What is it about?

As obesity increases in the U.S. so too does obesity hypoventilation related to sleep apnea. These are dangerous illnesses and doctors have only recently learned of common errors in their routine management. This article highlights those "pitfalls" of treatment that may lead to harm.

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Why is it important?

The harms that these patients may experience from well-meaning treatments are substantial - they may include unneeded mechanical ventilation (ICU), psychiatric illnesses like anxiety and depression, and unneeded or potentially harmful medicines.

Perspectives

Intensivists see countless cases of OHS/OSA who end up on ventilators because either too much oxygen or sedative is administered. Intensivists see many cases of OHS/OSA who are treated with furosemide (lasix) which drives up their bicarbonate and thus their CO2 values, sometimes to dangerous levels. It is not known how many patients' mental illnesses - especially depression - are fueled or determined entirely by OHS/OSA, but this is probably far more common than we realize. Intensivists see countless case - in my case a majority - of OHS/OSA patients who have been mislabeled as having COPD. So they receive potentially harmful medications for an illness they don't have and (steroids) can even make their OHS/OSA worse by promoting weight gain.

Dr Constantine Manthous
Lawrence & Memorial Hospital

Read the Original

This page is a summary of: Avoiding Management Errors in Patients with Obesity Hypoventilation Syndrome, Annals of the American Thoracic Society, January 2016, American Thoracic Society,
DOI: 10.1513/annalsats.201508-562ot.
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