Evolution of Patients With Chronic Obstructive Pulmonary Disease, Obesity Hypoventilation Syndrome, or Congestive Heart Failure Undergoing Noninvasive Ventilation in a Respiratory Monitoring Unit

González, Ángel Ortega; Romero, Germán Peces-Barba; Ormaechea, Itziar Fernández; Flores, René Chumbi; Frutos, Noelia Cubero de; Mangado, Nicolás González

doi:10.1016/s1579-2129(06)60563-6

Cited by 15 publications

(4 citation statements)

References 22 publications

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“…Although older series had reported a high mortality rate among hospitalized patients with OHS (56, 57), two prospective studies reported no in-hospital deaths among a total of 64 consecutive hospitalized patients with OHS (21,58). Of course, respiratory failure, if untreated, places these patients at markedly increased risk of death.…”

Section: Mortalitymentioning

confidence: 97%

“…Taken together, there is compelling evidence that CPAP is effective in the majority of patients with stable OHS, particularly in the subgroup with severe OSA. Bilevel PAP should be strongly considered in patients who fail CPAP, patients with OHS who experience acute-on-chronic respiratory failure (13,58), and patients who have OHS without OSA (46,93). Treatment of OHS with positive airway pressure improves blood gases, morning headaches, excessive daytime sleepiness and vigilance, dyspnea, pulmonary hypertension, leg edema, and secondary erythrocytosis (13,45,75,96).…”

Section: Overall Treatment Approachmentioning

confidence: 99%

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Assessment and Management of Patients with Obesity Hypoventilation Syndrome

Mokhlesi

Kryger²,

Grunstein³

2008

Proceedings of the American Thoracic Society

224

108

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Obesity hypoventilation syndrome (OHS) is characterized by obesity, daytime hypercapnia, and sleep-disordered breathing in the absence of significant lung or respiratory muscle disease. Compared with eucapnic morbidly obese patients and eucapnic patients with sleep-disordered breathing, patients with OHS have increased health care expenses and are at higher risk of developing serious cardiovascular disease leading to early mortality. Despite the significant morbidity and mortality associated with this syndrome, diagnosis and institution of effective treatment occur late in the course of the syndrome. Given that the prevalence of extreme obesity has increased considerably, it is likely that clinicians will encounter patients with OHS in their clinical practice. Therefore maintaining a high index of suspicion can lead to early recognition and treatment reducing the high burden of morbidity and mortality and related health care expenditure associated with undiagnosed and untreated OHS. In this review we define the clinical characteristics of the syndrome and review the pathophysiology, morbidity, and mortality associated with it. Last, we discuss currently available treatment modalities.

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Section: Mortalitymentioning

confidence: 97%

Section: Overall Treatment Approachmentioning

confidence: 99%

Assessment and Management of Patients with Obesity Hypoventilation Syndrome

Mokhlesi

Kryger²,

Grunstein³

2008

Proceedings of the American Thoracic Society

224

108

View full text Add to dashboard Cite

show abstract

“…In acute hypercapnic respiratory failure due to obesityhypoventilation syndrome, although no randomized clinical trial has been conducted to test the effectiveness of NIV for this indication, NIV is the preferred mode of ventilatory support, unless the patient is severely unwell or there is other organ dysfunction, in which case endotracheal intubation and mechanical ventilation in the ICU is mandatory. 31 NIV in this cohort results in improvements in pH and P aCO 2 , 9,20,22,32,33 with lower mortality in patients treated with NIV compared with those who refused it (3% mortality with NIV and 57% without 9 ). Lemyze and co-workers, 31 in a study exploring the determinants of NIV success in acute respiratory failure in the morbidly obese, found that pneumonia and high symptom-severity scores at admission were associated with NIV failure in this group, while high P aCO 2 and HCO 3…”

mentioning

confidence: 65%

“…18 Positive airway pressure (PAP) is effective in managing SEE THE ORIGINAL STUDY ON PAGE 28 both acute and chronic respiratory failure due to obesityhypoventilation syndrome. 9,[19][20][21][22][23] Despite this, there are no established guidelines for the use of NIV or CPAP in subjects with obesity-hypoventilation syndrome, and to date only a few randomized controlled trials have been published. Nevertheless, there is a strong physiologic rationale for the use of PAP in obesity-hypoventilation syndrome, and evidence supporting its use in this area is growing.…”

mentioning

confidence: 99%