title: A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs.
abstract: BACKGROUND
  The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS).
  
  
  METHODS
  35 year old African American gentleman with a body mass index (BMI) of 115 kg/m2presented to the hospital with respiratory distress. On admission he was noted to have multi-organ dysfunction including respiratory failure, renal failure, cardiac and liver abnormalities. His hospital course was remarkable for recurrent cardiac arrest following extubation, complicated tracheostomy, and progressive organ failure despite medical therapy. After a 30 day hospitalization, patient and family decided on terminal extubation owing to worsening medical condition and lack of therapeutic and disposition options.
  
  
  CONCLUSIONS
  The super obese present a number of challenges when admitted to the ICU. Patients with respiratory distress are frequently misdiagnosed and treated for asthma and COPD when obesity hypoventilation syndrome (OHS) is more consistent with the clinical picture. OHS in the superobese is often accompanied by multi-system organ dysfunction, a condition with high morbidity and mortality, with limited treatment options. Standard imaging techniques and procedures are made difficult or impossible by body habitus and often require expert intervention. Surgical options have been used in the treatment of the super obese and resulted in rapid weight loss, improvement in respiratory function, as well as improved metabolism and decreased inflammation. The role of surgery in MOHS remains to be elucidated.
  
  
  CONCLUSIONS
  Physicians should be aware of MOHS as a common condition with high morbidity and mortality. Optimal management remains to be determined.
authors.affiliation: Pulmonary and Critical Care Medicine at Medstar Washington Hospital Center, 36 Rhode Island Ave NE #2, Washington, DC 20002, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Tatusov
authors.affiliation: Endocrinology, Diabetes and Metabolism at Johns Hopkins University School of Medicine, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Joseph
authors.affiliation: Section of Pulmonary and Critical Care, MedStar Washington Hospital Center, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Cuneo
keywords: Malignant obesity hypoventilation syndrome; Metabolic syndrome; Morbid obesity; Multiple organ failure; Obesity hypoventilation syndrome; Super obesity