Commentary - Archives of General Internal Medicine (2021) Volume 5, Issue 9
Use of noninvasive ventilation in morbid obesity.
Department of Physical Medicine and Rehabilitation, Fordham University, New York, United States
- Corresponding Author:
- Domer Bach
Department of Physical Medicine and Rehabilitation
E-mail: [email protected]
Accepted date: October 28, 2021
Citation: Bach D. Use of noninvasive ventilation in morbid obesity. Arch Gen Intern Med 2021;5(9):6.
Non-Invasive Ventilation (NIV) mentions to the establishment of ventilatory support over the patient's upper airway with a mask or a like device. This method is illustrious from those which bypass upper airway with a tracheal tube, laryngeal mask, or tracheostomy and are therefore considered invasive. In this essay NIV refers to non-invasive positive pressure ventilation, and other less usually used techniques such as external negative pressure or rocking beds will not be discussed. NIV works by creating a positive airway pressure the pressure outside the lungs being better than the pressure inside of the lungs. This roots air to be forced into the lungs (down the pressure gradient), reducing the respiratory effort and reducing the work of breathing. It also aids to keep the chest and lungs expanded by increasing the functional residual capacity (the amount of air remaining in the lungs after expiration) after a usual expiration; this is the air existing in the alveoli available for gaseous exchange. There are two types of NIV non-invasive positive-pressure and Negative-Pressure Ventilation.
Continuous Positive Airway Pressure (CPAP) in this document mentions to the non-invasive application of positive airway pressure, once more using a face or nasal mask rather than in conjunction with invasive techniques. Though it might be exposed to debate as to whether the use of non-invasive CPAP in severe respiratory failure constitutes ventilatory support, it is involved in this document because of the confusion which commonly rises between NIV and CPAP in clinical practice.
Morbid obesity is defined by having a body mass index of 40 kg/m2 or more, and is accompanying with a number of comorbid circumstances which can harmfully impact endurance. Increased work of breathing and rearranging of hypothalamic respiratory drive can outcome in hypoventilation and in cor pulmonale. Morbidly obese persons, with or without complicating conditions, can convert nonstop ventilator dependent, that is, reliant on Non-Invasive Ventilatory Support (CNVS) or on Tracheostomy Mechanical Ventilation (CTMV).
NIV has come to be identical with Continuous Optimistic Airway Pressure (CPAP) and bi-level PAP at spans that can normalize AHI without providing full NVS to normalize CO2 and optimally rest inspiratory muscles. Bi-level PAP became existing in 1990 and often better normalized AHIs than CPAP but it has not been used at full ventilatory support settings aimed at normalization of CO2 in patients with ventilatory pump failure. Stated that eight of 34 patients who used sleep bilevel PAP did not have a substantial development in their PaCO2 despite normalization of their AHIs from 44 ± 45.4. Evaluated CPAP and distinctive bi-level therapy and reported that around 20% of individuals had a CO2>45 mm Hg after two years of therapy. Greater than the usual bi-level spans can be required to normalize CO2. The positive inspiratory pressures of mechanical ventilation during general anesthesia and neuromuscular blockade for patients with normal BMI are 17-25 cm H2O as are PIPs for any patients with slight or no quantifiable vital capacity but usual pulmonary compliance. However, patients with poor lung and chest wall obedience may require much higher pressures to normalize ventilation.