This project described prospectively obese, critically ill patients and the resources critical care nurses used to care for these challenging patients. It also examined the relationship between resources used by nurses and patient outcomes, including complications and length of stay. Forty-three participants were enrolled. Patients with a body mass index (BMI) 40 kg/m2 used the majority of equipment and personnel resources and experienced a prolonged length of stay. The most common equipment used was a specialty bed or mattress; the most common complications were related to the pulmonary system. Initial use of multiple resources may indicate a patient at risk for adverse outcomes. Nurses can use findings to anticipate care needs and develop interventions, such as optimal positioning, to avoid adverse outcomes.
Adams, J. P., & Murphy, P. G. (2000). Obesity in anaesthesia and intensive care. British Journal of Anaesthesia, 85, 91-108.
2.
American Nurses Association. (n.d.). Nursing-sensitive quality indicators for acute care settings and ANA's safety and quality initiative. Retrieved April 24, 2004, from http://www.nursingworld.org/readroom/fssafe99.html.4
3.
Bergstrom, N., Braden, B., Laguzza, A., & Holman, A. (1987). The Braden Scale for predicting pressure ulcer risk. Nursing Research, 36, 205-210.
4.
Block, B. M., Sirio, C. A., Cooper, G. S., DiGiuseppe, D. L., & Rosentahl, G. E. (2003). Use of intensive care–specific interventions in major teaching and other hospitals: A regional comparison. Critical Care Medicine, 28, 1204-1213.
5.
Buckley, F. P., Robinson, N. B., Simonowitz, D. A., & Dellinger, E. P. (1983). Anaesthesia in the morbidly obese: A comparison of anaesthetic and analgesic regimens for upper abdominal surgery. Anaesthesia, 38, 840-851.
6.
Burns, S. M., Egloff, M. B., Ryan, B., Carpenter, R., & Burns, J. E. (1994). Effect of body position on spontaneous respiratory rate and tidal volume in patients with obesity, abdominal distention and ascites. American Journal of Critical Care, 3, 102-106.
7.
Centers for Disease Control and Prevention. (2004, November 9). Obesity trends in the United States. Retrieved December 17, 2004, from http://%20www.cdc.gov/nccdphp/dnpa/obesity/trend/index.html
8.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease, 405, 373-383.
9.
Doering, L. V., Esmailian, F., Imperial-Perez, F., & Monsein, S. (2001). Determinants of intensive care unit length of stay after artery bypass graft surgery. Heart and Lung, 30, 9-17.
10.
Douglas, S., Daly, B., Gordon, N., & Brennan, P. (2002). Survival and quality of life: Short-termvs. long-termventilator patients. Critical Care Medicine, 30, 2655-2662.
11.
Douglas, S. L., Daly, B. J., Brennan, P. F., Harris, S., Nochomovitz, M., & Dyer, M. A. (1997). Outcomes of long-term ventilator patients: A descriptive study. American Journal of Critical Care, 6, 99-105.
12.
El-Solh, A., Sikka, P., Bozkanat, E., Jaafar, W., & Davies, J. (2001). Morbid obesity in the medical ICU. Chest, 120, 1989-1997.
13.
Engelman, D., Adams, D. H., Byrne, J. G., Aranki, S. F., Collins, J. J., Couper, G. S., et al. (1999). Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. Journal of Thoracic and Cardiovascular Surgery, 118, 866-873.
14.
Ezri, T., Gewurtz, G., Sessler, D. I., Medalion, B., Szmuk, P., Hagberg, C., et al. (2003). Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue. Anaesthesia, 58, 1111-1114.
15.
Gallagher, S. M. (1999). Tailoring care for obese patients. RN, 62, 43-46.
16.
Gallagher, S. M. (2002). Obesity and skin in the critical care setting. Critical Care Nursing Quarterly, 25, 69-75.
17.
Goodell, T. T. (1996). The obese trauma patient: Treatment strategies. Journal of Trauma Nursing, 3(2), 36-46.
18.
Green, S. M., & Gillett, A. (1998). Caring for patients with morbid obesity in the hospital. British Journal of Nursing, 7, 785-792.
19.
Gruberg, L., Weissman, N. J., Waksman, R., Fuchs, S., Deible, R., Pinnow, E. E., et al. (2002). The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: The obesity paradox. Journal of the American College of Cardiology, 39, 578-584.
20.
Hahler, B. (2002). Morbid obesity: A nursing care challenge. Medsurg Nursing, 11, 85-90.
21.
Hollenbeak, C., Murphy, D., Koenig, S., Woodward, R., Dunagan, W., & Fraser, V. (2000). The clinical and economic impact of deep chest surgical site infections following coronary artery bypass graft surgery. Chest, 118, 397-402.
22.
Hurst, S., Blanco, K., Boyle, D., Douglass, L., & Wikas, A. (2004). Bariatric implications of critical care nursing. Dimensions in Critical Care Nursing, 23, 76-83.
23.
Ibanez, J., Penafiel, A., Masrse, P., Jorda, R., Raurich, J. M., & Mata, F. (2000). Incidence of gastroesophageal reflux and aspiration in mechanically ventilated patients using small-bore nasogastric tubes. Journal of Parenteral and Enteral Nutrition, 24, 103-106.
24.
Kane, R. L. (1997). Understanding health care outcomes research. Gaithersburg, MD: Aspen.
25.
Knaus, W., Draper, E., Wagner, D., & Zimmerman, J. (1985). APACHE II: A severity of disease classification system. Critical Care Medicine, 13, 818-829.
26.
Landi, F., Onder, G., Gambassi, G., Pedone, C., Carbonin, P., & Bernabei, R. (2000). Body mass index and mortality among hospitalized patients. Archives of Internal Medicine, 160, 2641-2644.
27.
Miller, R. D. (2000). Anesthesia. Philadelphia, PA: Churchill Livingstone.
28.
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. (2002). Statistics related to overweight and obesity. Retrieved April 24, 2004, fromhttp://win.niddk.nih.gove/statistics/index.htm
29.
Peerless, J. R., Davies, A., Klein, D., & Yu, D. (1999). Skin complications in the intensive care unit. Clinics in Chest Medicine, 20, 453-461.
30.
Prentice, A. M., & Jebb, S. A. (2001). Beyond body mass index. Obesity Reviews, 2, 141-147.
31.
Ranucci, M., Cazzaniga, A., Soro, G., Morricone, L., Enrini, R., & Caviezel, F. (1999). Obesity and coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia, 13, 280-284.
32.
Rochon, P. A., Katz, J. N., Morrow, L. A., McGlinchey-Berroth, R., Ahlquist, M. N., Sarkarati, M., et al. (1996). Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Medical Care, 34, 1093-1101.
33.
Rudy, E. B., Daly, B. J., Douglas, S. L., Montenegro, H. D., Song, R., & Dyer, M. A. (1995). Patient outcomes for the chronically critically ill: Special care unit versus intensive care unit. Nursing Research, 44, 324-331.
34.
Schwann, T. A., Habib, R. H., Zacharias, A., Parenteau, G. L., Riordan, C. J., Durham, S. J., et al. (2001). Effect of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation. Annals of Thoracic Surgery, 71, 521-531.
35.
Seneff, M. G., Zimmerman, J. E., Knaus, W. A., Wagner, D. P., & Draper, E. A. (1996). Predicting the duration of mechanical ventilation—The importance of disease and patient characteristics. Chest, 110, 470-480.
36.
Sidani, S., Doran, D. M., & Mitchell, P. H. (2004). A theory-driven approach to evaluating quality of nursing care. Journal ofNursing Scholarship, 36, 60-65.
37.
Siro, C. A., Shepardson, L. B., Rotondi, A. J., Cooper, G. S., Angus, D. C., Harper, D. L., et al. (1999). Community-wide assessment of intensive care outcomes using a physiologically based prognostic measure: Implications for critical care delivery from Cleveland Health Quality Choice. Chest, 115, 793-801.
38.
Welton, J. M., Meyer, A. A., Mandelkehr, L., Fakhry, S. M., & Jarr, S. (2002). Outcomes of and resource consumption by high-cost patients in the intensive care unit. American Journal of Critical Care, 11, 467-473.
39.
Woodrow, P. (2000). Will nursing ICU patients in semi-recumbent positions reduce rates of nosocomial infection?Nursing Critical Care, 5, 174-178.
40.
Zimmerman, J. E., Wagner, D. P., Draper, E. A., Wright, L., Alzola, C., & Knaus, W. A. (1998). Evaluation of Acute Physiology and Chronic Health Evaluation III predictions of hospital mortality in an independent database. Critical Care Medicine, 26(8), 1297-1308.
