Obesity hypoventilation syndrome: a current review

Athayde, Rodolfo Augusto Bacelar de; Filho, José Ricardo Bandeira de Oliveira; Filho, Geraldo P. Rocha; Genta, Pedro Rodrigues

doi:10.1590/s1806-37562017000000332

Cited by 32 publications

(19 citation statements)

References 68 publications

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“…We continuously monitored following parameters during the anesthesia: pulse SpO 2 , End-tidal carbon dioxide partial pressure (P ET CO 2 ), mean blood pressure (MBP), heart rate (HR), electrocardiogram (ECG) and BIS. SpO 2 < 95% and P ET CO 2 < 10 mmHg were considered hypoxic adverse event and hyperventilation, respectively [10]. Two-Diameter Method was used to measure antral cross-sectional area of gastric antrum (CSA-GA) by ultrasound [Vivid, GE MEDICAL SYSTEMS CO.,LTD, China] with patients in the supine position before and after SJOV in the WNJ SJOV group, using the sagittal plane measurement at the xiphoid process level, with the help of the anatomical markers (the superior mesenteric artery,the left liver lobe and abdominal aorta) (Fig.…”

Section: Methodsmentioning

confidence: 99%

Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

et al. 2019

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Background Supraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation. Methods A single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO 2 , P ET CO 2 , BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO 2 less than 95%, P ET CO 2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well. Results A total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of P ET CO 2 < 10 mmHg, SpO 2 < 95% in the WNJ SJOV group dropped from 36 to 9% ( P = 0.009),from 33 to 6% ( P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% ( P = 0.001), and the total percentage of adverse events decreased from 36 to 12% ( P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO 2 < 95% from 27 to 6% ( P = 0.023), P ET CO 2 < 10 mmHg from 33 to 9% ( P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group ( P = 0.234). There were no obvious cases of nasal bleeding in all the three groups. Conclusions SJOV can effectively and safely maintain adequate oxygenati...

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Section: Methodsmentioning

confidence: 99%

Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

et al. 2019

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“…The presence of obesity and daytime hypoventilation (PaCO 2 ³ 45 mmHg) configure another syndrome defined as Obesity Hypoventilation Syndrome (OHS). In more than 90% of cases OHS is linked with OSAHS; however, the presence of OSAHS is not necessary for diagnosis of OHS 24 . Obesity may alter the normal mechanics of the upper airways and thus contribute to the pathophysiology of OS-AHS mainly in two ways: through the lipid backlog in peripharyngeal tissues and the increased respiratory effort related to abdominal weight 13 .…”

Section: The Interactions Between Osahs and Obesitymentioning

confidence: 99%

Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients

Salzano

Maglitto

Bisogno

et al. 2021

Acta Otorhinolaryngol Ital

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Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a disease characterised by upper airway obstruction during sleep, quite frequent in the general population, even if underestimated. Snoring, sleep apnoea and diurnal hypersomnia are common in these patients. Central obesity plays a key role: it reduces the size and changes the conformation of the upper airways, besides preventing lung expansion, with consequent reduction of lung volumes. Furthermore, obese people are also resistant to leptin, which physiologically stimulates ventilation; as a result, this causes scarce awakening during apnoea. OSAHS diagnosis is based on the combination of clinical parameters, such as apnoea/hypopnoea index (AHI), medical history, physical examination and Mallampati score. The first objective reference method to identify OSAHS is polysomnography followed by sleep endoscopy. Therapy provides in the first instance reduction of body weight, followed by continuous positive airway pressure (CPAP), which still remains the treatment of choice in most patients, mandibular advancement devices (MAD) and finally otolaryngology or maxillofacial surgery. Among surgical techniques, central is barbed reposition pharyngoplasty (BRP), used in the field of multilevel surgery.

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“…www.srpskiarhiv.rs some data, targeted anamnesis and/or heteroanamnesis have a high sensitivity of 90-100%, but significantly lower specificity: 50-70% [8]. Obesity per se leads to a greater likelihood of diseases such as systemic arterial hypertension, diabetes, dyslipidemia, and hypothyroidism [4]. Additional questions are directed towards sleep, snoring, daily somnolence, possible cyanosis, and pulmonary and cardiovascular symptoms.…”

Section: Polysomnographymentioning

confidence: 99%

“…respiratory function disorders without alveolar hypoventilation; 2. obesity hypoventilation syndrome (OHS); 3. obstructive sleep apnea syndrome (OSAS); 4. risk during and after surgical interventions [3]. OHS, also historically described as the Pickwickian syndrome (PS), is defined as daytime hypercapnia and hypoxemia (PaCO 2 > 45 mmHg and PaO 2 < 70 mmHg at sea level) in an obese patient (BMI > 30 kg/m 2 ) with sleep-disordered breathing in the absence of any other cause of hypoventilation [4]. OHS is a diagnosis of exclusion.…”

Section: Introductionmentioning

confidence: 99%

Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

Kašćak¹,

Andjelic²

2020

Srp Arh Celok Lek

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Introduction Pickwickian syndrome (PS), also known as hypoventilation syndrome in adults, consists of three factors: obesity [Body Mass Index (BMI) > 30 kg/m 2 ], daytime hypercapnia and sleep-disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. Timely recognition of PS is of utmost importance because such patients have significant morbidity and mortality. However, recent data indicate that PS is under-recognized and under-treated. We report a case of early-identified PS prehospitally with a favorable outcome after hospital treatment. Case outline A 67-year-old female patient was diagnosed prehospitally, and the diagnosis was later confirmed in hospital. Diagnostic criteria were as follows: BMI > 45,7 kg/m 2 (height 170 cm, weight 132 kg), hypercapnia, hypoxemia and respiratory acidosis (pCO 2-41 mmHg, pO 2-56 mmHg, pH 7.45) in the absence of other causes of hypoventilation. During hospitalization, the following diagnostic procedures were performed: standard laboratory analyses, chest radiography, electrocardiography, abdomen and heart echocardiography. An attempted sleep study (polysomnography) was interrupted due to a drop in oxygen saturation levels. Non-invasive mechanical ventilation and a diet were used as the first line of therapy. However, due to the development of a global respiratory insufficiency, the patient was intubated and placed on a mechanical ventilator. After 30 days of hospital treatment, the patient was released in a satisfactory general condition with recommendations for weight reduction and symptomatic therapy. Conclusion As obesity is becoming an epidemic of modern society, early recognition and treatment of PS is of crucial importance.

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Obesity hypoventilation syndrome: a current review

Cited by 32 publications

References 68 publications

Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

Obstructive sleep apnoea/hypopnoea syndrome: relationship with obesity and management in obese patients

Pickwickian syndrome - "the tip of the iceberg" in extremely obese patients

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