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Obesity/Hypoventilation Syndrome (Etiology (BMI > 30 kg/m2, Chronic…
Obesity/Hypoventilation Syndrome
Etiology
BMI > 30 kg/m2
Chronic hypoventilation leading to daytime hypercapnia and hypoxemia (PaCO2 > 45 mmHg and PaO2 < 70 mmHg
Sleep disordered breathing due to OSA
Pathophysiology
Fatty tissue restricts
Chest wall movement
reduces lung volumes
Decreases thoracic and lung compliance
Increases work of breathing
Clinical signs and symptoms
BMI > 30 Kg/m2 based off of height and weight
Blunted ventilatory response to hypercapnia
Diagnostics
ABG to document hypercapnia and hypoxemia breathing room air
History of fatigue, exertional dyspnea, findings consistent with OSA
Spirometries and lung volumes to diagnose lung restriction
Decreased TLC, IC, FRC, and FVC but normal FEV1/FVC
Differential diagnostics
CBC to determine presence of polycythemia
Thyroid screen to determine hypothyroidism
Respiratory Management
If pH is < 7.25 and obtunded with signs of hemodynamic instability consider intubation and mechanical ventilation
If pH > 7.25 and stable consider NPPV
Symptomatic patients consider CPAP