The Authors ’ Response The Emergent Malignant Obesity Hypoventilation Syndrome: A New Critical Care Syndrome

letter. The purpose of our article was 2-fold. First, to describe the features of the malignant obesity hypoventilation syndrome (MOHS), emphasizing that this is a multisystem disease. Our second objective was to highlight that this disorder is under-appreciated and frequently misdiagnosed. Obesity hypo-ventilation syndrome (OHS) was classically described as Pickwickian syndrome in a case report by Burwell, in 1956.1 This patient resembled a character depicted by Dickens in his story, The Posthumous Papers of the Pickwick Club, because both were obese with excessive hypersomnolence. Obesity hypoventilation syndrome is currently defined as the presence of awake hypercapnia (PaCO2> 45 mm Hg) in the obese patient (body mass index [BMI]> 30 kg/m2) after other causes that could account for awake hypoventilation, such as lung or neuromuscular disease, have been excluded (normal PaCO