Editorial| Volume 26, ISSUE 4, Pxiii-xiv, October 2010


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      Mary Jane Reed, MD, FACS, FASMBS, FCCM, FCCP Guest Editor
      As critical care practitioners, we have seen our ICU transformed over the last 20 years from a facility challenged with the care of an occasional morbidly obese patient to one that cares for multiple morbidly obese patients on a daily basis. Nevertheless, our approach to the management continues to be primarily empiric and without guidance from clinical research directed toward this population of patients. Although research is evolving in this area, large gaps in knowledge persist. Optimal dosing, for example, is unknown for many drugs, including those that may be lifesaving. Although a modest body of literature exists on antibiotic dosing in the obese, the studies addressing dosing of cardiac medications in these patients are infrequent and sporadic. Controversy continues to persist over whether a calorie-restricted diet is safe or beneficial in the critically ill obese patient.
      To address these care challenges, we enthusiastically embraced the opportunity to organize this collection of articles addressing the care of the critically ill obese and morbidly obese patient. Practitioners and clinical researchers with experience and interest have authored these articles, providing scientific backup whenever possible as well as wisdom and common sense that derives from years of practice. We hope that clinicians will find useful applications of this knowledge base and that clinical researchers will recognize areas requiring investigation.