Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline.

American Journal of Respiratory and Critical Care Medicine
Babak MokhlesiMihaela Teodorescu

Abstract

Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS).Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations.Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level <27 mmol/L to exclude the diagnosis of OHS in obese patients with sleep-disordered breathing when suspicion for OHS is not very high (<20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respirato...Continue Reading

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Citations

Aug 1, 2019·Annals of the American Thoracic Society·Israa SoghierBabak Mokhlesi
Nov 12, 2019·Expert Review of Respiratory Medicine·Paola PierucciOnofrio Resta
Oct 30, 2019·Annals of the American Thoracic Society·F Javier Gómez de TerrerosCarey C Thomson
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Feb 29, 2020·Annals of the American Thoracic Society·Winfried Randerath
Jan 25, 2020·Annals of the American Thoracic Society·Maximiliano Tamae KakazuBabak Mokhlesi
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Methods Mentioned

BETA
gastric bypass

Software Mentioned

Cochrane Collaboration Review Manager
GRADEpro Guideline Development Tool

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