Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome

Corral, Jaime; Mogollón, María V.; Sánchez-Quiroga, M-Ángeles; Terreros, Javier Gómez de; Romero, Odile; Caballero, Candela; Terán-Santos, Joaquín; Alonso-Álvarez, María Luz; Gómez-García, Teresa; González, Mónica; López-Martínez, Soledad; Lucas, Pilar de; Marı́n, José Marı́a; Romero, Odile; Díaz-Cambriles, Trinidad; Chiner, Eusebi; Egea, Carlos; Lang, Roberto M.; Mokhlesi, Babak; Masa, Juan F.

doi:10.1136/thoraxjnl-2017-210642

Cited by 63 publications

(41 citation statements)

References 45 publications

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“…A predefined sub‐analysis of the same study population has indicated that NIV may have beneficial effects on pulmonary hypertension and right ventricular remodelling when compared to CPAP therapy …”

Section: Management Of Obesity‐related Respiratory Failurementioning

confidence: 99%

“…A predefined sub-analysis of the same study population has indicated that NIV may have beneficial effects on pulmonary hypertension and right ventricular remodelling when compared to CPAP therapy. 52 These surrogate markers are important as, in interventional studies, the improvement in clinical parameters such as health-related quality of life are well correlated with change in PaCO 2 . 34 This is important to appreciate as large studies have not been conducted that would be adequately powered to appropriately assess such outcomes.…”

Section: Ohs With Significant Osamentioning

confidence: 99%

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Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

2019

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Obesity‐related respiratory failure is increasingly common but remains under‐diagnosed and under‐treated. There are several clinical phenotypes reported, including severe obstructive sleep apnoea (OSA), isolated nocturnal hypoventilation with or without severe OSA and OSA complicating chronic obstructive pulmonary disease (COPD). The presence of hypercapnic respiratory failure is associated with poor clinical outcomes in each of these groups. While weight loss is a core aim of management, this is often unachievable, and treatment of sleep‐disordered breathing with positive airway pressure (PAP) therapy is the mainstay of clinical practice. Although there are few long‐term clinical efficacy trials, the lack of equipoise would prevent the utilization of an untreated control group. The current data support the use of PAP therapy to improve respiratory failure and is associated with improvements in health‐related quality of life, reduced healthcare utilization and reduced mortality. Both continuous PAP (CPAP) and non‐invasive ventilation (NIV) appear safe and effective in patients with obesity‐related respiratory failure and OSA, with or without COPD, and the current evidence would not support a single therapy choice in all patients. There are no studies of CPAP in patients with isolated nocturnal hypoventilation, and NIV would be the current recommendation in this patient group. Whichever starting therapy is used, titration should be performed to correct sleep‐disordered breathing and reverse chronic respiratory failure, with consideration of step‐down of the treatment based on a clinical re‐evaluation. In contrast, failure to reach physiological and clinical treatment targets should lead to the consideration of treatment escalation.

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Section: Management Of Obesity‐related Respiratory Failurementioning

confidence: 99%

Section: Ohs With Significant Osamentioning

confidence: 99%

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

2019

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“…In the study by Corral et al [29], the effect of NIV therapy on cardiac dysfunction was assessed by echocardiography in patients with obesity hypoventilation syndrome (OHS). It was seen than mid-term NIV therapy was more effective regarding pulmonary hypertension, left ventricular hypertrophy and functional results when compared to CPAP and lifestyle changes.…”

Section: Pneumonia and Nivmentioning

confidence: 99%

“…In recent years, it has been suggested that sonography can visualize the patency of the upper respiratory tract. Endoscopy was used for this purpose but the ideal method hasn't been established [29].…”

Section: Pneumonia and Nivmentioning

confidence: 99%

Radiology Findings and Non-Invasive Ventilation Response

Işıklar¹,

Serin

Esquinas

2018

Advances in Respiratory Medicine

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Although NIV is a simple and useful method, considerable variation in its use across countries, regions and hospitals may be noted. The patient should be evaluated according to subjective response (respiratory distress, consciousness, problems related to mask and airflow), physiological responses (respiration rate, respiratory effort, air leakage) and patient-ventilator compliance (gas exchange, pulse oximetry, arterial blood gases). Normalization in respiration rate within 1 or 2 hours after initiation of treatment is one of the most important markers for recovery. The goal is to maintain respiration rate between 20 and 30 breaths/ minute. Reduction in intercostal and supraclavicular retractions, paradoxical respiration and sympathetic activity indicate success of treatment. Arterial blood gases are measured within first 2 hours in order to assess pH and CO 2 ; and as needed thereafter. In general, NIV is assessed by arterial blood gases, hemodynamic parameters and several laboratory tests. There is limited number of studies in NIV. Here, we aimed to assess radiological implications of gas distribution within lung tissue during NIV therapy.

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“…However, HMV is commonly initiated within the course of emergency hospitalisations due to acute on chronic respiratory failure in OHS, and patients may be difficult to wean from invasive mechanical ventilation. Although both CPAP and NIV have been shown to correct respiratory failure [9-11], NIV is superior to CPAP in improving exercise capacity and pulmonary hypertension [12]. The degree of sleep hypoventilation and apnoeas or hypopnoeas contributing to hypercapnia differs across the spectrum of OHS/OSAS, and the dominating underlying sleep-disordered breathing may guide the choice of initial positive pressure ventilation.…”

Section: Patient Selectionmentioning

confidence: 99%

Frontiers in Clinical Practice of Long-Term Care of Chronic Ventilatory Failure

Schwarz

Bloch

2019

Respiration

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Home mechanical ventilation (HMV) is an effective long-term treatment for chronic hypercapnic respiratory failure. In addition to the established practice of providing HMV for the treatment of chronic ventilatory failure in slowly progressive neuromuscular and chest wall disease, there is accumulating evidence for improvement of quality of life and prolongation of survival by HMV in highly prevalent diseases like chronic obstructive pulmonary disease and ever-increasing obesity hypoventilation syndrome as well as rapidly progressive neuromuscular disease. The key concepts for successful HMV are an experienced team selecting the right patients, timely initiation of adequate ventilation via an appropriate interface, and monitoring effectiveness during regular long-term follow-up. Coaching of patients with chronic respiratory failure on long-term HMV within a dedicated service and collaborations with community services for home care are essential. The current review describes various important practical aspects of HMV that remain frontiers in the implementation of the current knowledge in clinical practice and may help in providing effective HMV to all those in need.

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Echocardiographic changes with non-invasive ventilation and CPAP in obesity hypoventilation syndrome

Abstract: Pre-results, NCT01405976 (https://clinicaltrials.gov/).

Cited by 63 publications

References 45 publications

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Non‐invasive ventilation for obese patients with chronic respiratory failure: Are two pressures always better than one?

Radiology Findings and Non-Invasive Ventilation Response

Frontiers in Clinical Practice of Long-Term Care of Chronic Ventilatory Failure

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