EPIDEMIOLOGIE ACTUELLE DE LA COQUELUCHE (EXPERIENCE DE L'HOPITAL PEDIATRIQUE SAINT-ANTOINE A LILLE DE JANVIER 1999 A DECEMBRE 2000)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Determinants of noninvasive ventilation success or failure in morbidly obese patients in acute respiratory failure.

PurposeAcute respiratory failure (ARF) is a common life-threatening complication in morbidly obese patients with obesity hypoventilation syndrome (OHS). We aimed to identify the determinants of noninvasive ventilation (NIV) success or failure for this indication.MethodsWe prospectively included 76 consecutive patients with BMI>40 kg/m2 diagnosed with OHS and treated by NIV for ARF in a 15-bed ICU of a tertiary hospital.ResultsNIV failed to reverse ARF in only 13 patients. Factors associated with NIV failure included pneumonia (n = 12/13, 92% vs n = 9/63, 14%; pConclusionsMultiple organ failure and pneumonia were the main factors associated with NIV failure and death in morbidly obese patients in hypoxemic ARF. On the opposite, NIV was constantly successful and could be safely pushed further in case of severe hypercapnic acute respiratory decompensation of OHS

Patients characteristics at admission.

<p>Abbreviations: BMI, body mass index; NIV, non-invasive ventilation; ARF, acute respiratory failure; MRC, Medical Research Council dyspnea score; OSAS, obstructive sleep apnea syndrome; DNI status, do-not-intubate status; SAPS 2, simplified acute physiologic score 2; SOFA score, sequential organ failure assessment score; SABP, systolic arterial blood pressure.</p

Arterial blood gases at the time of noninvasive ventilation (NIV) initiation (H0), after 2 hrs of NIV (H2), and at the time of NIV failure (failure) in patients of the early NIV failure group (n = 13, left column).

<p>By comparison, arterial blood gases evolution during the first 48(n = 30, central column) and in patients with a delayed response to NIV (n = 33, right column).</p

Flow chart showing patients' outcome according to early (within the first 48 hrs) or late (after the 48^th hr) NIV success or failure.

<p>NIV  =  noninvasive ventilation; ARF  =  acute respiratory failure; OHS  =  obesity hypoventilation syndrome; DNI  =  do-not-intubate.</p