A Successful Treatment of Obesity Hypoventilation Syndrome, the Cause of Respiratory Failure in a Patient with Severe Obesity

Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is characterized by chronic alveolar hypoventilation in individuals with obesity, in the absence of other respiratory pathologies.It is often associated with hypercapnia (pCO 2 > 45 mmHg), hypoxemia, and concurrent obstructive sleep apnea syndrome in 90% of the cases.If left untreated, OHS can lead to serious complications, including pulmonary hypertension and cor pulmonale.A 70-year-old female patient with a body mass index of 62, hypertension, type 2 diabetes, and hypothyroidism presented with progressive leg edema and hypoxemia (SpO 2 = 66%).She was semi-mobile and dependent on a wheelchair.Arterial blood gas analysis confirmed compensated respiratory acidosis (pCO 2 = 66 mmHg, pO 2 = 55 mmHg, HCO 3 = 30 mmHg).Initial treatment included switching from continuous positive airway pressure to bilevel positive airway pressure (BiPAP) for hypercapnia and improved oxygenation.Nutritional support, physiotherapy, and the initiation of liraglutide resulted in a 23 kg weight loss over six months.The patient's oxygen saturation improved to 88%, and her symptoms of chronic respiratory failure decreased.Effective management of OHS requires a multidisciplinary strategy to prevent severe complications, including pulmonary hypertension, cor pulmonale, and early mortality.Non-invasive ventilation, such as BiPAP, is the first-line therapy to address hypercapnia and improve gas exchange.Early initiation of BiPAP can reduce the risk of long-term cardiovascular and pulmonary complications.Weight loss is a crucial component of OHS treatment.Liraglutide and other GLP-1 receptor agonists have shown promise in promoting weight loss while improving glycemic control.In severe cases, bariatric surgery remains an option, though careful preoperative assessment is required due to elevated perioperative risks.