Lim EH, Park SH, Won YH. Importance of proper ventilator support and pulmonary rehabilitation in obese patients with heart failure: Two case reports. World J Clin Cases 2023; 11(13): 3029-3037 [PMID: 37215405 DOI: 10.12998/wjcc.v11.i13.3029]
Corresponding Author of This Article
Yu Hui Won, MD, PhD, Professor, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, 20 Geonjiro, Deokjin-gu, Jeonju, Jeonbuk 54907, South Korea. wonyh@jbnu.ac.kr
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2023; 11(13): 3029-3037 Published online May 6, 2023. doi: 10.12998/wjcc.v11.i13.3029
Importance of proper ventilator support and pulmonary rehabilitation in obese patients with heart failure: Two case reports
Eun-Hee Lim, Sung-Hee Park, Yu Hui Won
Eun-Hee Lim, Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Sung-Hee Park, Yu Hui Won, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, South Korea
Sung-Hee Park, Yu Hui Won, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
Author contributions: Lim EH drafted the manuscript; Won YH and Park SH performed the data analysis; all authors contributed to the final diagnoses; Won YH and Park SH interpreted the data, wrote and revised the manuscript; all authors reviewed the manuscript before submission.
Supported byThe “Research Base Construction Fund Support Program” funded by Jeonbuk National University in 2021.
Informed consent statement: Informed written consent was obtained from both patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Hui Won, MD, PhD, Professor, Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, 20 Geonjiro, Deokjin-gu, Jeonju, Jeonbuk 54907, South Korea. wonyh@jbnu.ac.kr
Received: November 15, 2022 Peer-review started: November 15, 2022 First decision: February 17, 2023 Revised: February 26, 2023 Accepted: April 4, 2023 Article in press: April 4, 2023 Published online: May 6, 2023
Abstract
BACKGROUND
The optimal treatment for heart failure (HF) is a combination of appropriate medications. Controlling the disease using only medical therapy is difficult in patients with HF, severe hypercapnia, and desaturation. These patients should first receive ventilator support followed by pulmonary rehabilitation (PR).
CASE SUMMARY
We report two cases in which arterial blood gas (ABG) improved and PR was possible with appropriate ventilator support. Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia. Despite proper medical treatment, hypercapnia and desaturation resolved in neither case, and both patients were transferred to the rehabilitation department for PR. At the time of the first consultation, the patients were bedridden because of dyspnea. Oxygen demand was successfully reduced once noninvasive ventilation was initiated. As the patients’ dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime, they started engaging in functional training and aerobic exercise. After 4 mo of follow-up, both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.
CONCLUSION
Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.
Core Tip: We describe two patients with heart failure (HF) and obesity who experienced respiratory failure, including hypercapnia and hypoxia. Neither patient demonstrated a significant response to pharmacological management; however, in both cases, symptoms improved with noninvasive ventilation, and they were able to return to their daily life. These findings suggest that in patients with obesity and HF who developed pulmonary hypertension and cor pulmonale may need to be treated for obesity hypoventilation and sleep apnea. The symptoms of these comorbidities may improve when arterial blood gas levels are normalized with appropriate ventilator support and pulmonary rehabilitation.
