Noninvasive positive pressure therapy of the obesity hypoventilation syndrome
- Thomas J Martin, MD
Thomas J Martin, MD
- Associate Professor of Medicine
- Virginia Tech-Carilion School of Medicine
- Assistant Professor of Medicine
- Edward Via Virginia College of Osteopathic Medicine
- Associate Professor of Clinical Medicine
- University of Virginia School of Medicine
Obesity hypoventilation syndrome (OHS) is diagnosed in obese (body mass index [BMI] >30 kg/m2) patients when awake alveolar hypoventilation (PaCO2 >45 mmHg) cannot be attributed to pulmonary parenchymal disease, skeletal restriction, neuromuscular weakness, or pleural pathology . Most patients with OHS present with the signs or symptoms of chronic hypoventilation, although some may develop acute cardiopulmonary compromise that can be fatal if untreated. Application of positive airway pressure is the mainstay of therapy, regardless of the presentation or the presence or absence of sleep disordered breathing (eg, obstructive sleep apnea).
In this topic review, positive pressure therapy for patients with OHS is discussed. The pathogenesis, clinical manifestations, diagnosis, and treatment of OHS are discussed separately. (See "Clinical manifestations and diagnosis of obesity hypoventilation syndrome" and "Treatment and prognosis of the obesity hypoventilation syndrome" and "Epidemiology and pathogenesis of obesity hypoventilation syndrome".)
MODES OF NONINVASIVE POSITIVE PRESSURE THERAPY
There are two major categories of noninvasive positive pressure therapy that are used to treat patients with obesity hypoventilation syndrome (OHS):
●Continuous positive airway pressure (CPAP)
●Noninvasive positive pressure ventilation (NPPV)
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- MODES OF NONINVASIVE POSITIVE PRESSURE THERAPY
- Continuous positive airway pressure
- Noninvasive positive pressure ventilation
- - Bilevel positive airway pressure
- - Volume cycled ventilation
- - Hybrid modes
- INITIATING NONINVASIVE POSITIVE PRESSURE THERAPY
- Acute decompensated OHS
- Chronic compensated OHS
- - Follow-up
- - Supplemental oxygen
- SUMMARY AND RECOMMENDATIONS