[Challenges and physiotherapeutic solutions for obese patients in the acute and postacute intensive care setting]

Physical therapy for obese patients in intensive care units (ICUs) presents a significant challenge. Particularly, class III obesity (body mass index [BMI] ≥ 40, previously called morbid obesity) is associated with specific pathophysiological aspects such as reduced lung compliance, increased intra-abdominal pressure, and impaired respiratory mechanics. These factors complicate both ventilation and early rehabilitation, particularly in the areas of respiratory physiotherapy, exercise therapy, and early mobilization. This article outlines the physiotherapeutic challenges and strategies for dealing with obese patients in ICUs and respiratory intermediate care units (respiratory care units [RCUs]). Special emphasis is placed on the individual positioning of patients, an optimal positive end-expiratory pressure (PEEP) adjustment, and early mobilization. Additionally, the concept of ICU-acquired weakness (ICUAW) is discussed, which is exacerbated in obese patients due to simultaneous inflammation activation and reinforcing immobilization. An exemplary case study illustrates the importance of interdisciplinary collaboration and the use of a structured mobilization concept tailored to the specific needs of obese patients. Particularly, the early initiation of assisted mobilization, the continuous adjustment of ventilation, and the use of innovative techniques to support respiratory physiotherapy contribute to a significant improvement in patient's functionality and quality of life.