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Excess Body Weight Is Not Independently Associated with Outcome in Mechanically Ventilated Patients with Acute Lung Injury

James M. O'Brien Jr., MD; Carolyn H. Welsh, MD; Ronald H. Fish, MBA; Marek Ancukiewicz, PhD; Andrew M. Kramer, MD, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network*
[+] Article and Author Information

From University of Colorado Health Sciences Center, Denver, Colorado.


Grant Support: Dr. O'Brien is supported by a training grant from the National Institutes of Health (T32-HL07085). Dr. Welsh is the recipient of a Veterans Affairs merit review award. Contract N01-HR 46054-64 from the National Heart, Lung, and Blood Institute supports the Acute Respiratory Distress Syndrome Network.

Potential Financial Conflicts of Interest:Consultancies: J.M. O'Brien (Medical Simulation Corp.); Honoraria: J.M. O'Brien (Eli Lilly).

Requests for Single Reprints: James M. O'Brien Jr., MD, Division of Pulmonary Sciences and Critical Care Medicine, 4200 East 9th Avenue, Box C-272, Denver, CO, 80262; e-mail, James.OBrien@uchsc.edu.

Current Author Addresses: Dr. O'Brien: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Box C-272, Denver, CO 80262.

Dr. Welsh: Division of Pulmonary and Critical Care Medicine, Department of Veterans Affairs Medical Center, 111A 1055 Clermont Street, Denver, CO 80220.

Mr. Fish and Dr. Kramer: Division of Health Care Policy and Research, University of Colorado Health Sciences Center, 3570 East 12th Avenue, Suite 300, Box B-159, Denver, CO 80206.

Dr. Ancukiewicz: Department of Radiation-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114.

Author Contributions: Conception and design: J.M. O'Brien, C.H. Welsh, M. Ancukiewicz, A. Kramer.

Analysis and interpretation of the data: J.M. O'Brien, C.H. Welsh, R.H. Fish, M. Ancukiewicz, A. Kramer.

Drafting of the article: J.M. O'Brien, R.H. Fish.

Critical revision of the article for important intellectual content: J.M. O'Brien, C.H. Welsh, M. Ancukiewicz, A. Kramer.

Final approval of the article: J.M. O'Brien, C.H. Welsh, M. Ancukiewicz, A. Kramer.

Provision of study materials or patients: C.H. Welsh.

Statistical expertise: R.H. Fish, M. Ancukiewicz, A. Kramer.

Obtaining of funding: J.M. O'Brien.

Administrative, technical, or logistic support: J.M. O'Brien, C.H. Welsh, R.H. Fish, A. Kramer.

Collection and assembly of data: J.M. O'Brien, C.H. Welsh, R.H. Fish, M. Ancukiewicz.


Ann Intern Med. 2004;140(5):338-345. doi:10.7326/0003-4819-140-5-200403020-00009
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In this secondary analysis of a randomized trial of ventilator management in patients with acute lung injury, excess body weight was not independently associated with clinical outcomes. Factors that were independently associated with poorer outcomes were older age, higher Acute Physiology and Chronic Health Evaluation III scores, assignment to the 12-mL/kg tidal volume protocol, a lower baseline ratio of Pao2 to Fio2, and higher pre-enrollment peak airway pressure. Patients with trauma as the primary risk factor for acute lung injury had improved outcomes. Lack of interaction between BMI group and ventilator protocol assignment indicates that the benefit of lower tidal volume in the primary study was similar for patients with normal, overweight, or obese BMI.

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Figure 1.
Inclusion and exclusion criteria.

ARDS = acute respiratory distress syndrome; BMI = body mass index; NHLBI = National Heart, Lung, and Blood Institute.

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Figure 2.
Unadjusted differences in outcomes across body mass index (BMI) categories.

Mortality rate and ventilation variables are shown as the proportion of patients with the outcome (±SE). Ventilator-free days are shown as the mean for the BMI category. No statistically significant differences across BMI category were observed for any dependent variable.

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Summary for Patients

Excess Body Weight and Outcomes of Acute Lung Injury Requiring Mechanical Ventilation

The summary below is from the full report titled “Excess Body Weight Is Not Independently Associated with Outcome in Mechanically Ventilated Patients with Acute Lung Injury.” It is in the 2 March 2004 issue of Annals of Internal Medicine (volume 140, pages 338-345). The authors are J.M. O'Brien Jr., C.H. Welsh, R.H. Fish, M. Ancukiewicz, and A.M. Kramer, for the National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.

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