Characteristics of Obese Patients with Acute Hypercapnia Respiratory Failure Admitted in the Department of Pneumology: An Observational Study of a North African Population.

Sameh Msaad,Wajdi Ketata,Samy Kammoun,Rahma Gargouri,Amine Bahloul,Amina Kotti,Nesrine Kallel,Jihene Jdidi,Yassine Jmel,Nadia Moussa,Amel Saidane,Siraj Omar Wali

doi:10.1155/2022/5398460

Abstract

Background Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). Objectives To study the clinical pattern, noninvasive ventilatory support, as well as the short- and long-term outcomes of patients with OHS admitted in a ward because of AHRF. Methods We conducted a retrospective cohort study including all adults with OHS aged ≥ 18 − year − old, admitted in a 90-bed-ward for AHRF. Results A total of 44 patients were included. Fifteen (34.1%) and 29 (65.9%) patients were diagnosed with malignant OHS (mOHS) and nonmalignant OHS (non-mOHS), respectively, while 36 (81.8%) had coexisting obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with mOHS had a significantly higher rate of heart failure (100% vs. 31%; p < 0.001), chronic renal insufficiency (CRI) (73.3% vs. 41.4%; p = 0.04), and dyslipidemia (66.7% vs. 34.5%; p = 0.04) than those with non-mOHS. The mean forced vital capacity (FVC) in our patients was of 59.5% ± 18.5 of the predicted value, lower than what is usually reported in stable patients with OHS. At hospital admission, more than two-thirds (n = 34, 77.3%) were misdiagnosed as having asthma exacerbation (n = 4, 4.9.1%), chronic obstructive pulmonary disease (COPD) exacerbation (n = 12, 27.3%) and/or heart failure (n = 29, 65.9%). Acute pulmonary oedema (ACPE) (n = 16, 36.4%) and acute viral bronchitis (n = 12, 27.3%) were the main identified causal factors, while no cause could be determined in 5 (11.4%) patients. Noninvasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BIPAP) was very highly effective to treat AHRF, with only 2.27% of patients failing the modality. Median overall duration of ventilation was 9 hours per day (1.3–20) and was significantly longer in patients with mOHS than in those with non-mOHS (10 [6–18] vs. 8 [1.3–20], respectively; p = 0.01). Forty two of the forty-three patients discharged alive were treated with BIPAP or continuous positive airway pressure (CPAP) in 26 and 16 patients, respectively. The probability of survival was 90% at 12 months, while the probability of readmission for a new episode of AHRF was 56% at 6 months and 22% at 12 months, respectively. Conclusion AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS.

Highlights

Over the recent decades, the prevalence of obesity in North African countries has greatly increased due to the rapid epidemiological transition and dietary behaviour changes [1]
We found that obesity hypoventilation syndrome (OHS) was still a frequently unrecognized cause of Acute hypercapnic respiratory failure (AHRF), that Acute pulmonary oedema (ACPE) and viral bronchitis were the two main precipitating factors of AHRF in patients with OHS, and that bilevel positive airway pressure (BIPAP) was a highly safe and effective management option of AHRF in patients with OHS
Nm-OHS: nonmalignant obesity hypoventilation syndrome; M-OHS: malignant OHS; p: p value; M: male; F: female; LTOT: long-term oxygen therapy; CPAP: continuous positive airway pressure; BIPAP: bilevel positive airway pressure; ICU: intensive care unit; FEV1: forced expiratory volume first second; FVC: forced vital capacity; Pred: predicted; LVEF: left ventricular ejection fraction; LV: left ventricular; sPAP: systolic pulmonary artery pressure; AHI: apnea hypopnea index; TST90%: total sleep time with nSpO2 was less than 90%; AHRF: acute hypercapnic respiratory failure; APE: acute pulmonary oedema; IPAP: inspiratory positive airway pressure; EPAP: expiratory positive airway pressure. ∗: mean. ∗∗: median

Summary

Introduction

The prevalence of obesity in North African countries has greatly increased due to the rapid epidemiological transition and dietary behaviour changes [1]. Tunisia is one of these countries, and today features a high prevalence of obesity that has almost tripled over the last three decades, according to the latest statistics of the World Health Organization (WHO) It has increased from 8.7% in 1980 (Statistiques [2]) to 28% in 2010 among adults > 30 years, which means that over three million Tunisian adults are obese [3]. As observed in the majority of countries in the region, obesity is more common in women than men, with close to one third of Tunisian women reported to be obese [4] With this increasing obesity rate, the Tunisian population has experienced a major rise in the prevalence of many obesity-related diseases, in particular, type 2 diabetes, cardiovascular diseases, and the metabolic syndrome which today affect nearly a third of Tunisian adults [5]. Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS

Methods

Results

Discussion

Conclusion