Chest mechanics in morbidly obese non-hypoventilated patients

Abstract

Seventy-seven patients with morbid obesity, body mass index (BMI) 40–69·9 kg m⁻², who were candidates for gastroplasty, were studied in our laboratory as part of a pre-operative survey. They had no complaints other than obesity and were not cyanotic. A group of 28 lean subjects (BMI 20–29·8 kg m⁻²) who were candidates for abdominal surgery, without any respiratory complaint, were included as controls. For each patient a pulmonary function test was performed, measuring slow vital capacity with expiratory residual volume (ERV), forced vital capacity (flow/volume) and maximal voluntary ventilation (MVV).

In obese patients the MVV is reduced as BMI increases. This results in the reduction of expiratory flows and volumes. Forced expiratory volume in 1 sec (FEV₁) is reduced in proportion to the FVC reduction and is related to MVV. It is suggested that the main consequence of the burden of the chest wall by increased adipose mass is a reduction in its compliance, making inspiration increasingly difficult, and resulting in lower static volumes and flows.