Critical Illness

CI: Body Weight and Outcomes: Mixed ICU Patients (2007)

Thirteen primary research articles were evaluated for this topic. Subjects were primarily middle-aged to older adults (mean ages 45-65). Most studies consisted of primarily male subjects (41-80%). The patient population consisted of critically ill adults and trauma patients.

• Monitoring and Evaluation
  In critically ill medical and surgical ICU patients, what impact does elevated BMI have on mortality?

  • Conclusion
    There is conflicting evidence that mortality is increased in critically ill medical and surgical ICU patients with BMI > 25.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: In critically ill medical and surgical ICU patients, what impact does elevated BMI have on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I and Fleury J-C. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004; 32:998-1003.
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
      • Choban PS, Weireter LJ, Maynes C, Obesity and Increased Mortality in Blunt Trauma. The Journal of Trauma, 1991:31(9); 1253-1257.
      • El-Solh A, 2001, Pawan Sikka, Erkan Bozkanat, Wafaa Jaafar and Joan Davies. Morbid Obesity in the Medical ICU. Chest. 2001;120:1989-1997. 
      • Garrouste-Orgeas M, Troche G, Azoulay E, Caubel A, de Lassence A, Cheval C, Montesino L, Thuong M, Vincent F, Cohen Y, Timsit JF. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med. 2004 Mar;30(3):437-43.
      • Goulenok, Cyril, M Monchi, J-D Chiche, J-P Mira, J-F Dhainaut and A Cariou. Influence of overweight on ICU Mortality: a prospective study. Chest 2004;125:1441-1445.  
      • Nasraway SA, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med 2006; 34:964-970.
      • 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 Sep;139(9):983-7.
        
      • O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004; 140:338-345.
      • Obrien 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 Mar; 34(3):738-744.
      • Ray DE, Matchett SC, Baker K, Wasser T, and Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005; 127:2125-2131.
      • Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003; 123(4):1202-1207.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill medical and surgical ICU patients, what impact does low BMI have on mortality?

  • Conclusion
    A BMI < 20 is associated with mortality in critically ill medical and surgical ICU patients.
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: In critically ill medical and surgical ICU patients, what impact does low BMI have on mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Garrouste-Orgeas M, Troche G, Azoulay E, Caubel A, de Lassence A, Cheval C, Montesino L, Thuong M, Vincent F, Cohen Y, Timsit JF. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med. 2004 Mar;30(3):437-43.
      • Obrien 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 Mar; 34(3):738-744.
      • Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003; 123(4):1202-1207.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill medical and surgical ICU patients, what effect does weight have on infectious complications?

  • Conclusion
    There is fair evidence that weight status is not associated with increased rate of infection in critically ill medical and surgical ICU patients.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: In critically ill medical and surgical ICU patients, what effect does weight have on infectious complications?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Bercault N, Boulain T, Kuteifan K, Wolf M, Runge I and Fleury J-C. Obesity-related excess mortality rate in an adult intensive care unit: a risk-adjusted matched cohort study. Crit Care Med 2004; 32:998-1003.
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • El-Solh A, 2001, Pawan Sikka, Erkan Bozkanat, Wafaa Jaafar and Joan Davies. Morbid Obesity in the Medical ICU. Chest. 2001;120:1989-1997. 
      • Goulenok, Cyril, M Monchi, J-D Chiche, J-P Mira, J-F Dhainaut and A Cariou. Influence of overweight on ICU Mortality: a prospective study. Chest 2004;125:1441-1445.  
      • Ray DE, Matchett SC, Baker K, Wasser T, and Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005; 127:2125-2131.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill medical and surgical ICU patients, what effect does weight have on length of hospital stay?

  • Conclusion
    There is fair evidence that LOS is increased in critically ill medical and surgical ICU patients who have a BMI > 30.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: In critically ill medical and surgical ICU patients, what effect does weight have on length of hospital stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
      • El-Solh A, 2001, Pawan Sikka, Erkan Bozkanat, Wafaa Jaafar and Joan Davies. Morbid Obesity in the Medical ICU. Chest. 2001;120:1989-1997. 
      • Goulenok, Cyril, M Monchi, J-D Chiche, J-P Mira, J-F Dhainaut and A Cariou. Influence of overweight on ICU Mortality: a prospective study. Chest 2004;125:1441-1445.  
      • Nasraway SA, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med 2006; 34:964-970.
      • Obrien 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 Mar; 34(3):738-744.
      • Ray DE, Matchett SC, Baker K, Wasser T, and Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005; 127:2125-2131.
      • Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003; 123(4):1202-1207.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill medical and surgical ICU patients, what effect does weight have on days on mechanical ventilation?

  • Conclusion
    Most studies suggest that BMI > 30 does not lengthen the number of days on mechanical ventilation in critically ill medical and surgical ICU patients.
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Evidence Summary: In critically ill medical and surgical ICU patients, what effect does weight have on days on mechanical ventilation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown CVR, Neville AL, Rhee P, Salim A, Velmahos GC, and Demetriades D. The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients. J Trauma. 2005;59:1048-1051. 
      • Byrnes M, McDaniel M, Moore M, Helmer S and Smith R. The effect of obesity on outcomes among injured patients. J Trauma 2005; 58:232-237.
      • El-Solh A, 2001, Pawan Sikka, Erkan Bozkanat, Wafaa Jaafar and Joan Davies. Morbid Obesity in the Medical ICU. Chest. 2001;120:1989-1997. 
      • Goulenok, Cyril, M Monchi, J-D Chiche, J-P Mira, J-F Dhainaut and A Cariou. Influence of overweight on ICU Mortality: a prospective study. Chest 2004;125:1441-1445.  
      • O’Brien JM, Welsh CH, Fish RH, Ancukiewicz M, Kramer AM. Excess body weight is not independently associated with outcome in mechanically ventilated patients with acute lung injury. Ann Intern Med. 2004; 140:338-345.
      • Ray DE, Matchett SC, Baker K, Wasser T, and Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest 2005; 127:2125-2131.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006
     
  In critically ill medical and surgical ICU patients, what effect does weight have on cost of medical care?

  • Conclusion
    To date, adequately powered studies have not been conducted to demonstrate a significant difference in cost of medical care, when comparing critically ill medical and surgical ICU patients with BMI > 30 to those with BMI < 30.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
  • Search Plan and Results: Body Weight and Outcomes: Weight 2006