P108

Abstracts: 2007 Poster Session / Surgery for Obesity and Related Diseases 3 (2007) 299 –344

Methods: The study population consisted of 351 consecutive patients who underwent RYGB and was divided into 4 groups (Group1⫽none or gain; Group 2, ⬍5%; Group 3, 5-10%; Group 4, ⬎10%) depending on percentage of preoperative weight loss achieved. Data were collected regarding demographics, BMI change, and excess weight loss (EWL) and analyzed by ANOVA and Fisher’s exact test at the alpha⫽0.05 level. Results: All groups were demographically similar in age and were predominantly female. Maximum follow-up was 36 months. Groups 3 and 4 had significantly higher initial excess weight and BMI (p⬍0.05) but became similar after preoperative weight loss. Most patients (74%) were able to lose weight prior to surgery, with 36% losing ⬎ 5% body weight. Preoperative weight loss did not decrease the magnitude of expected postoperative weight loss. Patients who lost weight preoperatively demonstrated more EWL and BMI change (from initial weight) that was sustained far into the postoperative period and reached statistical significance at several time points (p⬍0.05). Conclusion: This study demonstrates that obese patients are capable of losing weight prior to RYGB and that this weight loss does not negatively impact the expected postoperative weight loss. Furthermore, preoperative weight loss combined with RYGB may result in better long-term EWL and BMI change than surgery alone. PII: S1550-7289(07)00350-4 P108.

VOLUME TARGETED VENTILATION VERSUS AIRWAY PRESSURE RELEASE VENTILATION IN THE MORBIDLY OBESE PATIENT. Omid Jazaeri, MD; Kenneth Miller, MEd, RRT-N; Michael Pasquale, MD, FACS; Mark Cipolle, PhD, MD, FACS Lehigh Valley Hospital and Health Networks, Allentown, PA Background: Approximately 65% of American adults are either overweight (BMI ⬎ 25 - 29.9 kg/m2) or obese (BMI ⬎ 30 kg/m2) according to the Centers for Disease Control and Prevention. A study spanning more than 7 years of ICU data (1995-2002) estimated the incidence of morbidly obese patients requiring ICU treatment as 14 cases per 1,000 admissions per year. Our aim was to evaluate the feasibility of airway pressure release ventilation (APRV) in providing support to morbidly obese patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Methods: Retrospective analysis of ICU stay in 24 morbidly obese patients requiring ventilatory support. Patients were divided into groups supported on either conventional volume-targeted ventilation (VT) or APRV. Admission body mass index (BMI), ventilator days and serial ratio of arterial oxygenation to inspired oxygen fraction (PF ratio) were measured. Results: Whereas no significant differences were noted in BMI or ventilator days between patients supported with VT ventilation or APRV, all serial PF ratios, except the initial measurement, were significantly higher in the APRV group versus the VT ventilation (P⬍ 0.05). Alveolar ventilation was augmented by APRV strategy compared to conventional ventilation. There were three deaths in the VT group and one in the APRV group. Conclusion: APRV is a feasible alternative to conventional volume targeted mechanical ventilation for augmentation of alveolar ventilation in morbidly obese patients with acute lung injury. Whether APRV reduces mortality, ICU stay or ventilator free days remains to be studied in a prospective fashion. Clinical interven-

335

tions can then be adjusted to this population and potential complications guarded against. Age BMI Mode Ventilator P/F 1 P/F 2* P/F 3* P/F 4* P/F 5* years kg/m2 Days 52 46 55 61 34 60 47 68 64 74 50 51 Mean

49 48 61 43 40 40 40 36 35 41 40 47 43

VT VT VT VT VT VT VT VT VT VT VT VT

11 21 42 33 42 30 8 34 9 15 14 19 23.2

200 154 122 167 190 148 173 74 120 284 293 105 169.1

278 109 154 79 220 138 141 330 310 283 224 115 198.42

195 148 148 70 146 130 366 228 220 336 196 258 203.4

278 22 170 88 165 126 270 465 223 332 256 176 214.3

240 152 170 175 218 144 230 460 226 314 194 199 226.83

62 42 45 48 48 70 41 48 24 67 41 41 Mean

60 38 40 41 41 36 35 44 37 50 37 37 41

APRV APRV APRV APRV APRV APRV APRV APRV APRV APRV APRV APRV

14 15 33 39 5 24 14 31 13 33 30 16 22.3

134 173 140 102 160 93 93 212 80 115 200 206 142.3

261 432 216 342 186 126 343 251 338 252 278 194 268.25

322 420 274 205 212 145 275 294 168 360 240 210 260.4

420 425 210 195 242 373 390 305 289 335 224 175 298.6

323 345 224 293 316 260 353 310 310 325 293 258 300.83

* Denotes P⬍ 0.05

PII: S1550-7289(07)00351-6 P109.

OBSTRUCTIVE SLEEP APNEA IN THE PACU FOLLOWING BARIATRIC SURGERY. Victor Chung, BS; Carolyn D’Ambrosio, MD, MS; Sean O’Reilly, MD; Jana Hudcova, MD; Roman Schumann, MD Tufts University School of Medicine, Boston, MA Background: Patients presenting for bariatric surgery have a high incidence of obstructive sleep apnea (OSA). To examine the effects of surgery and anesthesia on sleep-disordered breathing in the immediate postoperative period, we conducted a prospective observational trial in patients following laparoscopic gastric bypass (LGB). Methods: Patients were monitored upon arrival in the PACU by polysomnography (PSG) and transcutaneous CO2 (tCO2) for 8 hours. Data collection included patient demographics and standard PSG data. Patients with a PSG positive for OSA before surgery (PSGY) were compared to those who did not have a preoperative PSG (PSGN). Statistical analysis was performed by non-parametric Kruskal-Wallis or Sign test, respectively. A p ⬍ 0.05 was considered statistically significant. Results: 43 patients (9m, 34f), with a mean age of 42.8⫹11 and a mean BMI of 48.3⫹ 7.0 kg/m2 completed the study. 18 and 25 subjects were in the PSGY and in the PSGN group respectively. No significant difference between groups was found for demographics, the SpO2 nadir (p ⫽ 0.49, mean 89 ⫹ 6.6), the tCO2 max