ABSTRACT
Obesity-hypoventilation syndrome associated with COVID-19 rapidly leads to severe acute respiratory failure with the need for invasive mechanical ventilation, becoming a therapeutic challenge for intensive care personnel due to the absence of ventilatory strategies. The following is the case of a 51-year-old male patient with a history of Pickwickian syndrome who presented with severe SARS-CoV-2 pneumonia, which progressed early to severe acute respiratory distress syndrome requiring invasive mechanical ventilatory support with positive pressure, and the need for vasoactive support, also presenting with a malignant phenotype obesity-hypoventilation syndrome. Based on the above, we make a clinical management proposal based on the current scientific literature on obesity-hypoventilation syndrome and severe pneumonia secondary to SARS-CoV-2. Despite the high mortality related to COVID-19 and the difficulty presented during invasive mechanical ventilation, the patient's outcome was favourable. © 2021 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo