Non-invasive ventilation in super obese young patients: a case report

Abstract This case highlights a rare and life-threatening manifestation of obesity hypoventilation syndrome (OHS), complicated by hypercapnic encephalopathy, pulmonary hypertension and hypertensive heart disease, in a 34-year-old male with morbid obesity. Initially diagnosed with cardiac pathology, but after failing to improve with diuretics and oxygen therapy alone, the patient presented with severe hypercapnic encephalopathy and pulmonary hypertension. Non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP) was initiated and later switched to Average Volume Assured Pressure Support (AVAPS), resulting in significant clinical improvement. Despite persistently elevated carbon dioxide levels and respiratory acidosis, NIV therapy effectively enhanced gas exchange, improved consciousness and normalised blood gases. Multidisciplinary care, including dietary management and collaboration with cardiology and diabetes specialists, facilitated long-term recovery. This case highlights the critical role of early OHS diagnosis and the importance of tailored NIV strategies in managing severe respiratory failure, highlighting their potential to improve patient outcomes and reduce the need for intensive care.