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PLoS One. 2014 May 12;9(5):e97563. doi: 10.1371/journal.pone.0097563. eCollection 2014.

Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.

Author information

1
Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France.
2
Department of Biostatistics, Lille University Hospital, CHRU Lille, France.
3
Respiratory Step Down Unit, Schaffner Hospital, Lens, France.

Abstract

PURPOSE:

Acute respiratory failure (ARF) is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS). We aimed to identify the determinants of noninvasive ventilation (NIV) success or failure for this indication.

METHODS:

We prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital.

RESULTS:

NIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n = 12/13, 92% vs n = 9/63, 14%; p<0.0001), high SOFA (10 vs 5; p<0.0001) and SAPS2 score (63 vs 39; p<0.0001) at admission. These patients often experienced poor outcome despite early resort to endotracheal intubation (in-hospital mortality, 92.3% vs 17.5%; p<0.001). The only factor significantly associated with successful response to NIV was idiopathic decompensation of OHS (n = 30, 48% vs n = 0, 0%; p = 0.001). In the NIV success group (n = 63), 33 patients (53%) experienced a delayed response to NIV (with persistent hypercapnic acidosis during the first 6 hours).

CONCLUSIONS:

Multiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS.

PMID:
24819141
PMCID:
PMC4018299
DOI:
10.1371/journal.pone.0097563
[Indexed for MEDLINE]
Free PMC Article

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