CCM.0b013e31823e9a80
O'Brien JM, et al. The Association Between Body Mass Index, Processes of Care, and Outcomes From Mechanical Ventilation: a Prospective Cohort Study. Crit Care Med. 2012;40(5):1456-63. PubMed PMID: 22430246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between body mass index, processes of care, and outcomes from mechanical ventilation: a prospective cohort study. AU - O'Brien,James M,Jr AU - Philips,Gary S, AU - Ali,Naeem A, AU - Aberegg,Scott K, AU - Marsh,Clay B, AU - Lemeshow,Stanley, PY - 2012/3/21/entrez PY - 2012/3/21/pubmed PY - 2012/6/12/medline SP - 1456 EP - 63 JF - Critical care medicine JO - Crit Care Med VL - 40 IS - 5 N2 - OBJECTIVE: To determine the association between excess weight and processes of care and outcomes for critically ill adults. DESIGN: Prospective cohort study. SETTING: Three medical intensive care units at two hospitals. PATIENTS: Five hundred eighty mechanically ventilated adult patients admitted between February 1, 2006 and January 31, 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After adjusting weight based on the recorded fluid balance before enrollment, 21.9% of subjects were categorized into different body mass index categories than without this adjustment. We used a competing risk analysis with events of interest considered death during hospitalization and successful liberation from mechanical ventilation. We found no statistically significant difference between body mass index categories (<25 kg/m² vs. 25 to <30 kg/m² vs. ≥30 kg/m²) in the competing risks analyses when the results were unadjusted or adjusted for severity of illness and comorbidities. When the analyses were adjusted for the use of continuous infusions of opioids and/or sedatives and ventilator parameters (tidal volume per ideal body weight, positive end-expiratory pressure, and airway pressure), subjects with an overweight fluid-balance-adjusted body mass index had significantly lower hazard ratios for dying while hospitalized (adjusted hazard ratio 0.68 [95% confidence interval 0.47-0.99], p=.044), and those with an obese fluid-adjusted body mass index had significantly higher hazard ratios for successful extubation (adjusted hazard ratio 1.53 [95% confidence interval 1.14-2.06], p=.005). An analysis of longer-term mortality found lower adjusted hazard ratios for subjects with overweight (adjusted hazard ratio 0.74 [95% confidence interval 0.56-0.96]) and obese (adjusted hazard ratio 0.74 [95% confidence interval 0.59-0.94]) fluid-balance-adjusted body mass indices. CONCLUSIONS: Processes of provided care may affect the observed association between excess weight and outcomes for critically ill adults and should be considered when making inferences about observed results. It is unknown if disparities in processes of care are due to clinically justified reasons for variation, bias against heavier patients, or other reasons. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/22430246/The_association_between_body_mass_index_processes_of_care_and_outcomes_from_mechanical_ventilation:_a_prospective_cohort_study_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31823e9a80 DB - PRIME DP - Unbound Medicine ER -