and critical care clinicians need to adapt to deal with the global epidemic of
obesity with 400 million people already classified as obese and a further one
billion classified as overweight.
Pinder of the St Charles Gairdner (CORR) Hospital in Western Australia explored
the topic Obesity: A diagnostic Challenge and focused on the risks faced by the
obese and the challenges of diagnosing sepsis.
obesity was an increasing problem in developed and developing countries.
combined with sepsis is a really important topic for those of us in critical
care because it is almost a perfect storm - the increase in the incidence of
obese patients and sepsis being one of the most prominent issues we have to
look out for in the emergency care unit,” Pinder said.
“If you get
the diagnosis wrong and over diagnose sepsis when there isn’t sepsis we put
that particular patient at risk and we put other patients at risk by increasing
the risk presented by anti-microbial resistance.”
put patients at risk by missing a true diagnosis and if we under diagnose
sepsis obviously that has a significant impact,” Pinder said.
What's the preferred measure of assessing obesity
there was debate regarding whether calculating BMI or measuring waist
circumference was the preferred measure of assessing obesity.
in terms of weight classification normal weight was a BMI (Body Mass Index) of
between 18,5 and 25, overweight was a BMI above 25 and obesity was classified
as a BMI over 30. Using waist circumference assessment, a measurement over 94
cm classified men as overweight, while a measurement 80 applied to women. Men
with a waist circumference above 102 and women with a waist circumference over
88 were classified as obese.
Risks that obesity poses
obese patients were at higher risk of skin, soft tissue and surgical site
infections as well as acute pancreatitis. She said research had also shown
obesity was a “significant” risk factor for the 2009 H1N1 influenza outbreak
and was associated with poor outcome. Additional risks included maternal
sepsis, while obesity was an independent risk factor for future sepsis.
upside, there is the obesity paradox. Although these patients are more at risk
of certain infections there is evidence that their outcomes are better,” Pinder
are conflicting but there is evidence that obese patients do better than
non-obese patients in some conditions, including heart failure and sepsis.”
there was a need for further research because there might be other factors involved
such as the over-diagnosis of infection and different mg/kg doses of
Pinder said diagnosing sepsis in obese patients could be difficult. She it was
hard to complete a thorough examination as it was not easy to turn patients.
potential samples to do a sepsis screen can be difficult. Just obtaining a vein to get blood cultures
is tricky. The risk of contamination with skin and any fungal skin infections
is high and that makes interpretation of the situation difficult,” Pinder said.
“As this is
an increasing problem we need to get better at our examination technique,
starting with medical students. They should be focused on practicing
examination techniques on patients on all size ranges to get that level of
Medical treatment needs to be improved
added that imaging such as x-rays and scans presented a big problem with the
main issues revolving around difficulties with patient transport, scanner
weight restrictions, image acquisition and interpretation.
hospital when we tried to transport obese patients to the scanner some of the
passageways and doorways weren’t wide enough to get the bed through. Some lifts
weren’t big enough to accommodate the beds and once you get down to the scanner
some of the little corridors with all the equipment they have stacked there are
not very friendly. They don’t have any additional hoists or equipment,” Pinder
said. “In areas where there is a
significant population of obesity these things need to be planned for and in
any expansion or modification or building of new hospitals these things need to
be put in place,” Pinder said.
a major problem had been scanner tables with 150kg to 200kg weight limits as
well as technical difficulties with poor quality images, which made it
difficult to make a diagnostic decision.
have modified the new designs so that current models have a much higher weight
threshold, which is realistic with the growing problem of obesity,” Pander
that solutions could be to take images in sections and to use scanning
techniques and modification of the scanners to improve quality.
patients end up needing exploratory surgery to make a diagnosis,” Pinder said.11th Congress of the World Federation of Societies of Intensive and Critical Care Medicine press release