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

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

<h4>Purpose</h4>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.<h4>Method...

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Autores principales: Malcolm Lemyze, Pauline Taufour, Alain Duhamel, Johanna Temime, Olivier Nigeon, Nicolas Vangrunderbeeck, Stéphanie Barrailler, Gaëlle Gasan, Florent Pepy, Didier Thevenin, Jihad Mallat
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Publicado: Public Library of Science (PLoS) 2014
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spelling oai:doaj.org-article:1837f239ad484540a6ed5a9531d4e84f2021-11-18T08:19:47ZDeterminants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.1932-620310.1371/journal.pone.0097563https://doaj.org/article/1837f239ad484540a6ed5a9531d4e84f2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24819141/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.Malcolm LemyzePauline TaufourAlain DuhamelJohanna TemimeOlivier NigeonNicolas VangrunderbeeckStéphanie BarraillerGaëlle GasanFlorent PepyDidier TheveninJihad MallatPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 5, p e97563 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Malcolm Lemyze
Pauline Taufour
Alain Duhamel
Johanna Temime
Olivier Nigeon
Nicolas Vangrunderbeeck
Stéphanie Barrailler
Gaëlle Gasan
Florent Pepy
Didier Thevenin
Jihad Mallat
Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
description <h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
format article
author Malcolm Lemyze
Pauline Taufour
Alain Duhamel
Johanna Temime
Olivier Nigeon
Nicolas Vangrunderbeeck
Stéphanie Barrailler
Gaëlle Gasan
Florent Pepy
Didier Thevenin
Jihad Mallat
author_facet Malcolm Lemyze
Pauline Taufour
Alain Duhamel
Johanna Temime
Olivier Nigeon
Nicolas Vangrunderbeeck
Stéphanie Barrailler
Gaëlle Gasan
Florent Pepy
Didier Thevenin
Jihad Mallat
author_sort Malcolm Lemyze
title Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
title_short Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
title_full Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
title_fullStr Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
title_full_unstemmed Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
title_sort determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/1837f239ad484540a6ed5a9531d4e84f
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