Treatment of Obesity Hypoventilation Syndrome in Obesity (BMI ≥30 kg/m²) with Acute-on-Chronic Hypercapnic Respiratory Failure
This protocol addresses the urgent management of Obesity Hypoventilation Syndrome in patients with obesity (body mass index ≥30 kg/m²) who present with acute decompensated, acute-on-chronic hypercapnic respiratory failure — a high-acuity clinical scenario requiring timely, structured intervention.
Clinical Scenario
Patients with obesity (BMI ≥30 kg/m²) presenting with acute-on-chronic hypercapnic respiratory failure (acute decompensated obesity-related respiratory failure) require access to appropriate ventilatory support within one hour of emergency presentation. Specifically trained operators are required to manage interface selection, fitting, and setting titration.
Approach (Partial Overview)
Following assessment of suitability, noninvasive ventilation (NIV) with progressively titrated pressure settings is the cornerstone of treatment, applied alongside supplemental oxygen and aggressive concurrent management of the underlying precipitating cause. The complete titration strategy, sequencing, and weaning plan are available in the full protocol.
Treatment Goals — Within 24 Hours
Resolution of respiratory acidosis with arterial blood pH >7.3 · Arterial oxygen saturation >88% (arterial oxygen tension >8 kPa) · Correction of hypercapnia.
References
DOI: 10.1183/16000617.0097-2018
- Acute-on-chronic hypercapnic respiratory failure is habitually treated with NIV.
- Access to NIV should be available within 1 h of presentation to the emergency department for patients with acutely decompensated obesity-related hypercapnic respiratory failure with NIV delivered by specifically trained operators skilled in its application, including interface selection and fitting, along with a strategy to titrate ventilator settings in order to achieve adequate tidal volumes using supplementary oxygen as required.
- The underlying cause of the decompensation should be aggressively managed concurrently with supportive therapy for respiratory failure.
- Add oxygen to aim for SaO2 >88% (PaO2 >8 kPa) ensuring adequate correction of hypoventilation.
- Aim for pH >7.3.
- NIV should be applied as much as tolerated during the first 24 h of admission and once the respiratory acidosis has resolved, weaned during the daytime can commence with continued nocturnal NIV.