Medical Device Link.

Originally Published MDDI June 2004

R&D DIGEST

Critically ill, morbidly obese patients present serious challenges to physicians treating them. So what can be done about it? Medical technology could provide a number of solutions, according to Ali A. El-Solh, MD, MPH.

These issues have recently been brought to the forefront by the significant increase in gastric bypass surgery for the morbidly obese. According to the American Society for Bariatric Surgery, the annual rate of obesity surgeries rose from 37,000 in 2000 to 62,400 in 2001, and the number of cases is expected to exceed 100,000 when the data for 2003 are released.

There are significant difficulties in caring for critically ill, morbidly obese patients whose body mass index exceeds 50. The mechanical properties of the total respiratory system, the lung, and the chest wall are characterized by marked derangements when compared with subjects of a normal weight. 

Such changes require modified approaches to respiratory failure, as well as new techniques to deal with problems encountered treating high-weight patients in the intensive-care unit.

“The need for new technology to improve the quality of life of the morbidly obese has never been greater,” said El-Solh. “Up to this date, the healthcare industry has been reluctant to adapt devices to the needs of this population in the absence of clinical outcomes studies and reimbursable costs. However, with our current knowledge of the chronic health impact of obesity on daily life, powered exercise equipment like a powered treadmill, a powered bicycle, and powered parallel bars to redevelop muscles or restore motion should become a priority.”

Patients who are morbidly obese often need prolonged mechanical ventilation, extensive ventilation weaning periods, and a long ICU and hospital stay. These can all be attributed to the poor lung mechanics of such patients. In addition to requiring long recovery times, bariatric surgery, such as gastric bypass surgery, has a morbidity rate in excess of 10%. Early postsurgery complications include wounds splitting open, wound infection, bleeding, and pulmonary embolism.

El-Solh hopes that his research will provide the healthcare industry with the impetus to develop new technology that is designed to improve the quality of life of the morbidly obese. For example, he said, “even a [combination of] hardware and software technologies to detect and treat sleep apnea would be a major step in controlling hypertension and reducing the risk of cardiovascular diseases.” 

El-Solh addressed some of these topics in a commentary for the March 2004 issue of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. He practices at the Division of Pulmonary, Critical Care, and Sleep Medicine of Erie County Medical Center (Buffalo, NY). 

In April 2002, the IRS issued a regulation that cited obesity as a disease. “That allows patients to deduct the cost of bariatric surgery exceeding 7.5% of their gross income,” El-Solh said. “Hopefully, this classification may go beyond the realm of surgery to enable coverage for new, experimental medical devices.” 

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