RT Book, Section
A1 Fitzpatrick, Meghan E.
A1 Prendergast, Niall T.
A1 Rivera-Lebron, Belinda
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1186013283
T1 Obesity-Hypoventilation Syndrome (Pickwickian Syndrome)
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1186013283
RD 2024/04/16
AB In  obesity-hypoventilation  syndrome,  awake  alveolar  hypoventilation  appears  to  result  from  a  combination  of  blunted  ventilatory  drive  and  increased  mechanical  load  imposed  upon  the  chest  by  obesity.  Voluntary  hyperventilation  returns  the  PCO2  and  the  PO2  toward  normal  values,  a  correction  not  seen  in  lung  diseases  causing  chronic  respiratory  failure,  such  as  COPD.  Diagnostic  criteria  include  a  body  mass  index  greater  than  30,  an  arterial  partial  pressure  of  carbon  dioxide  greater  than  45  mm  Hg,  and  exclusion  of  other  causes  of  alveolar  hypoventilation.  Most  patients  with  obesity-hypoventilation  syndrome  also  suffer  from  obstructive  sleep  apnea,  which  must  be  treated  aggressively  if  identified  as  a  comorbid  disorder.  Therapy  of  obesity-hypoventilation  syndrome  consists  mainly  of  weight  loss,  which  improves  hypercapnia  and  hypoxemia  as  well  as  the  ventilatory  responses  to  hypoxia  and  hypercapnia.  Avoidance  of  sedative-hypnotics,  opioids,  and  alcohol  is  also  recommended.  NIPPV  is  helpful  in  many  patients.  Patients  with  obesity-hypoventilation  syndrome  have  a  higher  risk  of  complications  in  the  perioperative  period,  including  respiratory  failure,  intubation,  and  cardiac  failure.  Recognition  of  these  patients  in  the  perioperative  period  is  an  important  safety  measure.