Sasa Ivanovics, md
George Washington University
Newtown, Connecticut
Disclosure information not submitted.
Nivedita Prasanna, MD
Department of Anesthesiology and Critical Care Medicine
George Washington University
Washington, District of Columbia, United States
Disclosure information not submitted.
Diya Kallam, n/a
Medical Student
George Washington University Hospital, United States
Disclosure information not submitted.
Aditya Maddali
Medical Student
George Washington University Hospital, United States
Disclosure information not submitted.
Colin Jenkins, MD
Resident
University of Southern California Keck School of Medicine, United States
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Ivy Benjenk, RN, MPH, PhD
Research Coordinator
George Washington University Hospital, United States
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Katrina Hawkins, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
George Washington University Hospital, United States
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Andrea Levine, MD
Division of Pulmonary and Critical Care, Department of Medicine
University of Maryland, United States
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Paul Park, MD
Department of Anesthesiology
University of Maryland School of Medicine, United States
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Nathan Smischney, BS, MD, MSc
Department of Anesthesiology and Perioperative Medicine
Mayo Clinic, United States
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Patrick Wieruszewski, BCCCP, PharmD
Assistant Professor of Anesthesiology and Pharmacy
Mayo Clinic
Rochester, Minnesota
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Ashish Khanna, MD, FCCP, FASA,FCCM
Anesthesiologist & Intensivist, Associate Professor of Anesthesiology
Wake Forest Baptist Medical Center
Winston Salem, North Carolina
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Shravan Kethireddy, MD
Associate Staff Physician
University of Manitoba, United States
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Nikhil Meena, MD
Pulmonary and Critical Care Medicine
University of Arkansas For Medical Sciences Medical Center, United States
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Amanda Jackson, MD
Division of Gynecologic Oncology, Department of Obstetrics & Gynecology
Walter Reed National Military Medical Center, United States
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Matthew Wiepking, MD
Clinical Assistant Professor of Emergency Medicine and Surgery- Critical Care
University of Southern California Keck School of Medicine, United States
Disclosure information not submitted.
Jonathan Chow, MD
Department of Anesthesiology and Critical Care Medicine
George Washington University School of Medicine, United States
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David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
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Jeffrey Williams, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
George Washington University Hospital, United States
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Title: A Pandemic Within an Epidemic: Evaluation of Covid 19 in the Obese Population
Introduction: Obesity is a worldwide epidemic that leads to various complications. Evidence has shown increased morbidity and mortality among obese COVID-19 patients. The primary objective of our study was to compare the need for advanced respiratory support and mortality between obese and non-obese patients hospitalized with COVID-19. The secondary outcome of our study was a comparative analysis of respiratory parameters in the subgroup requiring invasive mechanical ventilation.
Methods: Retrospective review from a multicenter registry of hospitalized patients with COVID-19 admitted between March 2020 and June 2020. Patients were included if they were > 18 years old and admitted to the hospital with laboratory confirmed SARS-CoV-2 infection. Patients were stratified into healthy weight (BMI < 25), overweight (BMI 25 - 29.9), obese (BMI 30 -39.9), and morbidly obese (BMI > 40) categories. Patient characteristics and outcomes were analyzed using Chi-Squared tests for categorical variables and Kruskal-Wallis tests for continuous variables.
Results: Among the 519 adult patients identified, 111 (21%) were a healthy weight, 159 (31%) were overweight, 174 (33%) were obese, and 75 (14%) were morbidly obese. A total of 255 patients (49.1%) required invasive mechanical ventilation. Obesity [OR 1.63, 95% CI 1.04–2.54) and morbid obesity (OR 2.39, 95% CI 1.29–4.42] were independent predictors for mechanical ventilation. The overall in hospital mortality was 26.6%. There was a trend toward increased mortality in the morbidly obese group [26 (34.7%)] compared to patients with a BMI < 40 [112 (25.2%)] (p=0.087). Analysis of ventilation parameters showed sequential increase in end-expiratory (p< 0.05), peak (p< 0.05), and plateau pressures (p< 0.05) across the BMI categories. The median of the highest PEEP recorded among the healthy weight population was 12 (interquartile range [IQR] 10-16), 14 (IQR 12-16) in the overweight, 15 (IQR 12-18) in the obese, and 16 (IQR 14-18) in the morbidly obese (p < 0.0015). There were no differences in the rates of proning (p=0.30), neuromuscular blockade (p=0.05), APRV (0.79), and ECMO (0.58) among BMI categories.
Conclusion: This supports the growing body of evidence that obesity has the potential to serve as an independent predictor for outcomes of COVID-19 patients.