Evaluation
Figure 1. Summary Guideline Flowchart
Suspected OHS
a
NO
Hospitalized patient with
hypercapnic respiratory failure
High probability
of OHS
Ambulatory stable obese
patient
Low/moderate
probability of OHS
Serum bicarbonate
≥27 mmol/l
Serum bicarbonate
<27 mmol/l
Perform ABG OHS highly unlikely
Hypercapnia confirmed?
YES
Initiate NIV treatment
Discharge with NIV
not feasible
b
NIV with empiric
settings recommended
at hospital discharge
b
Perform other
studies or
treatments
Sleep study/PAP titration
within 3 months
OHS
Confirmed
OHS not
confirmed
OHS and
severe OSA
CPAP titration
& treatment
NIV titration &
treatment
OHS with no
OSA or mild/
moderate OSA
Case-by-case assessment
Continue CPAP therapy
Change to NIV therapy
Consider bariatric surgery Consider bariatric surgery
Adequate treatment of OHS Inadequate treatment of OHS
Sleep study/PAP titration
