الفهرس | Only 14 pages are availabe for public view |
Abstract SUMMARY 67 SUMMARY Morbid obesity is now an important problem allover the world due to its multiple co-morbidities and its marked harmful effect on the lifestyle of the patient. The reasons for obesity are multiple and complex.There are many factors that contribute to the development of obesity including genetic, hereditary, environmental, metabolic and eating disorders. There are also acquired causes of obesity as intake of steroids and hypothyroidism. Severely obese individuals have a greater risk of coronary artery disease, hypertension, type II diabetes mellitus, sleep apnea, pulmonary embolism. The difficulty in recognizing the signs and symptoms of peritonitis puts the obese patient at a greater risk of intra-abdominal sepsis. Premature death is, therefore, more common in severely obese individuals. Treatment possibilities include diet restriction, behavioral therapy, medical treatment and surgery. All non surgical treatment regimens have an extremely high rate of failure and surgery is therefore today the option for morbid obesity. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications. Safe and effective surgical treatment methods increase life expectancy and quality for patients with extreme excess weight. The sickest ones are the ones who benefit the most, but they are also the highest risk. Primary laparoscopic bariatric operations are preferred over the open procedures because of the reduced complications, wound infections, pulmonary and thromboembolic complications, reduced rate of incisional hernias, and decreased hospitalization. Excellent surgical outcomes require the appropriate selection of patients, thorough preoperative preparation, technically well-performed operations, and attentive postoperative care. Management of patients following bariatric surgery includes routine postoperative care, such as oxygenation and hemodynamic monitoring, pain management, mobilization, wound care, nutrition therapy, education, and emotional support. SUMMARY 68 Because of the growing number of indications and performance of bariatric surgeries, more obese patients are being admitted to the ICU. Sometimes, complications at the intra and postoperative of primary bariatric surgery or even presence of severe comorbidities may require intensive care, elective or emergency. Among factors predisposing to admission in the ICU are mentioned: male gender, age ≥ 50 years BMI ≥ 60 Kg/m2, diabetes mellitus, OSAS, cardiopathies, venous difficulty and complications in the intra or immediate postoperative mainly due to respiratory complications such as pneumonia, thromboembolic disease, sepsis, respiratory failure requiring mechanical ventilation and to a lesser extent, respiratory arrest. Because of the increasing numbers of bariatric surgeries, the risk of developing postoperative complications is also increased. So, an unusual postoperative abdominal pain, left shoulder tip pain, vomiting, or asense of impending doom should all be a call to action as should tachycardia, tachypnea, or oliguria. The increase in the number of bariatric procedures annually suggests that these patients will constitute an increasing portion of obese patients who require hospital and intensive care. A knowledge of the type of bariatric operation performed and an understanding of its anatomy and physiology are useful to provide optimal care for these patients, particularly when considering potential complications and their diagnosis and treatmen. Lastly, Obese patients, many of whom are now bariatric surgical patients, constitute an increasing percentage of critically ill patients. Obesity is characterized by a chronic proinflammatory state, changes in cellular immunity, hypercoagulability, and insulin resistance. These baseline physiologic derangements, coupled with the stress of critical illness, present unique challenges to the critical care team. Knowledge of the pathophysiology of obesity and of the presentation and treatment of serious complications of bariatric surgery are necessary to manage these patients effectively. |