Positioning of the Critically Ill Obese Patient for Mechanical Ventilation

Good positioning is a mandatory prerequisite for the management of critically ill obese patients. Supine position and Trendelenburg position can lead to dramatic cardiorespiratory consequences and should be absolutely avoided whenever possible. The ramped position facilitates obese patients’ intubation. For the more severely hypoxemic obese patients, prone position has proved safe and effective in recruiting the atelectatic dependent parts of the lungs during mechanical ventilation. Sitting position reduces work of breathing by reversing expiratory flow limitation and gas trapping and thus is the optimal position to provide noninvasive ventilation, to facilitate the weaning process from mechanical ventilation, and to prevent atelectasis and acute respiratory failure episodes in massively obese patients.