La ventilation mécanique au cours de l'insuffisance respiratoire aiguë hypercapnique du sujet obèse. Spécificités de la ventilation non invasive

Acute hypercapnic respiratory failure in obese patients is an increasing cause of hospitalization in intensive care units. Despite a few publications on this topic, noninvasive ventilation (NIV) has become the main modality of ventilatory assistance for these patients. NIV specificities are: efficacy of the bi-level mode, mandatory back-up frequency, additional oxygen therapy required, positive inspiratory pressures elevated in patients having obesity-hypoventilation syndrome (OHS) or associated COPD and obstructive sleep apneas (OSAS), positive expiratory pressure elevated in case of OSAS. Flow-preset mode should be tested in case of failure with bi-level mode. In patients with COPD or OHS, an associated nocturnal alveolar hypoventilation at stable state justifies to institute domiciliary NIV. The ventilatory settings will be set according to arterial blood gases and polysomnography a few months after discharge from AHRF.