Short-term and Long-term Effects of Nasal Intermittent Positive Pressure Ventilation in Patients With Obesity-Hypoventilation Syndrome

Llano, Luis A. Pérez de; Golpe, Rafael; Piquer, Montserrat Ortiz; Racamonde, A. Veres; Caruncho, Manuel Vázquez; Muinelos, Olga Caballero; Carro, Cristina Alvarez

doi:10.1378/chest.128.2.587

Cited by 247 publications

(231 citation statements)

References 22 publications

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“…Some case reports and observational studies [73][74][75] suggest that in this situation NIV can ameliorate the alveolar hypoventilation and avoid intubation, but so far RCTs are lacking.…”

Section: Obesity Hypoventilation Syndromementioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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“…Some case reports and observational studies [73][74][75] suggest that in this situation NIV can ameliorate the alveolar hypoventilation and avoid intubation, but so far RCTs are lacking.…”

Section: Obesity Hypoventilation Syndromementioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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“…23 There are no randomised controlled trials of the use of NIV in patients with ventilatory failure secondary to obesity. The outcome from invasive ventilation is generally poor and a case series in which patients who received NIV were compared with those who refused it showed a survival advantage for those receiving NIV (97% 42%) 24 ; it should be stressed that this was not controlled and that there may have been other reasons for the observed difference. Particular problems with NIV in very obese patients include upper airway obstruction during sleep and the fact that the impedance to inflation may be very high requiring either the use of volume ventilators or the novel mode of volumeassured pressure support.…”

Section: Obesitymentioning

confidence: 99%

Non-invasive ventilation: established and expanding roles

Elliott

2011

Clinical Medicine

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-Non-invasive ventilation (NIV) has become the standard of care for most patients with ventilatory failure due to an acute exacerbation of chronic obstructive pulmonary disease (COPD). In all but a small minority, even of the very sickest, there is little to be lost by at least a short trial of NIV. In patients with acute cardiogenic pulmonary oedema, NIV results in a more rapid physiological improvement and resolution of dyspnoea, but the benefits in terms of survival have been called into question by two recent randomised controlled trials. There are no randomised controlled trials of NIV in patients with acute ventilatory failure due to obesity but the outcome from invasive ventilation is poor and the results of NIV encouraging. Finally, NIV may have a role during the transition from active care, aimed to extend life, to palliative care.KEY WORDS: chronic obstructive pulmonary disease (COPD), cardiogenic pulmonary oedema, respiratory failure, obesity, palliative care

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“…NIPPV (with bilevel PAP or advanced modalities) when used long-term in patients with OHS who have failed CPAP therapy has been shown to effectively improve hypoventilation and daytime symptoms. [50,[74][75][76] Bi-level PAP therapy is beneficial in preventing obstructive events, improving expiratory flow limitation and also improves tidal volume by providing inspiratory pressure support. Bilevel therapy when used long term has been shown to improve blood gases, quality of life and ventilator responsiveness to CO 2 [50,70,[77][78][79][80][81].…”

Section: Bi-level Papmentioning

confidence: 99%

Obesity Hypoventilation Syndrome

2010

IJPM

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Obesity hypoventilation syndrome is a respiratory consequence of morbid obesity that is characterized by alveolar hypoventilation during sleep and wakefulness. The disorder involves a complex interaction between impaired respiratory mechanics, ventilatory drive and sleepdisordered breathing. Early diagnosis and treatment is important, because delay in treatment is associated with significant mortality and morbidity. Available treatment options include noninvasive positive airway pressure (PAP) therapies and weight loss. There is limited long-term data regarding the effectiveness of such therapies. This review outlines the current concepts of clinical presentation, diagnostic and management strategies to help identify and treat patients with obesityhypoventilation syndromes.

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Short-term and Long-term Effects of Nasal Intermittent Positive Pressure Ventilation in Patients With Obesity-Hypoventilation Syndrome

Cited by 247 publications

References 22 publications

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Non-invasive ventilation: established and expanding roles

Obesity Hypoventilation Syndrome

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