RESUMEN
La obesidad se ha convertido en una importante causa de comorbilidades, por lo cual es importante reconocer de forma temprana las enfermedades asociadas a esta afección, así como su tratamiento. El síndrome de hipoventilación del obeso o también llamado síndrome de Pickwick se ha definido por la triada de obesidad, hipoventilación diurna y respiración alterada durante el sueño, en ausencia de otra enfermedad que explique las alteraciones respiratorias. Se presenta el caso de un paciente de 53 años de edad, de color de piel blanca, masculino, de procedencia urbana, con antecedentes patológicos personales de hipertensión arterial, artritis gotosa, obesidad mórbida, angina de pecho inestable, episodios previos de fibrilación auricular y síndrome de Pickwick sin tratamiento para ello. El día 12 de febrero del 2023 fue traído por sus familiares al Hospital Dr. Gustavo Aldereguía Lima de la provincia Cienfuegos, por presentar, desde hacía siete días atrás, dificultad para respirar, fiebre de 39 ºC, y el día anterior había comenzado a expectorar con sangre. Se describen los procedimientos realizados y tratamientos ante cada complicación, hasta su fallecimiento. Por la importancia que tiene el diagnóstico, control y seguimiento a estos pacientes obesos con comorbilidades, para evitar desenlaces fatales, se decidió la presentación del caso.
Obesity has become an important cause of comorbidities, it is important to recognize the diseases associated with this condition early, as well as its treatment. Obese hypoventilation syndrome, also called Pickwick syndrome, has been defined by the triad of obesity, daytime hypoventilation and altered breathing during sleep, in the absence of another disease that explains the respiratory alterations. The case of a 53-years-old patient, white skin color, male, from urban origin, with a personal pathological history of high blood pressure, gouty arthritis, morbid obesity, unstable angina pectoris, previous episodes of atrial fibrillation and Pickwick syndrome without treatment for it, it is presented. On February the 12th, 2023, he was brought by his family to the Dr. Gustavo Aldereguía Lima Hospital in the Cienfuegos province, because he had had difficulty breathing, a fever of 39ºC, for seven days, and the day before he had begun to expectorate blood. The performed procedures and treatments for each complication are described, until his death. Due to the importance of diagnosis, control and follow-up of these obese patients with comorbidities, to avoid fatal outcomes, it was decided to present the case.
RESUMEN
En el Síndrome de Pickwick es una patología asociada a la obesidad que aun a dado a problemas cardiorrespiratorios está llegando a desencadenar diversas complicaciones y aumenta la morbilidad y mortalidad. Por tanto, entendiendo la importancia de este problema se realizó la presente investigación con el objetivo de determinar la prevalencia del Síndrome de Pickwick en la Caja Nacional de Salud Hospital Obrero N° 2. Se realizó un trabajo de diseño descriptivo y tipo de estudio transversal, con un universo de 305 personas. Para la realización del mismo se utilizó las historias clínicas que cumplían con los criterios de inclusión, siendo estos, pacientes internados en las áreas de neumología y medicina interna con problemas cardiorrespiratorios de 30 - 70 años de edad, con un índice de masa corporal ≥ 25 entre junio del 2009 a junio del 2010 Habiendo concluido el trabajo podemos inferir que esta patología, no es frecuente ya que solo se encontró 10 personas de las 305 estudiadas de las cuales seis eran pacientes de sexo femenino con una edad promedio entre 70 a 80 años, con un grado de obesidad mórbida, con complicaciones cardiacas y respiratorias como hipertensión, policitemia, insuficiencia cardiaca congestiva cor pulmonar, insuficiencia respiratoria crónica, hipertensión pulmonar, neumoconiosis y bronconeumonía.
The Pickwick syndrome is a condition associated with obesity, which together with cardiorespiratory problems is coming to unleash a variety of complications and even increase morbidity and mortality. Therefore, understanding the importance of this issue was conducted this research with the aim of determine the prevalence of the syndrome of Pickwick in Caja Nacional de Salud Hospital Obrero N° 2. This is a descriptive and transversal study, with a universe of 305 people.To achieve the same use case histories that met the inclusión criteria, and these, patients in the areas of pulmonology and internal medicine with cardiorespiratory problems of 30-70 years of age, body mass index ≥ 25 between June 2009 to June 2010. Having conduded its work, we can infer that this disease in our environment is rare, as only found 10 of the 305 people surveyed, of which six were female patients with an average age between 70 to 80, with a degree of morbid obesity, cardiac and respiratory complications such as hypertension, polycythemia, congestive heart failure corpulmonar, chronic respiratory failure, pulmonary hypertension, pneumoconiosis and bronchopneumonia.
RESUMEN
Para o clínico geral e os médicos de outras especialidades, tornou-se muito difícil distinguir todos os dezesseis distúrbios respiratórios do sono atualmente reconhecidos, devido ao imenso volume de conhecimento que se acumula e sua constante reorganização. O objetivo desta revisão é fornecer as principais informações a respeito de uma dessas síndromes respiratórias assaz prevalentes, mas menos conhecidas do que a síndrome da apnéia obstrutiva do sono, ou seja, a síndrome da hipoventilação relacionada à obesidade ou síndrome de Pickwick. A síndrome da hipoventilação relacionada à obesidade tem importância econômica e clínica significativa e sua prevalência aumenta à medida que aumenta a da obesidade, sendo importante o diagnóstico precoce. É uma síndrome distinta da apnéia do sono e diagnosticada com polissonografia respiratória, preferencialmente com medida da PETCO2 e gasometria arterial de repouso, além dos exames para detecção de comorbidades e para exclusão de outras causas de hipoventilação noturna. O tratamento inicial mais eficaz é a ventilação com pressão positiva, preferencialmente não invasiva. Os tratamentos adicionais, incluindo-se dietas, cirurgia bariátrica e tratamento das comorbidades, são geralmente necessários. O aumento da qualidade de vida e de sobrevida, bem como a redução dos custos sociais com o tratamento são indiscutíveis. São apresentados aspectos relevantes da evolução histórica, das definições, da fisiopatologia, do diagnóstico e do tratamento.
Its has become difficult for clinicians, who do not daily deal with sleep disturbances, to know and distinguish all sixteen respiratory sleep disturbances currently recognized, due to the huge volume of knowledge accumulated and its constant restructuring. This review goal is to provide basic understanding about a prevalent respiratory syndrome, which is not as well known as the obstructive sleep apnea syndrome: the Pickwick or obesity hypoventilation syndrome. Obesity hypoventilation syndrome has high economic and clinic significance, and its prevalence increases with the increase in obesity prevalence. An early diagnosis is essential. It is a syndrome distinct from obstructive sleep apnea syndrome and can be investigated with respiratory polysomnography, preferentially with PETCO2 measurement, nd arterial gasometry at rest, besides other tests targeted to detect comorbidities and to exclude other causes of nocturnal hypoventilation. The most efficient initial treatment known is non-invasive positive pressure ventilation. Additional treatment, including diet, bariatric surgery and comorbidities treatment, is usually necessary. An increase in survive and life quality, as well as a decrease in social cost with treatment are indisputable. Relevant aspects of history, definitions, physiopathology, diagnosis and treatment are presented.