To assess whether empiric nocturnal nasal continuous positive airway pressure (CPAP) in non surgical critically ill morbidly obese patients reduces pulmonary complications post extubation.
We conducted a nonconcurrent prospective study of normocapnic morbidly obese patients (BMI≥40 kg/m2) requiring mechanical ventilation for at least 48 hours. Analysis of pulmonary complications post extubation of critically ill morbidly patients assigned to either empiric nocturnal nasal CPAP or to standard medical therapy were performed. Data collected included sociodemographic variables, comorbidity index, presence of obstructive sleep apnea (OSA), APACHE II score, and hospital length of stay.
Out of the 123 non surgical morbidly obese patients who met the inclusion criteria, 53 patients were assigned to nocturnal nasal CPAP and 70 to standard medical therapy. Forty six patients were known to have OSA on admission and 53 were diagnosed after hospital discharge. Twenty seven complications were reported during the course of the study. Sixteen needed rescue noninvasive positive pressure ventilation, 9 required reintubation, and 2 developed cardiopulmonary arrest. The rate of complications was comparable between those assigned to empiric CPAP and those to standard medical therapy (10 and 17 events respectively, p=0.7). The presence and severity of sleep apnea did not correlate with the development of cardiopulmonary complications.
Although treatment of morbidly obese patients with the diagnosis of OSA should resume post extubation, the application of empiric nocturnal nasal CPAP in normocapnic morbidly obese patients may not reduce pulmonary complications post extubation.
Pending a randomized controlled study, the empiric use of nocturnal CPAP in non surgical critically ill morbidly obese patients may not reduce cardiopulmonary complications post extubation.
Ali El Solh, None.