• Respiratory care · Dec 2019

    Acute Respiratory Failure in Obesity-Hypoventilation Syndrome Managed in the ICU.

    • Nader Chebib, Pascale Nesme, Nathalie Freymond, Laurent Argaud, Thomas Rimmelé, Julien Bohé, Gilles Devouassoux, Souquet Pierre-Jean PJ Pneumologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France., and Claude Guérin.
    • Réanimation Médicale Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France. nader.chebib@chu-lyon.fr.
    • Respir Care. 2019 Dec 1; 64 (12): 1545-1554.

    BackgroundObesity-hypoventilation syndrome (OHS) is defined as the combination of obesity (body mass index ≥ 30 kg/m2) and daytime arterial hypercapnia (PaCO2 > 45 mm Hg) in the absence of other causes of hypoventilation, and can lead to acute hypercapnic respiratory failure in the ICU. Our objective was to describe the ventilatory management and outcomes of subjects with OHS who were admitted to the ICU for acute hypercapnic respiratory failure.MethodsWe retrospectively built a cohort of subjects with OHS who were admitted for acute hypercapnic respiratory failure in 4 ICUs of the university teaching hospital in Lyon, France, between 2013 and 2017. The main end point was the rate of success of noninvasive ventilation (NIV). Secondary end points were survival from OHS diagnosis to the last follow-up and risk factors for ICU admission and long-term survival.ResultsOne hundred fifteen subjects with OHS were included. Thirty-seven subjects (32.1%) were admitted to the ICU for acute hypercapnic respiratory failure. Congestive heart failure was the leading cause of acute hypercapnic respiratory failure (54%). At ICU admission, pH before NIV use was median (range) 7.26 (7.22-7.31) and PaCO2 was 70 (61-76) mm Hg. NIV was used as first-line ventilatory support in 36 subjects (97.2%) and was successful in 33 subjects (91.7%). ICU mortality was low (2.7%). The subjects admitted to the ICU were significantly older and had a lower FEV1 and vital capacity at the time of an OHS diagnosis. The difference in the restricted mean survival time was 663 d in favor of subjects not admitted to the ICU. Multivariate analysis showed that lower vital capacity at an OHS diagnosis was significantly associated with a higher risk of ICU admission. No factor was independently associated with long-term overall mortality in multivariate analysis.ConclusionsAcute hypercapnic respiratory failure in subjects with OHS was generally responsive to NIV and was frequently associated with congestive heart failure.Copyright © 2019 by Daedalus Enterprises.

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