B103-15 Lifting the Weight of Hypoxemia: A Case Series
Abstract
Acute respiratory distress syndrome (ARDS) is a critical illness marked by severe hypoxemia and impaired gas exchange, often requiring mechanical ventilation. Management is particularly challenging in morbid (BMI >40) and super-morbid (BMI >60) obesity due to altered respiratory mechanics and increased intra-abdominal pressure. Prone positioning is a proven intervention for severe ARDS (PaO2/FiO2 <150), improving oxygenation and reducing mortality, but data in extreme obesity are limited.
Case 1: A 55-year-old woman (BMI 64) with hypertension, obstructive sleep apnea, and psoriasis presented with acute hypoxemic and hypercapnic respiratory failure from decompensated heart failure and new-onset atrial flutter. Despite maximal ventilatory support (PEEP 16-20 cm H2O, FiO2 100%), her PaO2/FiO2 remained <100, and she developed severe right ventricular dysfunction with shock. Prone positioning for 12-16 hours daily improved oxygenation (ABG pO2 from 55 to 57.7 mmHg, SpO2 from low 70s to low-mid 80s). She tolerated proning without complications, but progressive multi-organ failure precluded ECMO due to body habitus.
Case 2 (Chergui et al., 2007): A 56-year-old man (BMI 42) with hypertension and diabetes developed severe ARDS from Legionella pneumonia, requiring intubation, deep sedation, and paralysis. Persistent hypoxemia and acute cor pulmonale prompted prone positioning for 12 hours daily over 3 days, resulting in marked improvement in oxygenation and respiratory mechanics…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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