Noninvasive ventilation influenced the survival of extreme super-super obese with obesity hypoventilation syndrome

• Main Authors: Mohammed Nasser Alwadai, Awad Alqahtani, Omprakash Palanivel
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Respiratory Care
• Subjects: expiratory positive airway pressure; inspiratory positive airway pressure; noninvasive ventilation; obesity hypoventilation syndrome; obstructive sleep apnea
• Online Access: http://www.ijrconline.org/article.asp?issn=2277-9019;year=2020;volume=9;issue=1;spage=116;epage=119;aulast=Alwadai
• ISSN: 2277-9019; 2321-4899

Recent studies conclude noninvasive ventilation (NIV) as a standard first-line therapy for any respiratory failure. The efficacy of NIV in obesity is well defined. In this context, the effectiveness of NIV in extreme super-super obese patients with obesity hypoventilation syndrome is not well studied, and the usage of NIV is controversial because of rare incidence. However, identifying the right patient, right timing, right clinical expertise, correct positions, and right appropriate NIV settings can produce positive results. Therefore, we present a unique case of a 32-year-old male weighing 283 kg, with body mass index >92 kg/m2 and carbon dioxide retention, whose symptoms were worsening despite adequate conventional treatment. He received continuous NIV for 70 h using a standard protocol with close monitoring. There was improvement in the patient vitals and medical condition with significant reduction in arterial carbon dioxide tension, leading to reduction in the length of intensive care unit stay and prevention of further complications. Long-term research is encouraged to validate NIV effectiveness in this group of patients.