• Creatinine
• Critical care
• Mitochondrial dysfunction
• Sarcopenia

• Critical Illness/therapy
• Humans
• Creatinine/analysis
• Creatinine/blood
• Creatinine/urine
• Animals
• Muscle, Skeletal/physiopathology
• Male
• Female
• Biomarkers/analysis
• Biomarkers/blood
• Intensive Care Units/organization & administration
• Intensive Care Units/statistics & numerical data
• Middle Aged
• Aged
• Monitoring, Physiologic/methods

• 19H03753 Japan Society for the Promotion of Science

• body mass index
• lung transplant survival
• obesity
• primary graft dysfunction
• underweight

• Artificial
• Critical care
• Hospital Mortality
• Obesity
• Obesity Paradox
• Pneumonia
• Respiration
• Ventilator-Associated

• Adult
• Female
• Humans
• Middle Aged
• Male
• Pneumonia, Ventilator-Associated/epidemiology
• Retrospective Studies
• Obesity/epidemiology
• Intensive Care Units
• Hospitalization
• Respiration, Artificial

• critical care
• early mobilization
• obesity
• physical therapy
• rehabilitation

• Male
• Humans
• Female
• Aged
• Critical Illness
• Cohort Studies
• Obesity/complications
• Intensive Care Units
• Body Mass Index
• Cardiovascular Diseases/complications
• Retrospective Studies

• Adult
• Humans
• Extracorporeal Membrane Oxygenation/adverse effects
• Thrombosis/etiology
• Respiratory Distress Syndrome/therapy
• Respiratory Distress Syndrome/complications
• Respiratory Insufficiency/etiology
• Respiratory Insufficiency/therapy
• Obesity, Morbid/complications
• Retrospective Studies

• Body mass index
• Critical care
• Follow-up studies
• Functional status
• Intensive care

• Humans
• Quality of Life/psychology
• Thinness
• Cohort Studies
• Intensive Care Units
• Obesity
• Survivors

• Atrial fibrillation
• Body mass index
• Critically ill patients
• Mortality
• Obesity

• in-hospital mortality
• intensive care unit
• nomogram
• prediction tool

• Humans
• Hospital Mortality
• Intensive Care Units
• Nomograms
• Organ Dysfunction Scores

This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care.

Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.

• ICU stay
• MIMIC-IV
• eICU
• nomogram
• obesity
• sepsis

• aneurysmal subarachnoid hemorrhage
• body mass index
• glasgow outcome scale
• mortality
• obesity paradox
• outcome
• surgery

• Body Mass Index
• Cohort Studies
• Female
• Glasgow Outcome Scale
• Humans
• Male
• Middle Aged
• Prospective Studies
• Retrospective Studies
• Subarachnoid Hemorrhage/surgery
• Treatment Outcome

• CCU
• MIMIC-III database
• body mass index
• mortality
• obesity paradox

• Adult
• COVID-19
• Cardiovascular Diseases
• Cohort Studies
• Coronary Care Units
• Critical Care
• Humans
• Obesity/complications
• Obesity/epidemiology
• Pandemics

• National Key Research and Development Program of China

• Children
• Chrononutrition
• Intensive care
• Intermittent feeding
• Nutrition
• Time restricted feeding

Data on the post-acute and post-infectious complications of patients who have recovered from severe coronavirus disease 2019 (COVID-19) are limited. While studies report that approximately 5–15% of COVID-19 hospitalized patients require intensive care and mechanical ventilation, a substantially higher number need non-invasive ventilation and are subject to prolonged hospitalizations, with long periods of immobility and isolation. The purpose of this study is to describe the post-infectious sequelae of severe viral illness and the post-acute complications of intensive care treatments in critically ill patients who have recovered from severe COVID-19 infection.

We performed a retrospective chart review of adult patients initially hospitalized with confirmed COVID-19 infection, who recovered and were transferred to a general medical ward or discharged home between March 15, 2020 and May 15, 2020, dates inclusive, after an intensive care unit (ICU) or high dependency unit (HDU) admission in a designated COVID-19 hospital in the United Arab Emirates. Demographic data, underlying comorbidities, treatment, complications, and outcomes were collected. Descriptive statistical analyses were performed.

Of 71 patients transferred out of ICU (n = 38, 54%) and HDU (n = 33, 46%), mean age was 48 years (SD, 9.95); 96% men; 54% under age 50. Mean ICU stay was 12.4 days (SD, 5.29), HDU stay was 13.4 days (SD, 4.53). Pre-existing conditions were not significantly associated with developing post-acute complications (Odds Ratio [OR] 1.1, 95% confidence interval [CI] 0.41, 2.93, p = 1.00). Fifty nine percent of patients had complications; myopathy, swallowing impairments, and pressure ulcers were most common. Delirium and confusion were diagnosed in 18% (n = 13); all were admitted to the ICU and required mechanical ventilation. Of note, of all patients studied, 59.2% (n = 42/71) had at least 1 complication, 32.4% (n = 23) had at least 2 complications, and 19.7% (n = 14) suffered 3 or more sequelae. Complications were significantly more common in ICU patients (n = 33/38, 87%), compared to HDU patients (n = 9/33, 27%) (OR 17.6, 95% CI 5.23, 59.21, p <0.05).

In a subset of critically ill patients who recovered from severe COVID-19 infection, there was considerable short-term post-infectious and post-acute disability. Long-term follow-up of COVID-19 survivors is warranted.

• Cerebral hemorrhage
• Obesity
• Stroke

• MIMIC III
• cardiothoracic surgery
• modified NUTRIC score
• mortality
• survival

• Body mass index
• Obesity
• Pediatric trauma
• Penetrating abdominal trauma
• Penetrating thoracic trauma
• Penetrating trauma

• Early strategies
• Macronutrients
• Obesity paradox
• Pregnancy
• Sedentary behavior

• critical care
• extracorporeal membrane oxygenation
• obesity
• perfusion
• ventilation

• Extracorporeal membrane oxygenation
• Obesity
• Re-aggravation
• Survival

• Mortality
• Obesity
• Subarachnoid hemorrhage
• Systematic review

• Humans
• Obesity/mortality
• Subarachnoid Hemorrhage/mortality

• Finnish Medical Foundation
• Juho Vainio Foundation
• Maire Taponen Foundation
• Petri Honkanen Foundation

• extracorporeal membrane oxygenation
• intra‐abdominal pressure
• obesity
• supine hypotensive syndrome

Obesity is associated with poor health outcomes but may be protective in intensive care unit patients. The objective of this study is to describe the characteristics of underweight, normal weight, and obese children, and to compare their length of stay, resource utilization, and mortality.

The charts of 1447 patients who were admitted to a tertiary-level pediatric intensive care unit during 1 calendar year were reviewed. Patients were divided into three groups: underweight (<5th percentile), normal (5th–95th percentiles), and obese (>95th percentile). Body mass index for age percentile was used for children older than age 2 years, and weight-for-height percentile was used for children younger than age 2 years. Demographic data, Pediatric Index of Mortality 2 score, Pediatric Index of Mortality 2 risk of mortality, hospital mortality, hospital length of stay, the use and duration of ventilator support, hemodynamic support, and dialysis were determined.

Fifteen percent of children were underweight, while 61.5% were normal weight and 23.5% were obese; 54.9% of the patients were male. The overall mortality was 1.87%, with no significant difference between the three weight groups. The racial distribution, prevalence, and duration of invasive and noninvasive ventilation, and the use of vasopressors, central venous lines, and dialysis were similar between three groups. Tube feeding and parenteral nutrition were used more often in the underweight group. Pediatric intensive care unit and hospital lengths of stays were higher in underweight children. Underweight children were younger when compared to normal or obese children. Pediatric Index of Mortality 2 scores and Pediatric Index of Mortality 2 risk of mortality scores were higher in underweight children.

There were no significant differences between the three weight groups in mortality. Underweight children were younger and sicker, and received tube feeding and parenteral nutrition more frequently.

• Child
• critical illness
• obesity
• underweight

• Body mass index (BMI)
• arm circumference (AC)
• morbidity
• mortality
• waist circumference (WC)

• Activities of Daily Living
• Aged
• Aged, 80 and over
• Aging/physiology
• Body Mass Index
• Cognition/physiology
• Cross-Sectional Studies
• Female
• Health Status
• Humans
• Independent Living
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Obesity, Abdominal/mortality
• Obesity, Abdominal/physiopathology
• Poland
• Prevalence
• Surveys and Questionnaires
• Waist Circumference/physiology

• Creatinine
• Glomerular filtration rate
• In-hospital mortality
• Long-term mortality
• Muscle mass
• Muscle wasting
• Sarcopenia
• Urinary creatinine excretion

• Acute Kidney Injury/mortality
• Adult
• Aged
• Biomarkers/blood
• Cohort Studies
• Creatinine/metabolism
• Critical Illness/mortality
• Female
• Glomerular Filtration Rate
• Hospital Mortality
• Hospitalization
• Humans
• Kidney Function Tests
• Male
• Middle Aged
• Renal Replacement Therapy
• Retrospective Studies
• Risk Factors

• extracorporeal life support
• extracorporeal membrane oxygenation
• obesity
• percutaneous cannulation

• Adult
• Body Mass Index
• Critical Illness/mortality
• Critical Illness/therapy
• Hospital Mortality
• Humans
• Intensive Care Units/statistics & numerical data
• Respiration, Artificial/statistics & numerical data
• Time Factors

Injury to skeletal muscle affects millions of people worldwide. The underlying regenerative process however, is a very complex mechanism, time-wise highly coordinated, and subdivided in an initial inflammatory, a regenerative and a remodeling phase. Muscle regeneration can be impaired by several factors, among them diet-induced obesity (DIO). In order to evaluate if obesity negatively affects healing processes after trauma, we utilized a blunt injury approach to damage the extensor iliotibialis anticus muscle on the left hind limb of obese and normal weight C57BL/6J without showing any significant differences in force input between normal weight and obese mice. Magnetic resonance imaging (MRI) of the injury and regeneration process revealed edema formation and hemorrhage exudate in muscle tissue of normal weight and obese mice. In addition, morphological analysis of physiological changes revealed tissue necrosis, immune cell infiltration, extracellular matrix (ECM) remodeling, and fibrosis formation in the damaged muscle tissue. Regeneration was delayed in muscles of obese mice, with a higher incidence of fibrosis formation due to hampered expression levels of genes involved in ECM organization. Furthermore, a detailed molecular fingerprint in different stages of muscle regeneration underlined a delay or even lack of a regenerative response to injury in obese mice. A time-lapse heatmap determined 81 differentially expressed genes (DEG) with at least three hits in our model at all-time points, suggesting key candidates with a high impact on muscle regeneration. Pathway analysis of the DEG revealed five pathways with a high confidence level: myeloid leukocyte migration, regulation of tumor necrosis factor production, CD4-positive, alpha-beta T cell differentiation, ECM organization, and toll-like receptor (TLR) signaling. Moreover, changes in complement-, Wnt-, and satellite cell-related genes were found to be impaired in obese animals after trauma. Furthermore, histological satellite cell evaluation showed lower satellite cell numbers in the obese model upon injury. Ankrd1, C3ar1, Ccl8, Mpeg1, and Myog expression levels were also verified by qPCR. In summary, increased fibrosis formation, the reduction of Pax7⁺ satellite cells as well as specific changes in gene expression and signaling pathways could explain the delay of tissue regeneration in obese mice post trauma.

• C57BL/6J
• fibrosis
• microarray
• obesity
• satellite cells
• skeletal muscle
• trauma

We hypothesized that the use of actual body weight might lead to more frequent misdiagnosis of acute kidney injury (AKI) than when ideal body weight is used in underweight and/or obese patients. We examined which definition of body weight is most effective in establishing a urinary diagnosis of AKI in septic patients.

Consecutive patients aged ≥ 20 years admitted to the intensive care unit of a university hospital between June 2011 and December 2016 were analyzed. Sepsis was defined in accordance with the Sepsis-3 criteria. AKI was defined as a urinary output of < 0.5 mL/kg/6h during intensive care unit stay. Patients were divided into one of four body mass index-based classes. The severity of illness and 90-day mortality were compared across the body mass index subgroups in patients diagnosed using the actual body weight or ideal body weight.

Of 5764 patients, 569 septic patients were analyzed. One hundred and fifty-three (26.9%) and 140 (24.6%) patients were diagnosed as having AKI using actual body weight and ideal body weight, respectively. There were no significant differences in the severity of illness among these groups. Also, 90-day mortality did not differ significantly among these groups. According to body mass index, 90-day mortality significantly differed in patients diagnosed using their actual body weights (underweight vs. normal vs. overweight vs. obese: 76.7% vs. 39.5% vs. 26.0% vs. 35.7%, P = 0.033).

Generally, using actual body weight to calculate the weight-adjusted hourly urine output for diagnosing AKI increased the sensitivity compared to ideal body weight, irrespective of the severity of illness in septic patients. Delayed diagnosis, however, was more common among underweight patients in this situation, and clinicians should be cautious when diagnosing urinary AKI using actual body weight.

• Acute kidney injury
• Body mass index
• Cystatin C
• Ideal body weight
• Intensive care unit
• Sepsis

Because conventional body mass index (cBMI) does not reflect fluid accumulation, modified BMI (mBMI, serum albumin multiplied by cBMI) is a more accurate measure of malnutrition status. This study aimed to determine whether mortality after intensive care unit (ICU) admission was associated with cBMI, mBMI, and/or serum albumin levels. The medical records of patients who were admitted to a tertiary hospital ICU between 1 January 2012 and 31 July 2016 were retrospectively reviewed. In total, 6169 ICU-admitted patients were included in the analyses. Multivariate Cox regression analyses revealed that low cBMI, mBMI and albumin level were significantly associated with 30-day and 1-year mortality after ICU admission (hazard ratio < 1.0, p < 0.05). The adjusted area under the curve (AUC) of mBMI for 1-year mortality was significantly higher than that of cBMI (p < 0.001), but not significantly different from that of albumin level (p = 0.098). Low values of mBMI, cBMI and albumin were independently associated with 30-day and 1-year mortality after ICU admission. Combining cBMI and albumin (mBMI) did not increase the validity of the AUC of albumin for 1-year mortality after ICU admission. Our study showed that serum albumin alone, rather than mBMI (combining cBMI), is recommended in predicting mortality among ICU patients.

• albumin
• body mass index
• critical care
• intensive care unit
• mortality

To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver transplantation.

The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation (OLT) complications, and short term outcomes of OLT performed from 2003 to 2011 (n = 46509). We divided patients into those with [body mass index (BMI) ≥ 40] and without (BMI < 40) morbid obesity. Multivariable logistic regression analysis was performed to characterize differences in in-hospital mortality, length of stay (LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the results.

Of the 46509 patients who underwent OLT during the study period, 818 (1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female (46.8% vs 33.4%, P = 0.002), Caucasian (75.2% vs 67.8%, P = 0.002), in the low national income quartile (32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities (modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage (P = 0.028) and respiratory complications (P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality (OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS (β: -4.44; 95%CI: -9.93, 1.05, P = 0.11) and charges for transplantation (β: $15693; 95%CI: -51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays (81.7%) as compared to those without morbid obesity (75.4%, P = 0.029).

Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.

• Deceased donors
• Outcome
• Complications
• Economics
• Selection criteria

• Critical illness
• Metabolism
• Obesity
• Skeletal muscle

• 3-Hydroxybutyric Acid/blood
• Aged
• Animals
• Body Composition
• Critical Illness
• Fasting/metabolism
• Fatty Acids/blood
• Female
• Glycerol/blood
• Humans
• Liver/metabolism
• Male
• Mice, Inbred C57BL
• Middle Aged
• Muscle Proteins/genetics
• Muscle Proteins/metabolism
• Muscle Weakness/metabolism
• Muscle Weakness/pathology
• Muscular Atrophy/metabolism
• Muscular Atrophy/pathology
• Nutritional Status
• Overweight/metabolism
• Overweight/pathology
• Parenteral Nutrition
• Quadriceps Muscle/anatomy & histology
• Quadriceps Muscle/metabolism
• Quadriceps Muscle/physiology
• Rectus Abdominis/anatomy & histology
• Rectus Abdominis/metabolism
• Rectus Abdominis/physiology
• Sepsis/metabolism
• Sepsis/pathology
• Triglycerides/metabolism