Source: Annual Congress 2002 - Treatment and outcome of acute respiratory failure in chronic disease
Disease area: Respiratory critical care, Sleep and breathing disorders

Abstract

Objectives: To evaluate the relevance of NPSG in severely overweight patients after ICU stay for ARF. Design: prospective study. Setting: medical and chirurgical ICU of a general hospital. Patients: 23 consecutive severely overweight patients (BMI > 31,1 for men, 32,3 for women). Measurements: ICU parameters were collected. Baseline pulmonary function parameters and polysomnography in sleep laboratory was performed. Results: 23 patients were included, age 62,0 ±] 10,2 years, sex M/W 14/9, BMI 38,5 ±] 6,4. PaO2/FIO2 on admission was 181,6 ±] 69,3, pH 7,24 ±] 0,08, pCO2 79,6 ±] 31,9, SAPS II score 39,2 ±] 13,7. Causes of ARF was acute exacerbation of COPD (8 cases), pulmonary edema (4 cases), pneumonia (3 cases), iatrogenic (2 cases), OHS (6 cases). Urgent application of endotracheal intubation was needed in 8 patients (34%), NPPV was performed on inclusion in 13 cases (56%), 2 patients were not ventilated. Success of NPPV was 4/13 (30%). ICU length of stay was 12,9d ±] 10,3, ICU mortality 4/23 (17%). 2 more patients died after leaving ICU. For the 17 remaining patients on baseline conditions: Epworth score was 8,11 ±] 3,21 IAH was 25,94 ±] 26,77. 7 had OSAS (IAH > 10/h), 4 COPD (FEV/FVC < 70%), 2 Overlap syndrome, 2 OHS, and 2 restrictive patterns only (TLC < 80%).
Conclusion: NPSG should be performed in severely overweight patients admitted in ICU for ARF after ICU stay.
Abbreviations: ARF=acute respiratory failure, BMI=body mass index, IAH=apnea-hypopnea index, NPPV=noninvasive ventilation, NPSG=nocturnal polysomnography OHS=obesity-hypoventilation syndrome, OSAS=obstructive sleep apnea syndrome.

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Citations should be made in the following way:
L. du Couëdic, S. Loutski, S. Dehette, Y. Domart, F. Martin (Compiegne, Dreux, France). ARF in severely overweight patients admitted in the ICU: relevance of polysomnography. Eur Respir J 2002; 20: Suppl. 38, 602

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