Appropriate Tidal Volume for Patients with Obesity Hypoventilation Syndrome

Ventilation Strategy for OHS Patients

The American Academy of Sleep Medicine recommends using predicted body weight (PBW) rather than actual body weight when calculating tidal volumes, as lung volume does not increase proportionally with body weight in patients with obesity 1
Target tidal volumes of 6-8 ml/kg PBW to provide lung-protective ventilation and reduce pulmonary complications, as recommended by the American Academy of Sleep Medicine 1, 3
For volume-targeted BiPAP, the recommended tidal volume target is 8 ml/kg using ideal body weight, according to the American Academy of Sleep Medicine 3
Consider individualized PEEP settings to reduce postoperative atelectasis and improve gas exchange, as suggested by the World Journal of Emergency Surgery 1
Monitor driving pressure (plateau pressure minus PEEP), as patients with obesity may require higher cut-off values than non-obese patients, according to the World Journal of Emergency Surgery 1

Using actual body weight instead of PBW leads to excessive tidal volumes, especially in obese patients, as noted by the World Journal of Emergency Surgery 1
Failure to adjust ventilation parameters based on clinical response may result in persistent hypoventilation, as warned by the American Academy of Sleep Medicine 3
Increase pressure support if arterial PCO2 remains 10 mmHg above goal for 10 minutes or more, as recommended by the American Academy of Sleep Medicine 3
Target PCO2 values less than or equal to the awake PCO2, according to the American Academy of Sleep Medicine 3
Monitor for adequate respiratory muscle rest, indicated by resolution of tachypnea and excessive inspiratory effort, as suggested by the American Academy of Sleep Medicine 3