Obstructive Lung Diseases |

Outcomes of Noninvasive Ventilation in Obese Patients During an Acute Exacerbation of Asthma FREE TO VIEW

Sundeep Shenoy*, MD; Viral Doshi, MD; Muhammad Rishi, MD; Aarthi Ganesh, MD; Shilpa Lankala, MD; Gargi Shah, MD; Janos Molnar, MD; Mira Iliescu, MD
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Rosalind Franklin University of Medicine and Science, North Chicago, IL

Chest. 2012;142(4_MeetingAbstracts):732A. doi:10.1378/chest.1381897
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SESSION TYPE: Asthma Predictors and Outcomes

PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Asthma with concurrent obesity is an under recognized phenotype with more severe disease. Aim of this study was to evaluate the use of non invasive ventilation (NIV) in obese patients with acute asthma exacerbation.

METHODS: A retrospective chart analysis of patients admitted for asthma exacerbation was done. Failed NIV was defined as a need for endotracheal intubation and ventilation within 24 hours of trial of NIV. A comparison between asthmatics with BMI>30 and those with BMI<30 was done.

RESULTS: A total of 218 patient encounters were evaluated, 127 individuals had BMI<30 and 91 individuals with BMI>30. NIV was attempted on 52/127(40.9%) in the BMI<30 group and 46/91(50.5%) in the BMI>30 group (p=0.160). However, 15/52 (28.8%) failed the NIV in the BMI<30 group versus only 4/46 (8.7%) in the obese group (p=0.012). The 2 groups did not differ in terms of age, sex, race, history of smoking, length of ICU or Hospital Stay, duration of Mechanical Ventilation, history of ICU or hospital admission or history of previous intubations, use of B agonist therapy(short & long acting) and corticosteroid therapy(inhaled & systemic) prior to admission. Recreational drug use (cocaine & heroine) was seen more commonly in individuals with BMI<30 (46.5% versus 28.6%; P=0.008); Asthmatics with BMI<30 had more acidosis (mean pH of 7.31 Vs 7.35; p=0.008). After adjusting for age, sex, recreational drug use, history of smoking, history of intubation, history of hospital and ICU admission due to asthma exacerbation, having a primary care physician, pH <7.35, PCO2 >45 mm hg on the initial blood gas & requirement of an Fio2 >40%, BMI < 30 remained closest to being a predictor (p=0.06) of failure of a trial of NIV in acute asthma exacerbation.

CONCLUSIONS: Obese asthmatics fared better when non-invasive ventilation was used during their acute asthma exacerbation.

CLINICAL IMPLICATIONS: NIV can be more beneficial to obese patients with acute asthma exacerbation.

DISCLOSURE: The following authors have nothing to disclose: Sundeep Shenoy, Viral Doshi, Muhammad Rishi, Aarthi Ganesh, Shilpa Lankala, Gargi Shah, Janos Molnar, Mira Iliescu

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Rosalind Franklin University of Medicine and Science, North Chicago, IL




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