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Determinants of non-invasive ventilation success or failure in morbidly obese patients in acute respiratory failure

Introduction

Malignant obesity hypoventilation syndrome (MOHS) refers to the association between morbid obesity (body mass index >40 kg/m2), daytime hypercapnia (PCO2 >45 mmHg) after other respiratory or neuromuscular causes of alveolar hypoventilation have been excluded, and multiple organ disorders (diabetes mellitus, arterial hypertension, metabolic syndrome, obstructive sleep apnea syndrome) [1]. Acute respiratory failure (ARF) is a common life-threatening complication of MHOS. Non-invasive ventilation (NIV) provides the cornerstone of the therapeutic management of decompensated MOHS [2]. We aimed to identify the determinants of NIV success or failure in this indication.

Methods

A monocentric prospective observational study including 48 patients with MOHS and treated by NIV for ARF over a 2-year period.

Results

NIV failed to reverse ARF in only seven patients. NIV failure was associated with a sixfold increase in in-hospital mortality (85.7% vs. 14.6%; P < 0.001). Factors associated with NIV failure and need for endotracheal intubation included pneumonia (n = 5, 71.4% vs. n = 8, 19.5%; P = 0.01), higher SOFA (11 vs. 5; P < 0.001) and SAPS 2 (69 vs. 39; P = 0.001) score at admission. The only factor associated with successful response to NIV was idiopathic decompensated MOHS (n = 19, 100% vs. n = 0, 0%; P = 0.03). In these patients, pH (7.23 vs. 7.28 vs. 7.44, respectively, at H0, H2, H24; P < 0.05) and PCO2 (74.5 vs. 68.5 vs. 57 mmHg, respectively, at H0, H2, H24; P < 0.05) dramatically improved with NIV.

Conclusion

NIV provides a very efficient therapy to reverse hypercapnic ARF in morbidly obese patients. Multiple organ failure and pneumonia are the main factors associated with NIV failure in patients with MOHS.

References

  1. 1.

    Marik PE, et al.: J Intensive Care Med. 2012, in press.

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    Piper AJ, et al.: Am J Respir Crit Care Med. 2011, 183: 292-298. 10.1164/rccm.201008-1280CI

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Correspondence to M Lemyze.

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Lemyze, M., Taufour, P., Mallat, J. et al. Determinants of non-invasive ventilation success or failure in morbidly obese patients in acute respiratory failure. Crit Care 17, P142 (2013). https://doi.org/10.1186/cc12080

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Keywords

  • Obstructive Sleep Apnea
  • Obese Patient
  • Sleep Apnea
  • Morbid Obesity
  • Obstructive Sleep Apnea Syndrome