CARDIOPULMONARY MONITORINGWeaning patients with obesity from ventilatory supportKacmarek, Robert M.a,b,c; Wanderley, Hatus V.a,b,c; Villar, Jesúsd,e; Berra, Lorenzoa,cAuthor Information aHarvard Medical School bMassachusetts General Hospital cDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA dCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid eMultidisciplinary Organ Dysfunction Evaluation Research Network (MODERN), Research Unit, Hospital Universitario Dr Negrin, Las Palmas de Gran Canaria, Spain Correspondence to Lorenzo Berra, MD, 55 Fruit Street – White 437, Boston, Massachusetts 02114, USA. Tel: +1 617 643 7733; e-mail: [email protected] Current Opinion in Critical Care: June 2021 - Volume 27 - Issue 3 - p 311-319 doi: 10.1097/MCC.0000000000000823 Buy Metrics Abstract Purpose of review Obesity prevalence is increasing in most countries in the world. In the United States, 42% of the population is obese (body mass index (BMI) > 30) and 9.2% is obese class III (BMI > 40). One of the greatest challenges in critically ill patients with obesity is the optimization of mechanical ventilation. The goal of this review is to describe respiratory physiologic changes in patients with obesity and discuss possible mechanical ventilation strategies to improve respiratory function. Recent findings Individualized mechanical ventilation based on respiratory physiology after a decremental positive end-expiratory pressure (PEEP) trial improves oxygenation and respiratory mechanics. In a recent study, mortality of patients with respiratory failure and obesity was reduced by about 50% when mechanical ventilation was associated with the use of esophageal manometry and electrical impedance tomography (EIT). Summary Obesity greatly alters the respiratory system mechanics causing atelectasis and prolonged duration of mechanical ventilation. At present, novel strategies to ventilate patients with obesity based on individual respiratory physiology showed to be superior to those based on standard universal tables of mechanical ventilation. Esophageal manometry and EIT are essential tools to systematically assess respiratory system mechanics, safely adjust relatively high levels of PEEP, and improve chances for successful weaning. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.