Key principles for rehabilitation of critically ill patients with obesity

PURPOSE: Patients with obesity who are admitted to an ICU bring specific challenges for rehabilitation during and after critical illness. This narrative review explores impact of differences in body compositions and pathophysiology on outcomes to summarise interprofessional, patient-centred rehabilitation strategies across the trajectory of recovery. METHODS: The interprofessional expert panel reviewed major trials and guidelines, integrating their clinical expertise with the current evidence. RESULTS: Three distinct phenotypes potentially influence outcomes for survivors. Whilst patients with preserved muscle mass may have a survival advantage, the phenotypes characterised by ectopic visceral fat or sarcopenia are frequently complicated by multimorbidity and polypharmacy, likely increasing the risk of adverse effects such as suboptimal sedation, prolonged ventilation and immobilisation, malnutrition, and impaired recovery. Targeted respiratory interventions, including secretion-clearance techniques and appropriate patient positioning to prevent atelectasis, reduce the work of breathing. Optimisation of communication and swallowing function is an essential component for facilitating safe oral intake and promoting active patient participation in rehabilitation. Concurrently, targeted nutrition strategies combined with early, targeted, progressive mobilisation might mitigate ICU acquired weakness and support functional recovery. The availability of appropriate weight‑based equipment is fundamental to ensuring safe mobilisation for both patients and healthcare professionals. CONCLUSION: Interprofessional collaboration is central to optimising outcomes and should extend beyond the ICU to structured post-ICU follow-up to address persistent, worsening, or newly emerging health impairments. Early rehabilitation in critically ill patients with obesity should integrate physiological, logistical, and psychosocial considerations to support equitable and functional recovery.

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Publication Details

Journal
Intensive Care Medicine
Published
2026-07-17
DOI
https://doi.org/10.1007/s00134-026-08541-z
Primary Topic
Intensive Care Unit Cognitive Disorders
Type
article
Field-Weighted Citation Impact
0.00

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article

Key principles for rehabilitation of critically ill patients with obesity

David J. McWilliams, Stefan Josef Schaller, Pierre Singer, Richard S Bourne et al.
Intensive Care Medicine
Intensive Care Unit Cognitive Disorders
article

Key principles for rehabilitation of critically ill patients with obesity

David J. McWilliams, Stefan Josef Schaller, Pierre Singer, Richard S Bourne, Carol Hodgson, Cheryl Hickmann, Vera Karner, Amy L. Freeman-Sanderson, Danielle E. Bear, Arthur R. H. van Zanten, Sabrina Eggmann, Margo van Mol, Dale M. Needham
article en

Abstract

PURPOSE: Patients with obesity who are admitted to an ICU bring specific challenges for rehabilitation during and after critical illness. This narrative review explores impact of differences in body compositions and pathophysiology on outcomes to summarise interprofessional, patient-centred rehabilitation strategies across the trajectory of recovery. METHODS: The interprofessional expert panel reviewed major trials and guidelines, integrating their clinical expertise with the current evidence. RESULTS: Three distinct phenotypes potentially influence outcomes for survivors. Whilst patients with preserved muscle mass may have a survival advantage, the phenotypes characterised by ectopic visceral fat or sarcopenia are frequently complicated by multimorbidity and polypharmacy, likely increasing the risk of adverse effects such as suboptimal sedation, prolonged ventilation and immobilisation, malnutrition, and impaired recovery. Targeted respiratory interventions, including secretion-clearance techniques and appropriate patient positioning to prevent atelectasis, reduce the work of breathing. Optimisation of communication and swallowing function is an essential component for facilitating safe oral intake and promoting active patient participation in rehabilitation. Concurrently, targeted nutrition strategies combined with early, targeted, progressive mobilisation might mitigate ICU acquired weakness and support functional recovery. The availability of appropriate weight‑based equipment is fundamental to ensuring safe mobilisation for both patients and healthcare professionals. CONCLUSION: Interprofessional collaboration is central to optimising outcomes and should extend beyond the ICU to structured post-ICU follow-up to address persistent, worsening, or newly emerging health impairments. Early rehabilitation in critically ill patients with obesity should integrate physiological, logistical, and psychosocial considerations to support equitable and functional recovery.

Intensive Care Medicine
University of Technology Sydney (AU), Royal Adelaide Hospital (AU), Johns Hopkins University (US), The University of Melbourne (AU), King's College London (GB), University of Zurich (CH), Manchester Academic Health Science Centre (GB), Royal Prince Alfred Hospital (AU), Johns Hopkins Medicine (US), University Hospital of Bern (CH), University Hospital Coventry (GB), Erasmus MC (NL), University Hospitals Coventry and Warwickshire NHS Trust (GB), University of Manchester (GB), UNSW Sydney (AU), National Institute for Health and Care Research (GB), Humboldt-Universität zu Berlin (DE), Herzliya Medical Center (IL), Sheffield Teaching Hospitals NHS Foundation Trust (GB), TiFN (NL), The George Institute for Global Health (AU), Haute École Provinciale de Hainaut Condorcet (BE), Ziekenhuis Gelderse Vallei (NL), University Children's Hospital Zurich (CH), Australian Physiotherapy Association (AU), Monash University (AU), Coventry University (GB), Medical University of Vienna (AT), Wageningen University & Research (NL), Erasmus University Rotterdam (NL)
European Commission, Medizinische Universität Wien, Gemeinsame Bundesausschuss
Zero hunger
Openalex Percentile: Top 7%
Intensive Care Unit Cognitive Disorders
DOIOpen Access PDFOpenAlex
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