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Acute decompensated obesity hypoventilation — SCE Respiratory MCQ

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HardSleep medicineAcute decompensated obesity hypoventilationSCE Respiratory

A patient with obesity hypoventilation has acute-on-chronic hypercapnic respiratory failure: pH 7.24, PaCO2 10.6 kPa and persistent hypoxaemia despite controlled oxygen. He is cooperative and protecting his airway. Which intervention should be started now?

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Correct answer: B — Bilevel NIV with controlled oxygen

Acute respiratory acidosis from obesity hypoventilation requires ventilatory support. Bilevel NIV augments tidal ventilation while oxygen is titrated to avoid worsening CO2 retention. Intubation is reserved for NIV failure, inability to protect the airway or other contraindications.

Reference: NICE NG202: Obstructive sleep apnoea and obesity hypoventilation syndrome. https://www.nice.org.uk/guidance/ng202/chapter/recommendations; BTS Guideline for Oxygen Use in Adults. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/emergency-oxygen/