Acute Applications of Noninvasive Ventilation in Obesity Hypoventilation Syndrome: Evidence and Key Practical Recommendations

Noninvasive ventilation (NIV) and sitting position are the two cornerstones of the initial therapeutic management of obese patients in acute respiratory failure (ARF). Strong evidence supports NIV in obese patients for type 2 (hypercapnic) ARF, for the prevention of ARF immediately after extubation, and for preoxygenation before intubation. Conversely, NIV should be cautiously used in case of type 1 (hypoxemic) ARF.