Clinical studyObesity-Associated hypoventilation in hospitalized patients: prevalence, effects, and outcome☆
Section snippets
Study sample
We evaluated consecutive adults older than 18 years of age with a body mass index ≥35 kg/m2, who were admitted to medical services of three teaching hospitals (the Denver Veterans Affairs Medical Center, Denver Health Medical Center, and University of Colorado Hospital). The criterion for body mass index was based on initial pilot data gathered over a 1-month period and literature review suggesting that most previously reported obesity-associated hypoventilation subjects have a body mass index
Results
Of 4332 consecutive admissions, 277 subjects (6%) had a body mass index ≥35 kg/m2. Among these severely obese inpatients, 127 were excluded: 10 had an FEV1/FVC ≤50% or prior lung resection, 10 could not give informed consent, 32 used opiates, and 75 refused to participate because they were unwilling to undergo arterial puncture. The remaining 150 were enrolled.
Of the 150 patients, 47 (31%) met the criteria for obesity-associated hypoventilation, whereas the remaining 103 had simple obesity. As
Discussion
In the present study, 6% of patients hospitalized on medical services of three teaching hospitals were severely obese (body mass index ≥35 kg/ m2) and 31% (1% of all screened admissions) had hypercapnia unexplained by other disorders. These patients more often required intensive care and invasive mechanical ventilation, and had a significantly greater likelihood of discharge to long-term care facilities. Most notably, mortality at 18 months following discharge was 23%, which was nearly twice
Acknowledgements
We are indebted to Jaclyn Martinez for help in preparing the manuscript; Douglas Robertson, Anna Baron, PhD, and Judy Maselli, MSPH, for assistance in data analysis; to John Weil, William Kaehny, Robert Anderson, and John Steiner for their critical review of the manuscript; and to Robert W. Schrier for his financial and intellectual support.
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Funding was provided by the Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado.