Dosing of medications in morbidly obese patients in the intensive care unit setting

Objective: To derive recommendations for the dosing of commonly used medications in the morbidly obese patient in the ICU. Data sources: Articles were obtained through computerized searches involving MEDLINE. The bibliographies of retrieved publications and textbooks were reviewed for additional references. Study selection: All studies involving the pharmacokinetics or pharmacodynamics of medications in obese subjects or patients. Data extraction: The emphasis was on studies involving morbidly obese patients but, in the absence of such data, investigations involving lesser forms of obesity were extracted. Data synthesis: There is a paucity of data upon which to make recommendations for dosing commonly used medications in the morbidly obese patient in the ICU, although recommendations were provided based on the available information. Conclusions: There is clearly a need for more investigations involving dosing regimens of medications in the morbidly obese population. Until such studies are available, the clinician must try to derive the best dosing regimens for medications based on the limited pharmacokinetic data available for some agents and clinical judgement.