Management of acute exacerbations of obesity-hypoventilation syndrome (AE/OHS) : Toward an early goal-directed therapy algorithm

Background: After 60 years of its first description in 1955, OHS remains a curiosity. Responsible for a large proportion of chronic respiratory failure, it is commonly diagnosed on the first hypercapnic acute exacerbation. It opposes diagnostic and therapeutic challenges to the clinician. Aim: To identify prognostic factors related to AE/OHS. To design an early goal-directed therapy algorithm for the management of AE/OHS. Methods: A retrospective study over a 13 years period (2002-2014). Were analyzed clinical, therapeutic and outcome characteristics. Univariate and multivariate analyses were performed to identify factors independently associated to ICU mortality. Results: One hundred patients were included. 50% of patients required immediate invasive mechanical ventilation. NIV was only possible in 44%, in whom 31.8% failed within 85.57±156,73hrs. 37% of patients required diuretics and 25% inotropic agents. Overall ICU mortality was 39%. Hypercapnic encephalopathy grade, NIV failure and use of inotropic agents were factors independently associated with mortality. Static and dynamic hypercapnic encephalopathy grade, diuretics and inotropic agents were integrated to design an early goal-directed therapy algorithm. Conclusion: This comprehensive study demonstrated a poor outcome of AE/OHS. This could be improved by the implementation of an early goal-directed therapy algorithm.