Influence of severe obesity on non-invasive ventilation strategies and responses in patients with acute hypercapnic respiratory failure in ICU

Gürsel, Gül; Aydoğdu, Müge; Gülbaş, Gazi; Özkaya, Şevket; Tasyurek, S; Yıldırım, Fatma

doi:10.1186/cc8474

Cited by 22 publications

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“…Repeated measures ANOVA within both modes showed that presence of obesity caused no difference in the reduction of PaCO 2 . A previous study carried out in our ICU to examine the effect of obesity on NPPV strategies and responses in patients with AHRF found that presence of obesity was not associated with the length of hospital stay, intubation rate, and mortality [16]. However, we found that obese patients should remain on NPPV 3 times longer than non-obese patients in order to reduce the PaCO 2 level to less than 55 mmHg, which was the primary endpoint.…”

Section: Discussionmentioning

confidence: 50%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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OBJECTIVES:Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure. In addition, short-term effects of body position and obesity within both modes were analyzed. MATERIAL and METHODS:We conducted a randomized controlled study in a 7-bed intensive care unit. The course of blood gas analysis and differences in ventilation variables were compared between BiPAP-S (n=33) and AVAPS-S (n=29), and between semi-recumbent and lateral positions in both modes. RESULTS:No difference was found in the length of hospital stay and the course of PaCO2, pH, and HCO3 levels between the modes. There was a mean reduction of 5.7±4.1 mmHg in the PaCO2 levels in the AVAPS-S mode, and 2.7±2.3 mmHg in the BiPAP-S mode per session (p<0.05). Obesity didn't have any effect on the course of PaCO2 in both the modes. Body positioning had no notable effect in both modes. CONCLUSION:Although the decrease in the PaCO2 levels in the AVAPS-S mode per session was remarkably high, the course was similar in both modes. Furthermore, obesity and body positioning had no prominent effect on the PaCO2 response and ventilator mechanics. Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between the modes.

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Section: Discussionmentioning

confidence: 50%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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“…The use of NIV for this purpose is widely spread. A study 12 has invetigated the factors associated to the response factors of NIV on the fisrt day of ICU hospitalization, in hypercapnic patients, despite the success being lower than in the present study (66%), it was possible to identify that patients who needed higher support pressures were the ones who presented higher chances of failures or unsuccess 12 . Lee et al 21 demonstrated that patients with PO complications can be treated with NIV, reducing both hospitalization and ICU time length, the most common complications being pneumonia and atelectasis.…”

Section: Discussionmentioning

confidence: 56%

“…Although the main indication of this study being hypercapnia (44%), the performance of NIV was similar, with 94% 14,22 . Bellinetti e Thomson 23 describe that patients with MIP and MEP 75% below what was predicted develop more respiratory complications 12 . These groups having greater incidence of respiratory complications also require greater use of NIV, which occured in this study, with no significant difference however.…”

Section: Discussionmentioning

confidence: 99%

“…According to the BMI classification, 33% presented with some degree of obesity, and of these, 36% made use of NIV. The use of NIV in obese patients with hypercapnia is effective, however, there is a need for a higher level of PEEP, resulting in improved oxygenation, and decreased carbon dioxide and alveolocapillar difference 12 . Another anthropometric factor evaluated was the waist circumference, which had an average of 98 cm, being more prone to common respiratory complications in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Within therapeutic alternatives, the noninvasive ventilation (NIV) has been used in order to improve respiratory function as a result of the deterioration of the cardiac function 8,9 . The NIV is indicated in the prevention and solution of respiratory failure, reducing the PO's reintubation rates, pneumonia and hypoxemia, impacting directly on hospitalization time length and at the intensive care unit (ICU) 3,[10][11][12] . The NIV also improves gas exchange and shunt, decreasing muscle work, pre-and afterload, reflecting in ventricular performance 3,11 .…”

Section: Introductionmentioning

confidence: 99%

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Respiratory muscle strength no influence the need for noninvasive ventilation after heart surgery

Daniel

Driessen²,

Fréz

et al. 2014

Fisioter. Pesqui.

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| The aim of this study was to investigate the relation between preoperative respiratory muscle strength and indication and performance of noninvasive ventilation in the planned heart surgery. We conducted a retrospective study using data collected from clinical records and analyzed 109 medical records and noninvasive ventilation accompanying paper. We analyzed the values of respiratory muscle strength, peak flow and respirometry, as well as the postoperative respiratory complications, correlating them with indication and performance of the noninvasive ventilation. The t test was performed for continuous variables; the chi-square was used to investigate the influence of preoperative respiratory muscle strength values in the indication of noninvasive ventilation. Noninvasive ventilation was used in 32 (29%) subjects and the prime motive indication was hipercapy (44%). The successful use of noninvasive ventilation was observed in 94%. The decrease in preoperative strength, despite having a lower performance, showed no significant difference in relation to its use and outcome (p=0. 73). The preoperative respiratory muscle strength was not able to provide for the use of noninvasive ventilation or its performance. de 109 prontuários e fichas de acompanhamento da ventilação não invasiva. Foram analisados força muscular respiratória, pico de fluxo e ventilometria e complicações pós-operatórias, correlacionando-as com a indicação e o desempenho da ventilação não invasiva. Foi utilizado o teste t de Student para as variáveis contínuas e teste quiquadrado para investigar a influência dos valores da força muscular respiratória pré-operatória com a indicação de desfecho da ventilação não invasiva. A ventilação não invasiva foi utilizada em 32 (29%) dos indivíduos, sendo a principal indicação a hipercapnia (44%). O sucesso com o uso da ventilação não invasiva foi de 94%. A diminuição da força muscular pré-operatória, apesar de ter apresentando um menor desempenho, não demostrou diferença significativa em relação à sua utilização e desfecho (p=0,73). A força muscular respiratória pré-operatória não foi capaz de prever a utilização da ventilação não invasiva nem seu desempenho.Descritores | Cirurgia Torácica; Ventilação Não Invasiva; Força Muscular.RESUMEn | El objetivo de este estudio fue verificar la relación entre la fuerza muscular respiratoria preoperatoria y la indicación y el desempeño de la ventilación no invasiva en pacientes sometidos a cirugía cardíaca electiva. Se llevó a cabo un estudio retrospectivo por encuesta y análisis de 109 registros hospitalarios y formularios de acompañamiento de la ventilación no invasiva. Se analizaron la fuerza muscular respiratoria, el pico de

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The clinical characteristics and hospital and post‐hospital survival of patients with the obesity hypoventilation syndrome: analysis of a large cohort

Marik

Chen

2016

Obesity Science & Practice

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SummaryObjectiveThe worldwide prevalence of obesity has reached epidemic proportions. Obesity hypoventilation syndrome (OHS) is a common yet largely undiagnosed and mistreated condition that likely carries a high mortality. The aim of this study was to determine the clinical characteristics, hospital outcome, outcome following hospital discharge and predictors of death in a large cohort of patients hospitalized with OHS. OHS is an important condition as many patients with this syndrome are misdiagnosed and receive inappropriate treatment.MethodsWe reviewed the electronic medical records of patients with unequivocal OHS admitted to a 525‐bed tertiary‐care teaching hospital over a 5‐year period. Demographic and clinical data as well as hospital disposition were recorded. In order to determine the patients' post‐discharge status, we linked our database to the database of death certificates of the State Registrar of Vital Records.ResultsWe identified 600 patients who met the inclusion criteria for this study. The patients' mean age was 58 ± 15 years with a mean body mass index of 48.2 ± 8.3 kg m−2; 64% were women. Thirty‐seven percent had a history of diabetes and 43% had been misdiagnosed as having chronic obstructive pulmonary disease, while none had been previously diagnosed with OHS. The most common admission diagnoses were respiratory failure, heart failure and sepsis. Ninety (15%) patients died during the index hospitalization. The patients' age, S‐creatinine, respiratory failure, sepsis and admission to the ICU were independent predictors of hospital mortality. The hospital survivors were followed for a mean of 1,174 ± 501 d (3.2 ± 1.3 years) from the index hospitalization. On follow‐up, 98 of the 510 (19%) hospital survivors died, with an overall cumulative mortality of 31.3%. The patients' age, S‐creatinine and admission to the ICU were independent predictors of post‐hospital mortality.ConclusionObesity hypoventilation syndrome is a common disease that is frequently misdiagnosed and mistreated and carries a 3‐year morality, which is significantly worse than that for most cancers combined. Considering the high mortality of this disease, all patients with a body mass index > 35 kg m−2 should be screened for OHS; those patients with both early and established OHS should be referred to a pulmonary and/or sleep specialist for evaluation for non‐invasive positive pressure ventilation, to a dietician for dietary counseling and lifestyle modification and to a bariatric surgeon for evaluation for bariatric surgery.

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Influence of severe obesity on non-invasive ventilation strategies and responses in patients with acute hypercapnic respiratory failure in ICU

Cited by 22 publications

References 0 publications

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Respiratory muscle strength no influence the need for noninvasive ventilation after heart surgery

The clinical characteristics and hospital and post‐hospital survival of patients with the obesity hypoventilation syndrome: analysis of a large cohort

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