[The obese patient in the intensive care unit--what is different?]

In many countries over the past years there has been a marked increase in the number of people with severe overweight - especially among the younger age groups up to 35 years. Accordingly, the number of intensive care patients suffering additionally from a significant obesity is also increasing continuously. Some particular features of these patients need to be observed. Differences to normal-weight patients involve, for example, respiratory physiology: the obesity leads to a decrease of lung volume and to a marked increase in breathing work as well as oxygen consumption. Clinically relevant changes occur in the upper airways and neck. Thus, mask ventilation, intubation or surgical interventions to secure the airways are clearly more difficult than in normal-weight patients. Obese intensive care patients are therefore primarily to be considered as patients with difficult airway conditions. In addition in cases of extreme obesity, drug distribution, degradation and excretion can differ from those of normal-weight patients. This must be taken into account for medication dosing. In spite of the overweight, obese patients may be undernourished upon admission to the ICU. Thus, for this group of patients also, enteral nutrition should be started as early as possible. Although obesity is accompanied by a higher mortality on account of the many possible comorbidities, numerous studies have confirmed that even extreme obesity does not increase the mortality rate in comparison with that of normal-weight patients.