Successfully treated respiratory failure and pulmonary hypertension caused by Pickwickian syndrome with nasal bilevel positive airway pressure ventilation

A 36-year-old women (height 157cm, weight 114kg, body mass index 46.2kg/㎡) with intolerable sleepiness and cyanosis was diagnosed with respiratory failure caused by Pickwickian syndrome. Echocardiography showed normal left ventricular systolic function and moderate pulmonary hypertension. Pulmonary artery systolic pressure was estimated at 50mmHg with doppler echocardiography. Oxygen inhalation and diuretics were started. Althouth the patient was treated with nasal continuous positive airway pressure ventilation, her hypoxemia and hypercapnia did not improve. Bilevel positive airway pressure ventilation with inspiratory pressure 10cmH2O and expiratory pressure 2cmH2O was quite effective in improving hypoxemia and hypercapnia, and pulmonary hypertension had disappeared at the discharge.

Obesity hypoventilation syndorome

sleep apnea syndrome

non-invasive positive airway pressure ventilation