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Observational Study
. 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

Malcolm Lemyze  1 , Pauline Taufour  1 , Alain Duhamel  2 , Johanna Temime  1 , Olivier Nigeon  3 , Nicolas Vangrunderbeeck  3 , Stéphanie Barrailler  1 , Gaëlle Gasan  1 , Florent Pepy  1 , Didier Thevenin  1 , Jihad Mallat  1
Affiliations
Observational Study

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

Malcolm Lemyze et al. PLoS One. .

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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart showing patients' outcome according to early (within the first 48 hrs) or late (after the 48th hr) NIV success or failure.
NIV  =  noninvasive ventilation; ARF  =  acute respiratory failure; OHS  =  obesity hypoventilation syndrome; DNI  =  do-not-intubate.
Figure 2
Figure 2. Arterial blood gases at the time of noninvasive ventilation (NIV) initiation (H0), after 2 hrs of NIV (H2), and at the time of NIV failure (failure) in patients of the early NIV failure group (n = 13, left column).
By comparison, arterial blood gases evolution during the first 48(n = 30, central column) and in patients with a delayed response to NIV (n = 33, right column).
See this image and copyright information in PMC

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