Obstructive Lung Diseases: Airways 5 |

Body Mass Index Predicts IPAP and EPAP Levels but not Duration of Non-Invasive Positive Pressure Ventilation in Patients With Hypercarbic Respiratory Failure FREE TO VIEW

Anastasiia Rudkovskaia, MD; Wassim Fares; Jeff Kwon, MD
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Bridgeport Hospital/Yale New Haven Health, Trumbull, CT

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):880A. doi:10.1016/j.chest.2016.08.980
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: It is well known that obesity adversely affects pulmonary mechanics with associated decrease of functional residual capacity, expiratory reserve volume and muscle strength. However, there are no available studies on the effects of obesity on non-invasive mechanical ventilation (NIMV) pressures.

METHODS: Adults admitted with hypercarbic respiratory failure (HRF) with PaCO2 >45 mmHg due to COPD exacerbation who required treatment with NIMV were identified by electronic medical record review. Patient with DNI/DNR orders and who required intubation were excluded from the study. NIMV success was defined as resolution of dyspnea, acute hypercarbia, increased work of breathing within 5 days from the start of NIMV with subsequent transfer outside of the medical ICU or step down unit. The association of BMI with IPAP and EPAP on the day of NIMV discontinuation were assessed using Pearson’s correlation and linear regression models. Multivariate models were separately adjusted for age and gender because of the small sample size.

RESULTS: Of the 26 subjects included into the study, majority (77%) were females. The mean age was 69±12 years. Ethnicity distribution is as follows: Caucasian 65%, Hispanics 19%, & African Americans 11%. The median BMI was 26.175 [20.57, 34.1] kg/m2 with 50% obese, out of which 8% were morbidly obese. All of the patients were treated with bronchodilators. Forty-six % of the patients had concurrent congestive heart failure exacerbation and received furosemide for diuresis; 80% of the patients received steroids and antibiotics. EPAP ranged from 5 to 8 cm H2O. IPAP ranged from 8 to 20 cm H2O. BMI correlated with both IPAP (r = 0.4826, p=0.013) and EPAP (r = 0.7486, p<0.001). There was no correlation with BMI and the length of NIMV (r=0.1941, p=0.342). On multivariate linear regression analysis adjusted for both age and gender, the association between BMI and IPAP remained significant (p<0.01), but only marginally significant with EPAP (p=0.05).

CONCLUSIONS: Obese people tend to require higher NIMV pressures for resolution of hypercarbic respiratory failure which might be explained by impaired elastic load due to reduced chest wall compliance and possible respiratory resistance due to lower lung volumes or both.

CLINICAL IMPLICATIONS: Larger studies are needed. However, based on the current study obese patients with COPD exacerbation may require higher NIMV pressures for resolution of acute hypercarbic respiratory failure.

DISCLOSURE: The following authors have nothing to disclose: Anastasiia Rudkovskaia, Wassim Fares, Jeff Kwon

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