THE PICKWICKIAN SYNROME CASE
Abstract
The article demonstrates a clinical case of Pickwickian syndrome. The clinical manifestation of the syndrome, a diagnostic approach including instrumental methods, and the up-to-date treatment based on the literature data are shown. The significance of maintaining lifestyle modification with accent on a normalization of body mass is emphasized.
There are two tasks in the treatment of Pickwickian syndrome: maintaining a healthy body weight and oxygen therapy. Weight loss is achieved first of all by the lifestyle modification, which means a hypocaloric diet, rational physical activity and also drugs therapy, which opportunities are rather limited. If conservative treatment for obesity is non-effective the expediency of the surgical intervention should be taken into account. Bariatric surgery has been shown to be the most effective modality of reliable and durable treatment for severe obesity. In practice, several mini-invasive and invasive surgical approaches exist to achieve the optimal weight in obese patients with or without obesity-hypoventilation syndrome. According to the guidelines issued by the National Institutes of Health, patients with body mass index greater than 35 kg/m2 and an obesity-related comorbid condition (including obesity-hypoventilation syndrome) or patients with a body mass index greater than 40 kg/m2 can be referred for surgical treatment. The second task can be achieved by noninvasive ventilation bi-level positive airway pressure (inspiratory and expiratory positive airway pressure).
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