Journal ArticleDOI
Extreme obesity in the intensive care unit: the malignant obesity hypoventilation syndrome.
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TLDR
A retrospective study of patients admitted to the ICU with a BMI of >40 kg/m and a PaCO2 greater than 45 mm Hg in patients admitted with hypercapnic respiratory failure showed that based on the clinical documentation, these patients fit the clinical criteria for OHS, however, only 3 of 61 patients had a confirmed diagnosis of OHS.Abstract:
Extreme obesity is currently a common medical condition. It is defined as having a body mass index (BMI) of >40 kg/m and is associated with an increased risk of mortality. A review of the clinical literature has shown that extreme obese patients are commonly admitted to the intensive care unit (ICU) for obstructive airway disease, pneumonia, and sepsis. A recent study found that patients with a BMI of >40 kg/m required greater mechanical ventilation and, therefore, a corresponding prolonged stay in the ICU. What are the other factors affecting the outcome of extreme obese patients in the ICU? In this issue of the Journal of Intensive Care Medicine, a new obesity-related condition among patients in the ICU with obesity hypoventilation syndrome (OHS) is now being described. The OHS is defined as the triad of obesity, daytime hypoventilation, and sleep-disordered breathing in the absence of an alternative neuromuscular, mechanical, or metabolic explanation for the hypoventilation episodes. Given this definition, a subtype condition has been identified in the extreme obese patients who had hypercapnic respiratory failure and multiorgan system dysfunction related to obesity, labeled as malignant obesity hypoventilation syndrome (MOHS). Marik and Desai coined this new term using a retrospective electronic chart review of 61 patients admitted to the ICU with a BMI of >40 kg/m and a PaCO2 greater than 45 mm Hg in patients admitted with hypercapnic respiratory failure. Supporting the description of MOHS, a statistical analysis of the documentation from this study confirmed the presence of multisystem disorder in extreme obesity by finding that 86% of the patients had congestive heart failure treated with diuretics, 71% had left ventricular failure, 61% had left ventricular diastolic dysfunction, 77% had pulmonary hypertension above 45 mm Hg, 90% had essential hypertension, and 64% had abnormal liver function tests and diagnosed with nonalcoholic steatohepatitis. Moreover, this retrospective study showed that based on the clinical documentation, these patients fit the clinical criteria for OHS, however, only 3 were diagnosed with this condition and the remaining (75%) were diagnosed with and treated for chronic obstructive lung disease (COPD). A primary question that arises after reading the study of Marik and Desai is ‘‘Are patients with extreme obesity admitted to the ICU with a diagnosis of COPD/asthma being misdiagnosed when in fact they could have unrecognized OHS?’’ It is known that patients with extreme obesity statistically have hypercapnic respiratory failure that increases the length of stay in the ICU due to prolonged necessity for mechanical ventilation. It is also well known that hypoventilation and oxygen disturbances are related to obesity even if there is no intrinsic lung disease. Therefore, mechanical ventilation in the extreme obese patient is one of many challenges clinicians face since the increase in the prevalence of obesity, with a corresponding increase in ICU admissions. It is very concerning that only 3 of 61 patients had a confirmed diagnosis of OHS. More interestingly, the management of extreme obese patients with bilevel positive airway pressure (BiPAP) in this study failed in 23% of the patients, thus requiring mechanical ventilation. This was an unexpected finding which highlights again the challenge of managing respiratory failure and the use of mechanical ventilation in extremely obese patients. What would have happened if OHS was part of the medical history of these patients admitted to the ICU? It is well known that extremely obese patients with concomitant untreated obstructive sleep apnea (OSA) presentread more
Citations
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Journal ArticleDOI
Perioperative management of obstructive sleep apnea in bariatric surgery: a consensus guideline
Christel A.L. de Raaff,Marguerite A. W. Gorter-Stam,Nico de Vries,Nico de Vries,Ashish C. Sinha,H. Jaap Bonjer,Frances Chung,Usha K. Coblijn,Albert Dahan,Rick S. van den Helder,Antonius A.J. Hilgevoord,David R. Hillman,Michael Margarson,Samer G. Mattar,Jan Paul Mulier,Madeline J. L. Ravesloot,Beata M.M. Reiber,Anne-Sophie van Rijswijk,Preet Mohinder Singh,Roos Steenhuis,Mark Tenhagen,Olivier M. Vanderveken,Johan Verbraecken,David P. White,Nicole van der Wielen,Bart A. van Wagensveld +25 more
TL;DR: This first international expert meeting provided 58 statements and recommendations for a clinical consensus guideline regarding the perioperative management of OSA patients undergoing MBS.
The obesity supine sudden death syndrome in the perioperative patient
TL;DR: Perioperative clinicians require an awareness of this condition to avoid this potential fatal outcome and a careful review of the perioperative events and a literature review is attributed to the obesity supine death syndrome.
Management of the Complications of Obese Patients in Critical Care: Evidence-Based Nursing
TL;DR: The results showed that the comprehensive management of complications for obese patients in critical care included assessment and physical examination, respiratory system and ventilator care, reproductive system and urinary system care, gastro-intestinal system Care, drug administration, skin care and a transfer system.
Journal ArticleDOI
Case report: fast reversal of malignant obesity hypoventilation syndrome after noninvasive ventilation and pulmonary rehabilitation
TL;DR: In this article, a 53-year-old man was diagnosed with malignant obesity hypoventilation syndrome (MOHS) evidenced by extreme obesity and multiorgan abnormalities, and after taken noninvasive ventilation (NIV) treatment, he was rescued.
Book ChapterDOI
The Superobese Patient
TL;DR: In bariatric medicine, which essentially deals with patients in the WHO class 2 and 3 categories, it is useful to further divide morbid obesity into more classes to help select patients for various bariatric procedures, for specific surgical approaches, for preoperative patient preparation and/or weight loss, etc.
References
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TL;DR: Effective weight loss was achieved in morbidly obese patients after undergoing bariatric surgery, and a substantial majority of patients with diabetes, hyperlipidemia, hypertension, and obstructive sleep apnea experienced complete resolution or improvement.
Journal ArticleDOI
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Journal ArticleDOI
Morbid Obesity in the Medical ICU
TL;DR: It is concluded that critically ill morbidly obese patients are at increased risk of morbidity and mortality compared to the nonobese patients.
Journal Article
Obesity Hypoventilation Syndrome: A State-of-the-Art Review
TL;DR: This review will include disease definition and epidemiology, clinical characteristics of the syndrome, pathophysiology, and morbidity and mortality associated with it, and treatment modalities will be discussed in detail.
Journal ArticleDOI
Obesity hypoventilation syndrome: Hypoxemia during continuous positive airway pressure
TL;DR: In this paper, the effect of 1 night of continuous positive airway pressure (CPAP) on sleep architecture, AHI, arousal indexes, and nocturnal oxygenation was assessed.