C. Rabec et al., MANAGEMENT OF RESPIRATORY-FAILURE IN OBES E PATIENTS - EFFICIENCY OF NASAL BI-LEVEL POSITIVE AIRWAY PRESSURE, Revue des maladies respiratoires, 15(3), 1998, pp. 269-278
Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH) -
a hypoventilation which is independent of apneas and increased by slee
p -, and COPD are mechanisms for respiratory failure in obese patients
. We thought nasal bi-level positive airway pressure to be a suitable
treatment : EPAP is useful to maintain upper airway patency and IPAP-E
PAP difference to correct OLH and COPD hypoventilation. Our purpose is
to report the results of such a therapeutic approach. We included 41
patients that we first treated by nasal bi-level positive airway press
ure for a respiratory failure with an uncompensated respiratory acidos
is. The initial setting was about 4 cmH(2)O for EPAP and 16 for IPAP.
Under supervision of a rent-time printed oximetry tracing, we furtherm
ore increased EPAP until disappearance of repetitive dips in oxygen sa
turation (that we assimilated to obstructive events) and IPAP until ob
taining an acceptable level of steady saturation (we assimilated a low
level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- II y
ears, BMI 42 +/- 9 kg/m(2), pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, Pa
O2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without
need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/
- 6 mmHg. Thus, nasal bi-level positive airway pressure appears to be
nn efficient treatment in these patients.