The impact of left heart dysfunction in patients with obesity hypoventilation syndrome with acute on chronic respiratory failure

Introduction: Noninvasive ventilation (NIV) is recommended in patients with obesity hypoventilation syndrome (OHS) with acute hypercapnic respiratory failure (AHRF). Left heart disease is frequently present in obese patients but its prognostic role in patients with OHS and AHRS is unknown. This study aimed to assess the impact of cardiac dysfunction on the outcome of acute NIV in this clinical setting. Methods: A prospective cohort study was undertaken in a respiratory intermediate care unit in an academic medical center between 2018 and 2019.  Clinical characteristics, echocardiographic data (that defined left heart dysfunction), NT-pro BNP levels, hours of NIV during the first 72 hours (dNIV-72h) and other data were recorded. The main outcome was NIV failure. Secondary outcomes were NIV duration and length of hospital stay. Results: 33 patients (20 female, mean age 63 years) with OHS and AHRF were included. 26 patients (78%) had left heart dysfunction. NIV failure was 3.3%, mean LOS was 9 days, mean NIV duration was 5.5 days. The presence of left heart dysfunction increased both dNIV-72h (p Conclusion: NIV failure rate was not influenced by the presence of left heart dysfunction nor by the NT-pro BNP levels. Patients with left heart dysfunction required prolonged use of NIV.