The emergent malignant obesity hypoventilation syndrome: A new critical care syndrome

摘要

We thank Drs Esquinas and BaHamman for their thoughtful letter. The purpose of our article was 2-fold. First, to describe the features of the malignant obesity hypo ventilation syndrome (MOHS), emphasizing that this is a multisystem disease. Our second objective was to highlight that this disorder is underappreciated and frequently misdiagnosed. Obesity hypo-ventilation syndrome (OHS) was classically described as Pickwickian syndrome in a case report by Burwell, in 1956.1 This patient resembled a character depicted by Dickens in his story, The Posthumous Papers of the Pickwick Club, because both were obese with excessive hypersomnolence. Obesity hypoventilation syndrome is currently defined as the presence of awake hypercapnia (PaCO2 > 45 mm Hg) in the obese patient (body mass index [BMI] > 30 kg/m2) after other causes that could account for awake hypoventilation, such as lung or neuromuscular disease, have been excluded (normal PaCO2 is 35-45 mmHg).2 While sleep-related breathing disorders are common in patients with OHS, this is not a defining feature. Obesity hypoventilation syndrome is distinguished from the overlap syndrome which is the term used to describe the association of chronic obstructive pulmonary disease (COPD) and OSA.3 Defined criteria to quantify the severity of OHS do not exist in the literature. Cabrera-Lacalzada and Diaz-Lobato have proposed grading patients with OHS as mild, moderate, or severe based on 5 factors, namely, PaCO2, PaO2, BMI, apnea-hypopnea index, and complications/comorbidities.4