We then decided to initiate NPPV: the PaCO* decreased rapidly; and 11 days after the beginning of mechanical ventilation, this technique could be interrupted, with the patient remaining alert and normocapnic. During this period of time, an important diuresis supervened, and the patient lost 12 kg (26 lb) of body weight without any diuretics. Six months after this episode, the patient remains well; pulmonary hypertension is stable (echocardiographic measurement), dyspnea is mild, and results of pulmonary function tests are stable. The PaC02 is still normal (5.2 kPa; 39 mm Hg).
This 60-year-old woman presented with a steady increase in body weight over more than 40 years and can be considered to have been morbidly obese for the last ten years. Two years before admission, her body weight had amounted to 175 kg (386 lb). The patient is diabetic and probably has mild angina pectoris, but cannot move far from home. During the three months preceding admission, her body weight had increased markedly; and simultaneously, ankle edema, central cyanosis, and drowsiness had appeared. Upon admission the patient s body weight was 195 kg (430 lb), and severe hypercapnia was detected.