Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study

Abstract

BACKGROUND Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.

Figure 1.

Chest computed tomography (A) and chest X-ray (B) upon admission. (A) Chest computed tomography demonstrating enhanced pulmonary vascular markings (asterisk) and infiltration shadows (triangle arrow) in the bilateral lung fields. (B) Chest X-ray taken immediately after endotracheal intubation, showing cardiomegaly (triangle arrow) and bilateral infiltrates (arrow).

Figure 2.

Patient’s photos on ICU admission and on the18^th day. (A) Patient with a body weight of at least 250 kg on ICU admission. (B) Encouraging the patient to get out of bed 3 days after extubation. ICU – Intensive Care Unit.

Figure 3.

Patient’s clinical course. (A) Ventilator settings. (B) Trajectories of daily net fluid balance and patient’s body weight. PIP – peak inspiratory pressure; PEEP – positive end-expiratory pressure; ICU – Intensive Care Unit.