ࡱ> #`bjbjmm >% \ \ \ 4 ===h=d> h>?"???WW,W$hR7\ "\UlW"\"\7 ??FVhVhVh"\ ?\ ?Vh"\VhVh}~ \ ?> \P=b\F<VdV,$V\ AtWXVhY[ZWWW77gjWWW"\"\"\"\ ,49 49  Obese Patients in Medical Intensive Care Unit: Influence of Counseling on Weight Loss and Cardiovascular Parameters Ana Vujaklija Brajkovi, Ivan Gornik and Vladimir Gaaparovi Division of Intensive Care Medicine, Department of Medicine, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, Croatia Type of publication: case series Running head: Obesity in ICU counseling and results ABSTRACT A case series of 12 obese patients admitted to medical intensive care unit (ICU) due to life-threatening diseases and the influence of weight loss on cardiovascular parameters is presented. We assessed body weight, body mass index (BMI), blood pressure, pulse, and laboratory values on admission. At discharge from ICU patients were counseled on how to lose weight. They were examined one and six months later. Statistically significant (P<0.05) decrease of body weight (median at the beginning of a treatment 134 kg, after six months 127.5 kg), BMI (median 41.5 kg/m2 at the beginning of a treatment; 38.9 kg/m2 after six months), systolic blood pressure (medians 145 mmHg and 130 mmHg), diastolic blood pressure (medians 95 mmHg and 85 mmHg) and pulse (medians 104 beats per minute, 78 beats per minute) was found. The reduction of the waist circumference was not significant. One patient died due to severe acute pancreatitis. Patients reported feeling much better after losing weight. Key words: obesity, hypertension, atrial fibrillation, heart failure, pancreatitis Introduction Overweight and obesity are widespread public health problems. Body mass index (BMI) is widely used method to estimate body fat mass. According to World Health Organization overweight is defined as a BMI between 2529.9 kg/m2 and obesity as a BMI >30 kg/m2. Nearly two thirds of adult population in the USA is overweight and 30.5% of the population is obese1. Recent studies also found increase in the prevalence of extreme obesity (BMI >40 kg/m2)2. In Croatia, according to some data, 38.11% of population is overweight, and 20.34% is obese3. Obesity is associated with many complications, for example cardiovascular disease, hypertension, diabetes mellitus type 2, sleep apnea, arthritis, pancreatitis, and even malignant diseases. We analyzed causes of hospitalization of obese patients in the Division of Intensive Care Medicine, Clinical Hospital Center Zagreb and influence of weight loss on their cardiovascular parameters. Patients and Methods Obese patients admitted to the Division of Intensive Care Medicine are reported. Data on body height, body mass, waist circumference, blood pressure, pulse, laboratory parameters (serum cholesterol, HDL cholesterol, LDL cholesterol, triglyceride and blood glucose), chest x-ray, electrocardiogram (ECG) and echocardiography was collected and analyzed. At discharge from ICU patients were advised on how to reduce body weight by making dietary changes and pursuing physical activity. Measurements were repeated one and six months later. Statistics Statistical analysis was performed withMedCalc  HYPERLINK "http://7.2.1.0" \t "_blank" 7.2.1.0. statistical software. Results are reported as median with range. Due to the small sample size, non-parametric methods were used: Wilcoxon test for paired samples and 2. Statistical significance was set at P=0.05. Results Twelve consecutive patients (10 male and 2 female) aged between 36 and 78 years (median 59 years) admitted to the ICU in the period from 2003 to 2007 are reported. Primary admission diagnoses were: atrial fibrillation (3 patients), global respiratory failure (2 patients), heart failure (2 patients), acute pancreatitis (2 patients), pulmonary embolism (1 patient), acute cholecystytis (1 patient), and hypertension (1 patient). One patient developed severe acute pancreatitis and died a day after ICU admission. Three patients demanded invasive mechanical ventilation. Median BMI for all patients at ICU admission was 42.6 kg/m2 (36.7 51.6 kg/m2) (Table 1). Hypertension was verified among 8 patients. Two patients were already using antihypertensive drugs, due to which their blood pressure was well controlled. Patient with severe pancreatitis that died presented with hypotension and tachycardia. Only one patient in our case series had normal values of blood pressure. Seven patients had pathological changes in their ECG: left electrical axis was observed in 5 patients, 3 patients had first degree atrioventricular block, and one patient had right bundle branch block. Five patients had cholesterol concentration within the recommend interval and three patients had normal triglycerides. Three patients that had concentrations of cholesterol and triglycerides in the recommended interval were already taking hypolipemic agents (statins and fibrates). Chest x-ray showed increased vascularity and heart dimension in 9 out of 11 patients. During the hospitalization in the ICU patients received appropriate caloric intake. At discharge from hospital they were counseled on how to reduce body weight. One month following the discharge from hospital statistically significant (P=0.008) reduction of body mass in 8 patients, whose data was available, was observed (median of body mass during hospitalization was 128 kg (101.5 147 kg), and one month later 124.8 kg (100 144 kg)) (Figure 1). Six months later we managed to contact eight patients. Body mass median for those eight patients at the beginning of the study was 134 kg and after six months 127.5 kg (90 141.5 kg) (Figure 1), which was statistically significant decrease of body mass (P=0.010). Body mass index also decreased significantly in both points in time. BMI median at the discharge from hospital for eight patients was 41.5 kg/m2 (37.6 51.6 kg/m2), and a month later it was 40.4 kg/m2 (37.1 50.8 kg/m2) (Figure 2), P=0.008. After six months BMI median was 38.9 kg/m2 (33.5 45 kg/m2). Statistically significant decrease of systolic and diastolic blood pressure was observed one month after the discharge from the hospital. Median for systolic blood pressure during the hospitalization was 145 mmHg and diastolic blood pressure 95 mmHg, one month later it was 130 mmHg and 85 mmHg (Figure 3). Heart rate also decreased (medians 104 beats per minute, 78 beats per minute). Body waist circumference decreased, though not by statistically significant amount. All patients reported that their quality of life improved with reduction of body weight. Discussion Our case series reports causes of hospitalization of obese patients in intensive care unit and the effect of weight loss on cardiovascular parameters. We showed that proper counseling at the time of discharge from hospital can motivate patients to change their lifestyle, lose weight and become physically more fit. Observed weight reduction was significant and had positive influence on cardiovascular parameters such as blood pressure and heart rate. The issue of obesity in the acute illness is important but unfortunately mainly understudied. According to recently published meta-analysis obesity is not associated with increased risk for ICU mortality, but morbidly obese patients tend to have longer hospital stay in comparison with normal weight patients4. Morbid obesity is also associated with respiratory failure, type of the ventilation (noninvasive or invasive) and the outcome of treatment5. All patients in this case series that needed respiratory support were invasively ventilated. Complications of acute pancreatitis are more frequent in obese patients6,7. In our series two patients were admitted in the ICU because of the pancreatitis and one of them died. Positive correlation was found between obesity, high blood pressure8,9 and atrial fibrillation10,11. Our data is in accordance with these findings. Hypertension was diagnosed in ten and atrial fibrillation in three patients. Considerable advances have been made in dietary, exercise, behavioural, pharmacologic and bariatric surgical approaches to successful long-term management of obesity. Recently performed research of overweight and obese people in Croatia found that they are motivated to lose weight12. Multidisciplinary approach, including dietary care, physical activity, psychological and medical care should be applied in order to achieve positive changes in patients lifestyle that would lead to weight loss. We tried to explore the correlation among obesity, acute diseases and the value of counseling on patients lifestyle changes. To our knowledge, this is the first attempt to address these issues in intensive care units in Croatia. In spite of small sample size, we showed that good counseling and regular examinations can positively influence patients efforts to lose weight and, consequently, to improve their blood pressure and overall well-being. References 1.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12761363&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" BONOW RO, ECKEL RH, N Engl J Med, 348 (2003) 2057. 2. FLEGAL KM, CARROLL MD, OGDEN CL,  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12365955&ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum"  JOHNSON CL, JAMA, 288 (2002) 1723.  - 3. FISTER K, KOLCI I, MILANOVI SM, KERN J, Coll Antropol, 33 Suppl 1 (2009) 25.- 4. HOGUE CW JR, STEARNS JD, COLANTUONI E, ROBINSON KA, STIERER T, MITTER N, PRONOVOST PJ, NEEDHAM DM, Intensive Care Med, 35 (2009) 1152. 5.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17255878&ordinalpos=21&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" DUARTE AG, JUSTINO E, BIGLER T, GRADY J, Crit Care Med, 35 (2007) 732. 6.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16636600&ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" PAPACHRISTOU GI, PAPACHRISTOU DJ, AVULA H, SLIVKA A, WHITCOMB DC, Pancreatology, 6 (2006) 279. 7.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=16549939&ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" MARTNEZ J, JOHNSON CD, SNCHEZ-PAY J, DE MADARIA E, ROBLES-DAZ G, PREZ-MATEO M, Pancreatology, 6 (2006) 206.  8. UHERNIK AI, MILANOVI SM, Coll Antropol, 33 Suppl 1 (2009) 75.  9.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18058454&ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" ROMERO R, BONET J, DE LA SIERRA A, AGUILERA MT, INVESTIGATORS OB, Blood Press, 16 (2007) 347. 10.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17560167&ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" AYER JG, ALMAFRAGY HS, PATEL AA, HELLYER RL, CELERMAJER DS, Heart Lung Circ, 17 (2008) 19. 11.  HYPERLINK "http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17846306&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum" ECHAHIDI N, MOHTY D, PIBAROT P, DESPRS JP, O'HARA G, CHAMPAGNE J, PHILIPPON F, DALEAU P, VOISINE P, MATHIEU P, Circulation, 116 Suppl 11 (2007) I213. 12. GUINA T, POKRAJAC-BULIAN A, TKALCI M, BASI MARKOVI N, CRNCEVI ORLI Z, CORI S, STIMAC D, Coll Antropol, 32 (2008) 601.- Correspondence address A. Vujaklija Brajkovi, MD Division of Intensive Care Medicine, Department of Medicine, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10000, Croatia e-mail:  HYPERLINK "mailto:avujaklija@gmail.com" avujaklija@gmail.com PRETILI PACIJENTI U INTERNISTI KOJ JEDINICI INTENZIVNE SKRBI: UTJECAJ SAVJETOVANJA NA SMANJENJE TJELESNE MASE I KARDIOVASKULARNE PARAMETRE SA}ETAK Ispitali smo u inak smanjenja tjelesne mase na kardiovaskularne parametre u 12 pretilih pacijenata primljenih u jedinicu intenzivne skrbi zbog ~ivotno ugro~avajuih bolesti. Pri prijemu su zabilje~eni tjelesna masa, indeks tjelesne mase (ITM), krvni tlak, puls i laboratorijski parametri. Prilikom otpusta iz jedinice intenzivne skrbi bolesnici su savjetovani kako smraaviti. Pregledani su mjesec dana i aest mjeseci nakon otpusta iz bolnice. Zabilje~eno je statisti ki zna ajno (P<0.05) smanjenje tjelesne mase (medijan prije savjetovanja iznosio je 134 kg, nakon aest mjeseci 127.5 kg), ITM (medijan 41.5 kg/m2 prije savjetovanja, nakon aest mjeseci 38.9 kg/m2), sistoli kog krvnog tlaka (medjiani 145 mmHg i 130 mmHg), dijastoli kog krvnog tlaka (medijani 95 mmHg i 85 mmHg) te pulsa (medijani 104/min, 78/min). Smanjenje opsega struka nije bilo zna ajno. Jedan pacijent je preminuo od posljedica teakog pankreatitisa. Svi pacijenti koji su smraavili su izjavili da se osjeaju puno bolje. TABLE  SEQ Table \* ARABIC 1. PATIENTS DATA ON ADMISSION (diagnosis, need for mechanical ventilation, anthropometric measures, blood pressure, heart rate, ECG, biochemical analysis) Patient Diagnosis MVHeight (m)BM (kg)BMI (kg/m2)WC (cm)SBP (mm Hg)DBP (mm Hg)HR (1/min)ECGSerum cholesterol (mmol /l)HDL cholesterol (mmol /l)Triglyceride (mmol /l)Blood glucose (mmol /l)1.Heart failureno1.8513037.9813516510093left electrical axis, 1st degree AV block6.51.795.22.Atrial fibrillationno Z^xz  0 8 ` j |   : O Z i ~sh]hO6hw mH sH hO6hbmH sH hO6h .emH sH hO6hmH sH hx}mH sH hO6hO6mH sH hO6hSXH*mH sH hO6hlmH sH hO6h]v^mH sH hO6hSXmH sH hO6h"OJQJhO6hlOJQJhO6h5hOJQJhO6h.y.OJQJhO6hSXOJQJ b d f h j 5 6 7 8 9 : [ yzdgd"|dgd:p| $da$gd:p|щ J W Y \ d f 6 ƺޮvh]QhO6hC6mH sH hO66H*mH sH hO6hO66H*mH sH hO6hO66mH sH hO6hSX6H*mH sH hk06mH sH hO6hSX6mH sH hO66mH sH hO6hCs6mH sH hO6h;;6mH sH hO6h"6mH sH hO6h?6mH sH hO6h,k 6mH sH hO6hSXmH sH hO6h2WqmH sH !<Fvxyz+1GRABSøøth]QhO6h1H*mH sH hO6h1mH sH hO6hwH*mH sH hO6hwmH sH hO6hBH*mH sH hO6h;;mH sH hO6h7mH sH hO6hBmH sH hO6hSX5mH sH hO6hSXmH sH hO6hSX6mH sH hO6h;;6mH sH hO6ha6mH sH hO6hC6mH sH hO6h?6mH sH SX?D`fȽȲꈀwnbVhO6hLcY5mH sH hO6h2Wq5mH sH hO65mH sH hk05mH sH hk0mH sH hO6hk0mH sH hO6hLmH sH hO6h=mH sH hxH*mH sH h"|hSXmH sH h"|h"|mH sH h"|h"mH sH hO6hSXH*mH sH hO6h1mH sH hO6hSXmH sH hO6h"mH sH  `rtEaJdC$Eƀgd:p|dgd:p|JdC$Eƀgd:p| #&@ADyҺҤ莤xl`hO6hSX6mH sH hO6h "6mH sH hO6hZmH sH hO6h;mH sH hO6h;;mH sH hO6h "mH sH hO6h,k mH sH hO6h0mH sH h0mH sH h ~+mH sH hO6mH sH hO6hSXmH sH hO6h:XimH sH hO6h)mH sH hO6hSX5mH sH -5?C@HRTbpr6NV4<fl÷جؠؕЕЕЕЕЕЬzohO6h+mH sH h+mH sH hO6h)mH sH h}SmH sH hO6h?ymH sH hO6hSX5mH sH hO6h;;mH sH hO6hSXH*mH sH hO6hSX^JmH sH hO6mH sH hO6hSXmH sH hO6hSX6mH sH  jhO6hSX6UmH sH ++8R[qrstY^ij >A?ABp˿zood\d\dh.SmH sH ho0;ho0;mH sH hO6h(mH sH hu&mH sH hmH sH hO6h=mH sH hO6h"SmH sH hO6h sH*mH sH h ~+mH sH hO6h smH sH hO6h=H*mH sH hO6hxB*mH phsH h+mH sH hO6mH sH hO6hxmH sH hO6h:XimH sH  pqDELc $  j /!1!@!A!ĹĹϘύύϘύϘϮϘςvvvvvvhO6hSXH*mH sH hO6h@#mH sH hO6hmH sH hO6ho+mH sH hO6h;;mH sH hO6h)mH sH hO6h(mH sH hO6hmH sH hO6hSXmH sH ho0;mH sH ho0;hvmH sH ho0;ho0;mH sH h mH sH .F!u##H%&((*,,:;R;^<< >>x?EEE & Fhd^h`gd:p| !$da$gd!w !$da$gd%!dgdGdgd:p| $da$gd:p|A!F!G!`!!!!!!!""")"8"?"W"x""""###2#<#=#H#U#s#t#v#####$:$I$n$~shshO6h<@mH sH hO6hmH sH h emH sH hO6hLmH sH hO6hSX5mH sH hO6hamH sH hO6hmH sH hO6hMmH sH hO6h;;mH sH hO6h@#mH sH hO6h:HmH sH hO6he\BmH sH hO6ho+mH sH hO6hSXmH sH 'n$v$$$$$G%H%%%&&&1&9&;&=&|&}&&&&&&& ' ' 'k''''''''uj^jhO6hvH*mH sH hO6hSWmH sH hO6hd|mH sH hxH*mH sH hd|mH sH hbmH sH hO6hgmH sH hkhkB*mH phfsH  hxH* hp,4H*h.h@h7RGhBOB*mH phsH h5hTmH sH hO6h)mH sH hO6hmH sH hO6hmH sH #'''( (((((((2(<(`(a(b(c({(}(~((((((((((((((()*zrg\hGhGmH sH hGh&MmH sH hmH sH hmH sH hO6hzmH sH hO6hcmH sH hO6hfvmH sH hvH*mH sH hO6hvH*mH sH hxH*mH sH hO6hmH sH hO6hTmH sH hO6hmH sH hO6hSWmH sH hO6h emH sH h emH sH #*******+++!+#+0+1+l+n++++++++++++++,-,F,V,W,f,{,,,,,ͷͬج͎͎ͬ{pehO6hSXmH sH hO6hmH sH hO6h.jmH sH hQFmH sH hO6h&~mH sH hhmH sH hO6hmH sH hO6hmH sH hO6h)mH sH hGmH sH hGhGmH sH hGH*mH sH ',,,,,,--------------8/:/P/R/T/^/`/̷seTCs h5h P+CJOJQJ^JaJ h5h3CCJOJQJ^JaJh%!CJOJQJ^JaJ h5h{mCJOJQJ^JaJ h5hCCJOJQJ^JaJ h5h CJOJQJ^JaJ h5hSXCJOJQJ^JaJ)jh5hSXCJOJQJU^JaJ h5hp,4CJOJQJ^JaJhO6hSX5mH sH hO6h 'y5mH sH hO6h(mH sH `/b/j/x/////00 0000000000000000п򮿮yhZZE)jh5hgCJOJQJU^JaJhCJOJQJ^JaJ h5h{mCJOJQJ^JaJ h5h CJOJQJ^JaJ h5hp,4CJOJQJ^JaJ$h5hx0J%CJOJQJ^JaJ h5hxCJOJQJ^JaJ h5h;/CJOJQJ^JaJ h5h P+CJOJQJ^JaJ h5h3CCJOJQJ^JaJh%!CJOJQJ^JaJ0h1i111111111111111111t2u22222222222333333 4sbssbɪbsbssbɪ h5hpd!CJOJQJ^JaJ)jh5hpd!CJOJQJU^JaJ h5hxCJOJQJ^JaJ h5h;/CJOJQJ^JaJhCJOJQJ^JaJ h5h{mCJOJQJ^JaJ h5h CJOJQJ^JaJ)jh5hgCJOJQJU^JaJ h5hgCJOJQJ^JaJ& 44444D4t44444444466U6V6W6d6e6p6u6w6y6{6|697:7u7v7777޼ވwwfވwf h5h{mCJOJQJ^JaJ h5h CJOJQJ^JaJ)jh5hSXCJOJQJU^JaJ h5hSXCJOJQJ^JaJhCJOJQJ^JaJ h5heDCJOJQJ^JaJ h5hxCJOJQJ^JaJ h5h;/CJOJQJ^JaJ h5hpd!CJOJQJ^JaJ"7777777777777Z8[888888888888̻̕sseWIWhE.CJOJQJ^JaJhCJOJQJ^JaJh CJOJQJ^JaJ h5h CJOJQJ^JaJ h5hSXCJOJQJ^JaJ)jh5hSXCJOJQJU^JaJ h5hxCJOJQJ^JaJ h5hp,4CJOJQJ^JaJ h5h;/CJOJQJ^JaJh0JCJOJQJ^JaJ$hMh{x0JCJOJQJ^JaJ88888:::::::::;;ͼziXJ3, hO6hpF,h!whpFCJOJQJaJmH nH sH tH h CJOJQJ^JaJ h5h CJOJQJ^JaJ h5hCJOJQJ^JaJ h5h&CJOJQJ^JaJhp CJOJQJ^JaJh 0J%CJOJQJ^JaJ$hhG0J%CJOJQJ^JaJ hhGCJOJQJ^JaJ hGhGCJOJQJ^JaJ h5hxCJOJQJ^JaJ h5h5|nCJOJQJ^JaJ;; ;R;d;;;;;;<<<.<2<J<N<n<p<<<<<<<< > >>D>r>>>6A@AzAAAAB(B*B󖎆xqxqxqxqxjxjx h]h0 h]h?\t h]h z h]h*"h]h05h]h*"5hO6hAmH sH &jh*"hpF6UmH sH  jh*"hpF6UmH sH hx}6mH sH h*"h#6mH sH h*"ht6mH sH h*"h(a@6mH sH h*"hpF6mH sH )*B0BTBlB|BBBBBBBBB CC6CHCJCPCCCCCCCCCCDDD DDD2D6D@DBDFDXD^DfDnDvD|DEEEEEEEFFFɺh.SmHnHsH uhO6hSXmH sH jhO6hSXUmH sH hO6hmH sH hO6hSXCJOJQJaJhO6hxCJOJQJaJhO6h0mH sH h]h0H* h]h z h]h@# h]h06EEFFFFFFFFFFFFGGG0GJGaGyGzGFf$d$Ifa$gd:p| d$Ifgd:p|dgd:p|$ & Fd^`a$gd:p|FF0F1F]FFFFFFFFFFFFGGJGKGaGbGyGzG}G~GGGGGGGĵ{o`P`{ohO6h%CJH*OJQJaJhO6h%CJOJQJaJhjCCJOJQJaJhO6h]BCJOJQJaJhO6h%CJH*aJmH sH hjCCJaJmH sH hO6h%CJaJmH sH hO6hSXB*mH phsH hO6hSXmH sH hO6h/ymH sH hO6h=mH sH hO6hmH sH jhO6hSXUmH sH zG}GGGGGGGGGGGGGGGGGGGFf2$d$Ifa$gd:p|$d$Ifa$gd:p|1.814745.371401451101197.31.231.954.53.Atrial fibrillationno1.813842.591207582right bundle branch block3.90.721.176.34.Hypertensionno1.7116.540.311221409056left electrical axis4.20.812.035.65.Atrial fibrillationno1.8514642.6613613090551st degree AV block6.11.041.985.26.Respiratory insufficiencyyes1.7912639.321508098left electrical axis4.50.71.166.47.Pulmonary embolismno1.8138.542.74150951144.51.041.527.28.Pancreatitisno1.7215050.241901101046.60.8210.59.Cholecystytisno1.64101.537.55145100827.72,34.910.Respiratory insufficiencyyes1.5512451.6114515090105left electrical axis, 1st degree AV block3.60.721.676.811.Heart failureno1.9614136.71351308058left electrical axis5.40.982.064.612.Pancreatitisyes-160--9560134---20.4median (min - max)1.8 (1.55 -1.96)138.25 (101.5 - 160)42.6 (36.7 -51.6)135.5 (122 -145)145 (95 -190)90 (60 -110)95 (55 -134)5.4 (3.6 -7.7)0.9 (0.7-1.23)1.79 (0.82-2.06)5.95 (4.5-20.4)MV- mechanical ventilation, BM - body mass, BMI - body mass index, WC - waist circumference, SBP - systolic blood pressure, DBP - diastolic blood pressure, HR - heart rate, ECG -electrocardiogram- patient passed away one day after the admission in the ICU Figure 1. Change of body mass one month (T1) and six months (T6) after the discharge from the hospital  Figure 2. Change of body mass index one month (T1) and six months (T6) after the discharge from the hospital  Figure 3. Decrease of blood pressure and pulse frequency before counseling (blue) and one month after the beginning of counseling (red)  Captions for figures and tables Table 1. Patients data on admission (diagnosis, need for mechanical ventilation, anthropometric measures, blood pressure, heart rate, ECG, biochemical analysis) (MV= mechanical ventilation, BM=body mass, BMI =body mass index, WC= waist circumference, SBP = systolic blood pressure, DBP = diastolic blood pressure, HR = heart rate) (- patient passed away one day after the admission in the ICU) Figure 1. Change of body mass one month (T1) and six months (T6) after the discharge from the hospital Figure 2. Change of body mass index one month (T1) and six months (T6) after the discharge from the hospital Figure 3. 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