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Sample records for airway pressure cpap

  1. Continuous Positive Airway Pressure (CPAP)

    Science.gov (United States)

    ... heart disease, diabetes, and stroke. What Are the Disadvantages Of CPAP? The CPAP device needs to be ... able to advise you on the treatment options. Copyright © 2015 American Academy of Otolaryngology–Head and Neck ...

  2. Motivational Interviewing (MINT) Improves Continuous Positive Airway Pressure (CPAP) Acceptance and Adherence: A Randomized Controlled Trial

    Science.gov (United States)

    Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James

    2012-01-01

    Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…

  3. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant.

    Science.gov (United States)

    Diblasi, Robert M

    2009-09-01

    Nasal continuous positive airway pressure (CPAP) is a noninvasive form of respiratory assistance that has been used to support spontaneously breathing infants with lung disease for nearly 40 years. Following reports that mechanical ventilation contributes to pulmonary growth arrest and the development of chronic lung disease, there is a renewed interest in using CPAP as the prevailing method for supporting newborn infants. Animal and human research has shown that CPAP is less injurious to the lungs than is mechanical ventilation. The major concepts that embrace lung protection during CPAP are the application of spontaneous breathing at a constant distending pressure and avoidance of intubation and positive-pressure inflations. A major topic for current research focuses on whether premature infants should be supported initially with CPAP following delivery, or after the infant has been extubated following prophylactic surfactant administration. Clinical trials have shown that CPAP reduces the need for intubation/mechanical ventilation and surfactant administration, but it is still unclear whether CPAP reduces chronic lung disease and mortality, compared to modern lung-protective ventilation techniques. Despite the successes, little is known about how best to manage patients using CPAP. It is also unclear whether different strategies or devices used to maintain CPAP play a role in improving outcomes in infants. Nasal CPAP technology has evolved over the last 10 years, and bench and clinical research has evaluated differences in physiologic effects related to these new devices. Ultimately, clinicians' abilities to perceive changes in the pathophysiologic conditions of infants receiving CPAP and the quality of airway care provided are likely to be the most influential factors in determining patient outcomes.

  4. Oscillating Positive Airway Pressure Versus CPAP for the Treatment of Obstructive Sleep Apnea

    Science.gov (United States)

    Haba-Rubio, José; Petitpierre, Nicolas Julien; Cornette, Françoise; Tobback, Nadia; Vat, Sopharat; Giallourou, Theresia; Al-Jumaily, Ahmed; Heinzer, Raphael

    2015-01-01

    Although continuous positive airway pressure (CPAP) is the most effective therapy for obstructive sleep apnea (OSA), it is not always well tolerated by the patients. Previous physiological studies showed that pressure oscillations applied to the pharynx could activate upper airway muscles, but it is not clear whether these pressure oscillations could be tolerated during sleep in OSA patients. The aim of this study was to assess the tolerance of oscillating positive airway pressure (O-PAP) (a CPAP device delivering high-frequency pressure oscillations to the upper airway) compared to CPAP. Fourteen OSA patients currently on CPAP [age 59.9 ± 10.1 years old, BMI 34.8 ± 7.2 kg/m2, initial apnea–hypopnea index (AHI): 58.7 ± 25.2 events/h] used O-PAP or CPAP on two consecutive nights under polysomnography, in a single-blind randomized crossover design to assess sleep quality. A subtherapeutic pressure (70% of the optimal titrated pressure) was applied in both conditions and the residual AHI with each technique was also compared. There was no difference in measured or perceived sleep quality between the two treatment modalities (sleep efficiency 90.0% versus 88.1%, p = 0.54). Despite the small sample, we also found a trend toward a decrease in residual respiratory events with O-PAP compared to CPAP (median AHI 14.3 versus 20.5/h, p = 0.194). The good tolerance of O-PAP and the positive trend toward a reduction in residual AHI should stimulate further research on the effects of O-PAP in OSA patients. PMID:26029694

  5. Nasal CPAP

    Science.gov (United States)

    Continuous positive airway pressure; CPAP; Bilevel positive airway pressure; BiPAP; Autotitrating positive airway pressure; APAP; nCPAP; Non-invasive positive pressure ventilation; NIPPV; Non-invasive ventilation; ...

  6. Cerebral hemodynamics in patients with obstructive sleep apnea syndrome monitored with near-infrared spectroscopy (NIRS) during positive airways pressure (CPAP) therapy: a pilot study

    Science.gov (United States)

    Zhang, Zhongxing; Schneider, Maja; Laures, Marco; Fritschi, Ursula; Lehner, Isabella; Qi, Ming; Khatami, Ramin

    2014-03-01

    In obstructive sleep apnea syndrome (OSA) the periodic reduction or cessation of breathing due to narrowing or occlusion of the upper airway during sleep leads to daytime symptoms and increased cardiovascular risk, including stroke. The higher risk of stroke is related to the impairment in cerebral vascular autoregulation. Continuous positive airways pressure (CPAP) therapy at night is the most effective treatment for OSA. However, there is no suitable bedside monitoring method evaluating the treatment efficacy of CPAP therapy, especially to monitor the recovery of cerebral hemodynamics. NIRS is ideally suited for non-invasive monitoring the cerebral hemodynamics during sleep. In this study, we will for first time assess dynamic changes of cerebral hemodynamics during nocturnal CPAP therapy in 3 patients with OSA using NIRS. We found periodic oscillations in HbO2, HHb, tissue oxygenation index (TOI) and blood volume associated with periodic apnea events without CPAP in all OSA patients. These oscillations were gradually attenuated and finally eliminated with the stepwise increments of CPAP pressures. The oscillations were totally eliminated in blood volume earlier than in other hemodynamic parameters. These results suggested that 1) the cerebral hemodynamic oscillations induced by OSA events can effectively be attenuated by CPAP therapy, and 2) blood flow and blood volume recovered first during CPAP therapy, followed by the recovery of oxygen consumption. Our study suggested that NIRS is a useful tool to evaluate the efficacy of CPAP therapy in patients with OSA bedside and in real time.

  7. Association between obstructive sleep apnea (OSA and depression and the effect of continuous positive airway pressure (CPAP treatment

    Directory of Open Access Journals (Sweden)

    El-Sherbini AM

    2011-12-01

    Full Text Available Amr Makram El-Sherbini1, Adel Salah Bediwy2, Ashraf El-Mitwalli31Department of Psychiatry, Elminia University Hospital, Faculty of Medicine, Elminia, 2Chest Department, Faculty of Medicine, Tanta University, 3Department of Neurology, Mansoura School of Medicine, University of Mansoura, Mansoura, EgyptBackground: Obstructive sleep apnea (OSA is a relatively common disorder which has a negative impact on the psychological well-being of affected individuals.Objective: To assess the association between OSA and depression as well as the effect of treatment with continuous positive airway pressure (CPAP.Methods: A total of 37 newly diagnosed individuals with OSA underwent an overnight polysomnography and were assessed using the Epworth Sleepiness Scale (ESS, the Hamilton Depression Rating Scale (HDRS, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Patients were assessed before and after 2 months of CPAP use.Results: Of the 37 patients included in the study, 21 (56.7% had clinically relevant depression as indicated by a score >10 on the HDRS and eleven patients (29.7% met the diagnostic criteria for a major depressive episode using the Structured Clinical Interview. Scores on the HDRS were correlated with the Apnea Hypoxia Index, ESS scores, and oxygen saturation. Patients showed a significant reduction in depressive symptoms and improvement in ESS scores after CPAP treatment.Conclusion: Patients with OSA should be screened carefully for depressive disorders. CPAP should be tried first before starting other treatment modalities for depression.Keywords: obstructive sleep apnea, depression in OSA, CPAP and depression

  8. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials.

    Science.gov (United States)

    Jullian-Desayes, Ingrid; Joyeux-Faure, Marie; Tamisier, Renaud; Launois, Sandrine; Borel, Anne-Laure; Levy, Patrick; Pepin, Jean-Louis

    2015-06-01

    Reducing cardiometabolic risk may represent an important target for effective obstructive sleep apnea (OSA) treatment. The impact of continuous positive airway pressure (CPAP), the first line therapy of OSA, on metabolic or inflammatory markers is still debated. A systematic literature search using several databases was performed. We provide a systematic analysis of randomized studies comparing therapeutic versus sham CPAP intervention and also include studies using a CPAP withdrawal design. We addressed the impact of CPAP on the following cardiometabolic biomarkers: 1) plasma and urine catecholamines and their metabolites that reflect sympathetic activity; 2) insulin resistance and lipid metabolism biomarkers; 3) oxidative stress, systemic and vascular inflammation biomarkers; 4) liver enzymes highlighting the association between OSA and nonalcoholic fatty liver disease (NAFLD); 5) coagulation biomarkers. The impact of CPAP on sympathetic activity is robust across studies and occurs rapidly. In contrast to sympathetic activity, the well-designed studies included in this review failed to demonstrate that CPAP alters metabolic or inflammatory markers in OSA. CPAP did not change glucose, lipids, insulin resistance levels or the ratio of patients with metabolic syndrome. In unselected OSA patients, it is not realistic to expect a clinically relevant decrease in cardiometabolic biomarkers with CPAP therapy.

  9. Reexpansion of atelectasis caused by use of continuous positive airway pressure (CPAP before radiation therapy (RT

    Directory of Open Access Journals (Sweden)

    Sarit Appel, MD

    2016-04-01

    Conclusion: This is the first reported use of CPAP for reexpansion of atelectasis before RT planning and treatment. Reexpansion of atelectasis improved RT planning, decreased dose to uninvolved lung, and removed the need for replanning. Further study of CPAP as an initial intervention to improve RT delivery in patients with malignant atelectasis is warranted.

  10. CPAP Tips

    Science.gov (United States)

    ... Queue Queue __count__/__total__ Find out why Close CPAP Tips from FDA USFoodandDrugAdmin Subscribe Subscribed Unsubscribe 15, ... apnea and use a continuous positive airway pressure (CPAP) device when sleeping? Here are some tips from ...

  11. Nasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Lamwers, Stephanie; Tepel, Martin;

    2012-01-01

    Obstructive sleep apnoea (OSA) is linked to increased cardiovascular risk. This risk can be reduced by nasal continuous positive airway pressure (nCPAP) treatment. As OSA is associated with an increase of several vasoconstrictive factors, we investigated whether nCPAP influences the digital volum...

  12. Multiple applications of the Boussignac continuous positive airway pressure system

    NARCIS (Netherlands)

    Dieperink, Willem

    2008-01-01

    Continuous positive airway pressure, (CPAP) is a form of treatment to support patients with dyspnea. For the application of CPAP a mechanical ventilator or complex CPAP apparatus is mostly used. The Boussignac CPAP (BCPAP) system developed by George Boussignac does not need such apparatus. The BCPAP

  13. Five-Minute Awake Snoring Test for Determining CPAP Pressures (Five-Minute CPAP Test): A Pilot Study

    Science.gov (United States)

    Camacho, Macario; Ruoff, Chad M.; Kawai, Makoto; Modi, Rahul; Arbee, Jabri; Hekmat, Anahid; Robertson, Matthew; Certal, Victor; Capasso, Robson; Kushida, Clete A.

    2016-01-01

    Objective. To develop a quick, simple, bedside test for determining continuous positive airway pressures (CPAP) for obstructive sleep apnea (OSA) patients. Study Design. Prospective case series at a tertiary medical center. Methods. The Five-Minute Awake Snoring Test for Determining CPAP (Five-Minute CPAP Test) was developed and tested. Patients wear a soft-gel nasal triangle mask while holding a tongue depressor with the wide section (1.75 cm) between the teeth. Fixed pressure nasal CPAP is applied while the patient simulates snoring at 4 centimeters of water pressure. The pressure is incrementally titrated up and then down to determine the lowest pressure at which the patient cannot snore (Quiet Pressure). Results. Overall, thirty-eight patients participated. All could simulate snoring. Correlation coefficients were statistically significant between Quiet Pressures and body mass index (rs = 0.60 [strong positive relationship], p = 0.0088), apnea-hypopnea index (rs = 0.49 [moderate positive relationship], p = 0.039), lowest oxygen saturation (rs = −0.47 [moderate negative relationship], p = 0.048), and oxygen desaturation index (rs = 0.62 [strong positive relationship], p = 0.0057). Conclusion. This pilot study introduces a new concept, which is the final product of over one year of exploration, development, and testing. Five-Minute CPAP Test is a quick, inexpensive, and safe bedside test based on supine awake simulated snoring with nasal CPAP. PMID:26881088

  14. Five-Minute Awake Snoring Test for Determining CPAP Pressures (Five-Minute CPAP Test: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Macario Camacho

    2016-01-01

    Full Text Available Objective. To develop a quick, simple, bedside test for determining continuous positive airway pressures (CPAP for obstructive sleep apnea (OSA patients. Study Design. Prospective case series at a tertiary medical center. Methods. The Five-Minute Awake Snoring Test for Determining CPAP (Five-Minute CPAP Test was developed and tested. Patients wear a soft-gel nasal triangle mask while holding a tongue depressor with the wide section (1.75 cm between the teeth. Fixed pressure nasal CPAP is applied while the patient simulates snoring at 4 centimeters of water pressure. The pressure is incrementally titrated up and then down to determine the lowest pressure at which the patient cannot snore (Quiet Pressure. Results. Overall, thirty-eight patients participated. All could simulate snoring. Correlation coefficients were statistically significant between Quiet Pressures and body mass index (rs=0.60 [strong positive relationship], p=0.0088, apnea-hypopnea index (rs=0.49 [moderate positive relationship], p=0.039, lowest oxygen saturation (rs=-0.47 [moderate negative relationship], p=0.048, and oxygen desaturation index (rs=0.62 [strong positive relationship], p=0.0057. Conclusion. This pilot study introduces a new concept, which is the final product of over one year of exploration, development, and testing. Five-Minute CPAP Test is a quick, inexpensive, and safe bedside test based on supine awake simulated snoring with nasal CPAP.

  15. Five-Minute Awake Snoring Test for Determining CPAP Pressures (Five-Minute CPAP Test): A Pilot Study.

    Science.gov (United States)

    Camacho, Macario; Ruoff, Chad M; Kawai, Makoto; Modi, Rahul; Arbee, Jabri; Hekmat, Anahid; Robertson, Matthew; Zaghi, Soroush; Certal, Victor; Capasso, Robson; Kushida, Clete A

    2016-01-01

    Objective. To develop a quick, simple, bedside test for determining continuous positive airway pressures (CPAP) for obstructive sleep apnea (OSA) patients. Study Design. Prospective case series at a tertiary medical center. Methods. The Five-Minute Awake Snoring Test for Determining CPAP (Five-Minute CPAP Test) was developed and tested. Patients wear a soft-gel nasal triangle mask while holding a tongue depressor with the wide section (1.75 cm) between the teeth. Fixed pressure nasal CPAP is applied while the patient simulates snoring at 4 centimeters of water pressure. The pressure is incrementally titrated up and then down to determine the lowest pressure at which the patient cannot snore (Quiet Pressure). Results. Overall, thirty-eight patients participated. All could simulate snoring. Correlation coefficients were statistically significant between Quiet Pressures and body mass index (r s = 0.60 [strong positive relationship], p = 0.0088), apnea-hypopnea index (r s = 0.49 [moderate positive relationship], p = 0.039), lowest oxygen saturation (r s = -0.47 [moderate negative relationship], p = 0.048), and oxygen desaturation index (r s = 0.62 [strong positive relationship], p = 0.0057). Conclusion. This pilot study introduces a new concept, which is the final product of over one year of exploration, development, and testing. Five-Minute CPAP Test is a quick, inexpensive, and safe bedside test based on supine awake simulated snoring with nasal CPAP.

  16. CPAP Tips

    Medline Plus

    Full Text Available ... you have sleep apnea and use a continuous positive airway pressure (CPAP) device when sleeping? Here are ... views 2:02 Loading more suggestions... Show more Language: English Content location: United States Restricted Mode: Off ...

  17. CPAP Tips

    Medline Plus

    Full Text Available ... Published on Dec 12, 2012 Do you have sleep apnea and use a continuous positive airway pressure ( ... A Beginner's Guide to Your CPAP Machine for Sleep Apnea Relief - Duration: 5:58. DANDLINC 16,458 ...

  18. Continuous Positive Airway Pressure Strategies with Bubble Nasal Continuous Positive Airway Pressure: Not All Bubbling Is the Same: The Seattle Positive Airway Pressure System.

    Science.gov (United States)

    Welty, Stephen E

    2016-12-01

    Premature neonates are predisposed to complications, including bronchopulmonary dysplasia (BPD). BPD is associated with long-term pulmonary and neurodevelopmental consequences. Noninvasive respiratory support with nasal continuous positive airway pressure (CPAP) has been recommended strongly by the American Academy of Pediatrics. However, CPAP implementation has shown at least a 50% failure rate. Enhancing nasal CPAP effectiveness may decrease the need for mechanical ventilation and reduce the incidence of BPD. Bubble nasal CPAP is better than nasal CPAP using mechanical devices and the bubbling provides air exchange in distal respiratory units. The Seattle PAP system reduces parameters that assess work of breathing.

  19. O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso El impacto del CPAP en la rehabilitación cardíaca de pacientes con ICC: caso clínico The impact of continuous positive airway pressure (CPAP on the cardiac rehabilitation of patients with congestive heart failure: case report

    Directory of Open Access Journals (Sweden)

    Murillo Frazão de Lima e Costa

    2010-07-01

    Full Text Available A insuficiência cardíaca congestiva é uma patologia que limita a função física do paciente. Neste estudo foi analisada uma paciente, realizando um programa de reabilitação cardíaca associado à pressão positiva contínua nas vias aéreas, aferindo-se antes do estudo e após 6 semanas, o teste de caminhada de 6 minutos (TC6M, questionário de qualidade de vida e ecocardiograma. A paciente aumentou a distância no TC6M de 152,5 m para 520,44 m. O questionário Minnesota reduziu de 62 para 18. A fração de ejeção subiu de 33% para 36%. Na paciente estudada a conduta melhorou o desempenho físico e a qualidade de vida.La insuficiencia cardíaca congestiva es una patología que limita la función física del paciente. En este estudio fue analizada una paciente, realizando un programa de rehabilitación cardíaca asociado a la presión positiva continua en las vías aéreas, realizando antes del estudio y después de 6 semanas, el test de caminata de 6 minutos (TC6M, cuestionario de calidad de vida y ecocardiograma. La paciente aumentó la distancia en el TC6M de 152,5 m a 520,44 m. El cuestionario Minnesota redujo de 62 a 18. La fracción de eyección subió de 33% a 36%. En la paciente estudiada la conducta mejoró el desempeño físico y la calidad de vida.Congestive heart failure is a pathology that limits the patient's physical function. This study analyzed one patient who was submitted to a cardiac rehabilitation program associated to Continuous Positive Airway Pressure (CPAP, by assessing the results of the six-minute walk test (6MWT and a questionnaire on the quality of life and performing an echocardiographic assessment before the study and after six weeks. The distance walked by the patient increased from 152.5 m to 520.44 m at the 6MWT. The Minnesota questionnaire score decreased from 62 to 18. Ejection fraction increased from 33% to 36%. Therefore, the management chosen for this case improved the patient's physical performance

  20. The influence of multilevel upper airway surgery on CPAP tolerance in non-responders to obstructive sleep apnea surgery.

    Science.gov (United States)

    Azbay, Sule; Bostanci, Asli; Aysun, Yasin; Turhan, Murat

    2016-09-01

    The aim of this study was to evaluate the influence of multilevel upper airway surgery on subsequent continuous positive airway pressure (CPAP) use and tolerance in patients with moderate to severe obstructive sleep apnea (OSA). The study cohort enrolled 67 consecutive patients, who underwent septoplasty plus modified uvulopharyngopalatoplasty (mUPPP) with or without modified tongue base suspension (mTBS) due to CPAP intolerance, and who had residual OSA requiring CPAP therapy [non-responders to surgery, apnea-hypopnea index (AHI) >15 events/h] that had been confirmed by control polysomnography at the sixth month postoperatively. A questionnaire including questions on postoperative CPAP use, problems faced during CPAP use after the surgery, change in OSA symptoms, and satisfaction with the surgery was designed, and filled through interviews. Seventeen (25.4 %) patients had septoplasty plus mUPPP and 50 (74.6 %) had septoplasty plus mUPPP combined with mTBS. Postoperatively, mean AHI (45.00 ± 19.76 vs. 36.60 ± 18.34), Epworth sleepiness scale (ESS) score (18.00 ± 4.45 vs. 13.00 ± 4.72), oxygen desaturation index (ODI) (48.98 ± 16.73 vs. 37.81 ± 17.03), and optimal CPAP level (11.80 ± 1.40 vs. 8.96 ± 1.20) were decreased (p CPAP before surgery, almost half (47.8 %) of the cases used CPAP without problems postoperatively. Postoperative CPAP users had significantly higher postoperative AHI (p = 0.001), supine AHI (p = 0.009), ESS (p = 0.019), and ODI (p = 0.014), and significantly lower postoperative minimum O2 saturation (p = 0.001) compared with non-users. Multilevel upper airway surgery with less invasive techniques may improve CPAP tolerance in well-selected patients.

  1. 综合护理在持续气道正压通气 CPAP 在新生儿呼吸衰竭中的临床应用比较%Clinical application of comprehensive nursing in continuous positive airway pressure (CPAP) in neonatal respiratory failure

    Institute of Scientific and Technical Information of China (English)

    江玉凤

    2015-01-01

    目的:分析综合护理对实施持续气道正压通气治疗的呼吸衰竭新生儿的作用效果。方法选择本院收治的呼吸衰竭新生儿58例为研究对象,随机分为2组,均实施持续气道正压通气治疗。实验组采取综合护理措施,分析其治疗护理前后血气相关指标 p(O2)、p(CO2)、pH 的变化,比较2组患儿护理满意度、住院时间、住院费用、疾病认知度。结果与治疗前相比较,实验组 p(O2)经 CPAP 治疗后12 h、24 h 明显升高,p(CO2)明显降低,pH 升高,差异有统计学意义(P <0.05);对照组p(O2)、p(CO2)、pH 较治疗前未见明显变化,差异无统计学意义(P >0.05);经过 CPAP 治疗后,与对照组比较,实验组 p(O2)升高,p(CO2)降低,pH 升高,差异有统计学意义 P <0.05);治疗后12 h 与24 h 相比较,实验组 p(O2)、p(CO2)、pH 无明显变化,差异无统计学意义(P >0.05);对护理人员的满意度进行评价,实验组总满意度100%,对照组总满意度仅为71.43%,2组比较差异有统计学意义(P <0.05);实验组患者的住院时间较对照组缩短,住院费用降低,2组间比较差异有统计学意义(P <0.05);与对照组比较,实验组患者对疾病认知度的评分较高,组间比较差异有统计学意义(P <0.05)。结论对出现呼吸衰竭的新生儿采取持续气道正压通气治疗,并采取综合护理措施,能够及时的纠正低氧血症及高碳酸血症,缓解呼吸衰竭,患者的护理满意度明显提高。%ABSTRACT:Objective To analyze effect of comprehensive nursing in continuous positive airway pressure (CPAP)treatment of respiratory failure in neonates.Methods A total of 58 new-borns with respiratory failure were randomly divided into two groups.They were both implement-ed continuous positive airway pressure (CPAP)treatment,the treatment

  2. Noninvasive respiratory support of juvenile rabbits by high-amplitude bubble continuous positive airway pressure.

    Science.gov (United States)

    Diblasi, Robert M; Zignego, Jay C; Tang, Dennis M; Hildebrandt, Jack; Smith, Charles V; Hansen, Thomas N; Richardson, C Peter

    2010-06-01

    Bubble continuous positive airway pressure (B-CPAP) applies small-amplitude, high-frequency oscillations in airway pressure (DeltaPaw) that may improve gas exchange in infants with respiratory disease. We developed a device, high-amplitude B-CPAP (HAB-CPAP), which provides greater DeltaPaw than B-CPAP provides. We studied the effects of different operational parameters on DeltaPaw and volumes of gas delivered to a mechanical infant lung model. In vivo studies tested the hypothesis that HAB-CPAP provides noninvasive respiratory support greater than that provided by B-CPAP. Lavaged juvenile rabbits were stabilized on ventilator nasal CPAP. The animals were then supported at the same mean airway pressure, bias flow, and fraction of inspired oxygen (FiO2) required for stabilization, whereas the bubbler angle was varied in a randomized crossover design at exit angles, relative to vertical, of 0 (HAB-CPAP0; equivalent to conventional B-CPAP), 90 (HAB-CPAP90), and 135 degrees (HAB-CPAP135). Arterial blood gases and pressure-rate product (PRP) were measured after 15 min at each bubbler angle. Pao2 levels were higher (p<0.007) with HAB-CPAP135 than with conventional B-CPAP. PaCO2 levels did not differ (p=0.073) among the three bubbler configurations. PRP with HAB-CPAP135 were half of the PRP with HAB-CPAP0 or HAB-CPAP90 (p=0.001). These results indicate that HAB-CPAP135 provides greater respiratory support than conventional B-CPAP does.

  3. Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark

    DEFF Research Database (Denmark)

    Hansen, Bo M; Esbjørn, Barbara Hoff; Greisen, G

    2004-01-01

    To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period.......To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period....

  4. Upper airway obstruction during midazolam sedation: modification by nasal CPAP.

    Science.gov (United States)

    Nozaki-Taguchi, N; Isono, S; Nishino, T; Numai, T; Taguchi, N

    1995-08-01

    We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to midazolam sedation for spinal anaesthesia.

  5. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2012-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  6. Continuous positive airway pressure therapy: new generations.

    LENUS (Irish Health Repository)

    Garvey, John F

    2010-02-01

    Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and A-Flex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

  7. Comparison of Efficacy and Tolerance of Automatic Continuous Positive Airway Pressure Devices With the Optimum Continuous Positive Airway Pressure.

    Science.gov (United States)

    Tommi, George; Aronow, Wilbert S; Sheehan, John C; McCleay, Matthew T; Meyers, Patrick G

    Patients diagnosed with obstructive sleep apnea syndrome were randomly placed on automatic continuous positive airway pressure (ACPAP) for 2 hours followed by manual titration for the rest of the night. One hundred sixty-one patients entered the study, with at least 50 patients titrated with each of 3 ACPAP devices. The optimum continuous positive airway pressure (CPAP) was defined as the lowest pressure with an apnea-hypoxia index of ≤5/hr, which ranged from 4 cm to 18 cm. Success with ACPAP was approximately 60%-80% when the optimum CPAP was 4-6 cm but fell to below 30% if the optimum CPAP was ≥8 cm (P = 0.001). Average ACPAP ranged from 2 to 10 cm below the optimum level if the optimum CPAP was ≥8 cm. Patients who responded to a low CPAP but deteriorated on higher pressures failed to respond to any of the automatic devices. We recommend that CPAP titration be performed manually before initiation of ACPAP in patients with obstructive sleep apnea. The basal pressure for ACPAP should be the optimum pressure obtained by manual titration. Limits on the upper level of ACPAP may be necessary for patients who deteriorate on higher positive pressures.

  8. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Science.gov (United States)

    Camacho, Macario; Zaghi, Soroush; Tran, Daniel; Song, Sungjin A.; Chang, Edward T.; Certal, Victor

    2016-01-01

    Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP) therapeutic treatment pressures for patients with obstructive sleep apnea (OSA) who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD) for age was 54.6 ± 22.4 years and for body mass index was 28.5 ± 5.9 kg/m2. The Spearman's rank correlation coefficient (rs) between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs = 0.29, nasal obstruction rs = −0.30), moderately correlated (body mass index rs = 0.42 and lowest oxygen saturation rs = −0.47), or strongly correlated (apnea-hypopnea index rs = 0.60 and oxygen desaturation index (rs = 0.62)). No statistical significance was found with one-way analysis of variance (ANOVA) between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064), nasal septal deviation (p value = 0.4979), or mask type (p value = 0.5136). Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index. PMID:26904126

  9. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Directory of Open Access Journals (Sweden)

    Macario Camacho

    2016-01-01

    Full Text Available Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP therapeutic treatment pressures for patients with obstructive sleep apnea (OSA who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD for age was 54.6±22.4 years and for body mass index was 28.5±5.9 kg/m2. The Spearman’s rank correlation coefficient (rs between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs=0.29, nasal obstruction rs=-0.30, moderately correlated (body mass index rs=0.42 and lowest oxygen saturation rs=-0.47, or strongly correlated (apnea-hypopnea index rs=0.60 and oxygen desaturation index (rs=0.62. No statistical significance was found with one-way analysis of variance (ANOVA between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064, nasal septal deviation (p value = 0.4979, or mask type (p value = 0.5136. Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index.

  10. Bubble–CPAP vs. Ventilatory–CPAP in Preterm Infants with Respiratory Distress

    Directory of Open Access Journals (Sweden)

    Mohammad-Reza Baneshi

    2011-06-01

    Full Text Available Objective:Application of Continuous Positive Airway Pressure (CPAP in neonate with respiratory distress is associated with reduction of respiratory failure, reduced complications and mortality. Bubble CPAP (B-CPAP and ventilator-derived CPAP (V-CPAP are two most popular CPAP modes. We aimed to determine whether B-CPAP and V-CPAP would have different survival rate and possible complications. Methods: This prospective clinical trial was performed on 50 preterm neonates weighing 1000-2000 gr who were admitted to the neonatal intensive care unit of Afzalipoor Hospital because of respiratory distress between June 2009 and May 2010. Patients were randomly allocated into treatment groups using minimization technique. Survival analysis was applied to estimate and compare survival rates. Duration of oxygen therapy, hospital stay as well as hospitalization costs were compared using independent sample t-test. Findings:Estimated survival rates at 24 hours in B-CPAP and V-CPAP groups were 100% and 77% respectively. Corresponding figures at 48 hours were 100% and 71%. In addition the hospitalization cost in V-CPAP group was significantly higher than in B-CPAP group. Conclusion: According to our results, B-CPAP was effective in the treatment of neonates who were suffering from respiratory distress and reduced the duration of hospital stay. In addition to mentioned benefits, its low cost may be the reason to use B-CPAP broadly compared with V-CPAP.

  11. Mood Predicts Response to Placebo CPAP

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    Carl J. Stepnowsky

    2012-01-01

    Full Text Available Study Objectives. Continuous positive airway pressure (CPAP therapy is efficacious for treating obstructive sleep apnea (OSA, but recent studies with placebo CPAP (CPAP administered at subtherapeutic pressure have revealed nonspecific (or placebo responses to CPAP treatment. This study examined baseline psychological factors associated with beneficial effects from placebo CPAP treatment. Participants. Twenty-five participants were studied with polysomnography at baseline and after treatment with placebo CPAP. Design. Participants were randomized to either CPAP treatment or placebo CPAP. Baseline mood was assessed with the Profile of Mood States (POMS. Total mood disturbance (POMS-Total was obtained by summing the six POMS subscale scores, with Vigor weighted negatively. The dependent variable was changed in apnea-hypopnea index (ΔAHI, calculated by subtracting pre- from post-CPAP AHI. Negative values implied improvement. Hierarchical regression analysis was performed, with pre-CPAP AHI added as a covariate to control for baseline OSA severity. Results. Baseline emotional distress predicted the drop in AHI in response to placebo CPAP. Highly distressed patients showed greater placebo response, with a 34% drop (i.e., improvement in AHI. Conclusion. These findings underscore the importance of placebo-controlled studies of CPAP treatment. Whereas such trials are routinely included in drug trials, this paper argues for their importance even in mechanical-oriented sleep interventions.

  12. Continuous positive airway pressure breathing increases cranial spread of sensory blockade after cervicothoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Eerd, M.J. van; Seventer, R. van; Gielen, M.J.M.; Giele, J.L.P.; Scheffer, G.J.

    2007-01-01

    BACKGROUND: Continuous positive airway pressure (CPAP) increases the caudad spread of sensory blockade after low-thoracic epidural injection of lidocaine. We hypothesized that CPAP would increase cephalad spread of blockade after cervicothoracic epidural injection. METHODS: Twenty patients with an e

  13. A Randomized Trial of Low-Flow Oxygen versus Nasal Continuous Positive Airway Pressure in Preterm Infants

    DEFF Research Database (Denmark)

    Heiring, Christian; Steensberg, Jesper; Bjerager, Mia

    2015-01-01

    BACKGROUND: Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of 'atelectotrauma', potentially promoting lung development in neonates. OBJECTIVES: To assess whether replacing nCPAP by low-flow O2 by nasal cannula affects lung function expre...

  14. Type of mask may impact on continuous positive airway pressure adherence in apneic patients.

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    Jean Christian Borel

    Full Text Available RATIONALE: In obstructive sleep apnea patients (OSA, continuous positive airway pressure (CPAP adherence is crucial to improve symptoms and cardiometabolic outcomes. The choice of mask may influence CPAP adherence but this issue has never been addressed properly. OBJECTIVE: To evaluate the impact of nasal pillows, nasal and oronasal masks on CPAP adherence in a cohort of OSA. METHODS: Newly CPAP treated OSA participating in "Observatoire Sommeil de la Fédération de Pneumologie", a French national prospective cohort, were included between March 2009 and December 2011. Anthropometric data, medical history, OSA severity, sleepiness, depressive status, treatment modalities (auto-CPAP versus fixed pressure, pressure level, interface type, use of humidifiers and CPAP-related side effects were included in multivariate analysis to determine independent variables associated with CPAP adherence. RESULTS: 2311 OSA (age = 57(12 years, apnea+hypopnea index = 41(21/h, 29% female were included. Nasal masks, oronasal masks and nasal pillows were used by 62.4, 26.2 and 11.4% of the patients, respectively. In univariate analysis, oronasal masks and nasal pillows were associated with higher risk of CPAP non-adherence. CPAP non-adherence was also associated with younger age, female gender, mild OSA, gastroesophageal reflux, depression status, low effective pressure and CPAP-related side effects. In multivariate analysis, CPAP non-adherence was associated with the use of oronasal masks (OR = 2.0; 95%CI = 1.6; 2.5, depression, low effective pressure, and side effects. CONCLUSION: As oronasal masks negatively impact on CPAP adherence, a nasal mask should be preferred as the first option. Patients on oronasal masks should be carefully followed.

  15. Effect of continuous positive airway pressure treatment on serum adiponectin level and mean arterial pressure in male patients with obstructive sleep apnea syndrome

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-long; YIN Kai-sheng; LI Chong; JIA En-zhi; LI Yan-qun; GAO Zhao-fang

    2007-01-01

    Background Recent research suggested that obstructive sleep apnea syndrome (OSAS) might be independently associated with hypoadiponectinemia, which was linked to some complications of OSAS, such as hypertension, diabetes,etc. This study was conducted to investigate the effect of continuous positive airway pressure (CPAP) treatment on changes of both serum adiponectin levels and mean arterial pressure and their possible links in male OSAS patients.Methods Twenty-three adult male patients with moderate-to-severe OSAS but without obesity, coronary heart disease and diabetes were recruited. Their blood sampleswere collected and moming mean arterial pressure (MAP) was measured before CPAP treatment and on day 3, 7, 14 of CPAP treatment respectively. The serum adiponectin concentration was tested with radioimmunoassay.Results Compared with the serum adiponectin level before CPAP treatment, no significant change was found in OSAS patients on day 3 and day 7 of CPAP treatment (P>0.05). It was not until day 14 of CPAP treatment did a significant elevation in serum adiponectin level occur (P<0.01). Meanwhile, the MAP showed no statistically significant difference among its levels before CPAP, on day 3 and day 7 of CPAP treatment (P>0.05). However, on day 14 of CPAP treatment,a significantly lower MAP than that obtained before treatment was observed (P<0.05).Conclusions CPAP treatment can gradually reverse hypoadiponectinemia and reduce MAP in OSAS patients.Hypoadiponectinemia might be involved in the pathogenesis of OSAS-mediated hypertension.

  16. Septum necrosis following CPAP treatment of preterm infant

    DEFF Research Database (Denmark)

    Fjaeldstad, Alexander; Cipliene, Rasa; Ramsgaard-Jensen, Trine

    2014-01-01

    This case describes the complications of intensive respiratory support in a preterm infant. During two months of rigorous nasal continuous positive airway pressure (CPAP) therapy with intermittent use of CPAP-mask and -prongs, an ulcer in the nasal mucus membrane developed into septum necrosis...

  17. Introduction of bubble CPAP in a teaching hospital in Malawi

    NARCIS (Netherlands)

    Van den Heuvel, M.; Blencowe, H.; Mittermayer, K.; Rylance, S.; Couperus, A.; Heikens, G. T.; Bandsma, R. H. J.

    2011-01-01

    Background: Continuous positive airway pressure (CPAP) is relatively inexpensive and can be easily taught; it therefore has the potential to be the optimal respiratory support device for neonates in developing countries. Objective: The possibility of implementing bubble CPAP in a teaching hospital w

  18. All-cause mortality from obstructive sleep apnea in male and female patients with and without continuous positive airway pressure treatment

    DEFF Research Database (Denmark)

    Jennum, Poul; Tønnesen, Philip; Ibsen, Rikke;

    2015-01-01

    BACKGROUND: More information is needed about the effect on mortality of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA), especially in women. METHODS: We employed a historical cohort study design, using data from 25,389 patients with a diagnosis of OSA......, irrespective of whether they received CPAP treatment. CPAP treatment improved survival, as illustrated by the hazard ratio of 0.62 (P

  19. Cost-Effectiveness of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnea-Hypopnea in British Columbia

    Directory of Open Access Journals (Sweden)

    MCY Tan

    2008-01-01

    Full Text Available BACKGROUND: Obstructive sleep apnea-hypopnea (OSAH is a common disorder characterized by recurrent collapse of the upper airway during sleep. Patients experience a reduced quality of life and an increased risk of motor vehicle crashes (MVCs. Continuous positive airway pressure (CPAP, which is the first-line therapy for OSAH, improves sleepiness, vigilance and quality of life.

  20. Maxillomandibular Advancement Surgery as Alternative to Continuous Positive Airway Pressure in Morbidly Severe Obstructive Sleep Apnea : A Case Report

    NARCIS (Netherlands)

    Doff, Michiel H. J.; Jansma, Johan; Schepers, Rutger H.; Hoekema, Aamoud

    2013-01-01

    Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderat

  1. Effect of Continuous Positive Airway Pressure on Airway Inflammation and Oxidative Stress in Patients with Obstructive Sleep Apnea

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    Promsrisuk Tichanon

    2016-01-01

    Full Text Available Background. Airway inflammation and oxidative stress may be linked in obstructive sleep apnea (OSA patients. We determined the effectiveness of continuous positive airway pressure (CPAP therapy in reducing fractional exhaled nitric oxide (FeNO and malondialdehyde (MDA levels in OSA patients. Methods. Thirteen patients with OSA and 13 normal controls were recruited. FeNO and MDA levels were measured in the controls and in OSA patients before and after three months of CPAP therapy. Results. FeNO and MDA levels were higher in the patients compared to the age and gender matched controls (FeNO: 25.9 ± 5.0 versus 17.5 ± 5.9 ppb, P<0.001; MDA: 14.6 ± 7.8 versus 2.1 ± 0.3 μmol/L, P<0.001. FeNO and MDA levels were lower post-CPAP compared to pre-CPAP (FeNO: 25.9 ± 5.0 versus 17.0 ± 2.3 ppb, P<0.001; MDA: 14.6 ± 7.8 versus 10.0 ± 6.4 μmol/L, P<0.01. Apnea-hypopnea index (15.9 ± 6.6 versus 4.1 ± 2.1/h, P<0.001 and mean arterial pressure (P<0.01 decreased following CPAP treatment. Daytime mean SpO2 (P<0.05 increased. Conclusion. Our study demonstrates that CPAP therapy yields clinical benefits by reducing upper airway inflammation and oxidative stress in OSA patients.

  2. Nap-titration : An effective alternative for continuous positive airway pressure titration

    NARCIS (Netherlands)

    Hoekema, A; Stegenga, B; Meinesz, AF; van der Hoeven, JH; Wijkstra, PJ

    2006-01-01

    When treating Obstructive Steep Apnea-Hypopnea Syndrome (OSAHS) several alternatives for standard (manual) continuous positive airway pressure (CPAP) titration are feasible. A practical alternative is titration without polysomnography during an afternoon nap (Nap-titration). The aim of the present s

  3. Cardiovascular risk in patients with sleep apnoea with or without continuous positive airway pressure therapy

    DEFF Research Database (Denmark)

    Lamberts, Morten; Nielsen, O W; Lip, G Y H;

    2014-01-01

    BACKGROUND: The prognostic significance of age and continuous positive airway pressure (CPAP) therapy on cardiovascular disease in patients with sleep apnoea has not been assessed previously. METHODS: Using nationwide databases, the entire Danish population was followed from 2000 until 2011. Firs...

  4. Upper airway finding on CT scan with and without nasal CPAP in obstructive sleep apnea patients

    Energy Technology Data Exchange (ETDEWEB)

    Akashiba, Tsuneto; Sasaki, Iwao; Kurashina, Keiji; Yoshizawa, Takayuki; Otsuka, Kenzo; Horie, Takashi (Nihon Univ., Tokyo (Japan). School of Medicine)

    1991-04-01

    The area of upper airway (from the nasopharynx to the hypopharynx) was measured by means of computed tomography (CT) scan in 15 confirmed cases of obstructive sleep apnea (OSA) and in 4 normal controls while they were awake. The minimum cross-sectional area (MA) of the upper airway was 14.7+-20.0 mm{sup 2} in OSA patients and 80.0+-33.1 mm{sup 2} in normal controls and the difference was statistically significant (p<0.01). In OSA patients, MA did not correlate with age, body weight, apnea index, desaturation index, mean nadir-SO{sub 2} and lowest SO{sub 2}. MA was also measured with OSA patients while nasal continuous positive airway pressure (NCPAP) of 10 cmH{sub 2}O was applied and it was found that MA was significantly widened when NCPAP therapy was performed. We conclude that upper airway narrowing is consistent finding in OSA patients but the degree of narrowing does not correlate with parameters of apnea and gas exchange during sleep, and NCPAP is effective to widen the area of upper airway in OSA patients. (author).

  5. Continuous positive airway pressure and noninvasive ventilation in prehospital treatment of patients with acute respiratory failure

    DEFF Research Database (Denmark)

    Bakke, Skule A; Bøtker, Morten Thingemann; Riddervold, Ingunn S;

    2014-01-01

    Continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are frequently used inhospital for treating respiratory failure, especially in treatment of acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease. Early initiation of treatment...... is important for success and introduction already in the prehospital setting may be beneficial. Our goal was to assess the evidence for an effect of prehospital CPAP or NIV as a supplement to standard medical treatment alone on the following outcome measures; mortality, hospital length of stay, intensive care...... examine prehospital CPAP. Of these, only one small, randomized controlled trial shows a reduced mortality rate and a reduced intubation rate with supplemental CPAP. The other three studies have neutral findings, but in two of these a trend toward lower intubation rate is found. The effect of supplemental...

  6. Continuous Positive Airway Pressure Device Time to Procurement in a Disadvantaged Population

    Directory of Open Access Journals (Sweden)

    Lourdes M. DelRosso

    2015-01-01

    Full Text Available Introduction. The management of obstructive sleep apnea (OSA in patients who cannot afford a continuous positive airway pressure (CPAP device is challenging. In this study we compare time to CPAP procurement in three groups of patients diagnosed with OSA: uninsured subsidized by a humanitarian grant (Group 1, uninsured unsubsidized (Group 2, and those with Medicare or Medicaid (Group 3. We evaluate follow-up and adherence in Group 1. We hypothesize that additional factors, rather than just the ability to obtain CPAP, may uniquely affect follow-up and adherence in uninsured patients. Methods. 30 patients were in Groups 1 and 2, respectively. 12 patients were in Group 3. Time of CPAP procurement from OSA diagnosis to CPAP initiation was assessed in all groups. CPAP adherence data was collected for Group 1 patients at 1, 3, 6, and 9 months. Results. There were no significant differences between groups in gender, age, body mass index, or apnea hypopnea index. The mean time to procurement in Group 1 was shorter compared to Group 2 but not significant. Compared to both Group 1 and Group 2, Group 3 patients had significantly shorter times to device procurement. Conclusion. Time to procurement of CPAP was significantly shorter in those with Medicaid/Medicare insurance compared to the uninsured.

  7. Effects of continuous positive airway pressure on energy balance regulation: a systematic review

    Science.gov (United States)

    Shechter, Ari

    2016-01-01

    Obesity is both a cause and a possible consequence of obstructive sleep apnoea (OSA), as OSA seems to affect parameters involved in energy balance regulation, including food intake, hormonal regulation of hunger/satiety, energy metabolism and physical activity. It is known that weight loss improves OSA, yet it remains unclear why continuous positive airway pressure (CPAP) often results in weight gain. The goal of this systematic review is to explore if and how CPAP affects the behaviour and/or metabolism involved in regulating energy balance. CPAP appears to correct for a hormonal profile characterised by abnormally high leptin and ghrelin levels in OSA, by reducing the circulating levels of each. This is expected to reduce excess food intake. However, reliable measures of food intake are lacking, and not yet sufficient to make conclusions. Although studies are limited and inconsistent, CPAP may alter energy metabolism, with reports of reductions in resting metabolic rate or sleeping metabolic rate. CPAP appears to not have an appreciable effect on altering physical activity levels. More work is needed to characterise how CPAP affects energy balance regulation. It is clear that promoting CPAP in conjunction with other weight loss approaches should be used to encourage optimal outcomes in OSA patients. PMID:27824596

  8. Long-Term Effects of Continuous Positive Airway Pressure Treatment on Sexuality in Female Patients with Obstructive Sleep Apnea

    OpenAIRE

    Petersen, Marian; Kristensen, Ellids; Berg, Søren; Midgren, Bengt

    2013-01-01

    Introduction Results from a previous study showed that sexuality was negatively affected in females with untreated obstructive sleep apnea (OSA). Data are sparse on the long-term effects of nocturnal continuous positive airway pressure (CPAP) treatment on sexual difficulties and sexual distress in female patients with OSA. Aim The aim of the present study was to investigate the effects after 1 year of CPAP treatment on sexual difficulties, sexual distress, and manifest sexual dysfunction in f...

  9. Patient and Partner Experiences With Obstructive Sleep Apnea and CPAP Treatment: A Qualitative Analysis.

    Science.gov (United States)

    Luyster, Faith S; Dunbar-Jacob, Jacqueline; Aloia, Mark S; Martire, Lynn M; Buysse, Daniel J; Strollo, Patrick J

    2016-01-01

    Few studies have investigated factors associated with continuous positive airway pressure (CPAP) treatment for sleep apnea from the patients' and their partners' perspective. This qualitative research study explored patients' and partners' experiences of CPAP and facilitators and barriers to CPAP use, and elicited suggestions for a first-time CPAP user program. Data from 27 participants were collected via four sleep apnea patient and four partner focus groups. Qualitative content analysis identified five themes: knowledge of sleep apnea, effects of sleep apnea, effects of CPAP, barriers and facilitators of CPAP, and ideas for a new user support program. Patients and partners emphasized the importance of partner involvement in the early CPAP treatment period. These data suggest consideration of a couple-oriented approach to improving CPAP adherence.

  10. Otic Barotrauma Resulting from Continuous Positive Airway Pressure: Case Report and Literature Review

    Science.gov (United States)

    McCormick, Justin P.; Hildrew, Douglas M.; Lawlor, Claire M.; Guittard, Jesse A.; Worley, N. Knight

    2016-01-01

    Background: Obstructive sleep apnea (OSA) is a growing problem affecting millions of people in the United States. The prevalence of OSA has risen drastically in the past few decades concurrently with the increasing prevalence of obesity. Subsequently, there has been an ever-increasing rise in the use of continuous positive airway pressure (CPAP) devices. While using CPAP devices may lead to many adverse effects, the majority of these effects are described as relatively benign. Case Report: We describe the detailed clinical course and outcome for a patient with otic barotrauma as a result of excessive self-titration of CPAP therapy in an in-home setting. We also discuss the pathophysiology of otic barotrauma and present a review of current literature on the topic. Conclusion: While the benefits of CPAP are clear, we must take into account the rare but possible effects on ear structure and function. Many studies describe an increase in middle ear pressure with the use of CPAP, but few describe the effects of this increased pressure on the middle ear, such as the otic barotrauma described in this case. Given the increased prevalence of OSA, it is important to understand the risks associated with CPAP therapy. PMID:27303224

  11. CPAP in chronic heart failure

    Directory of Open Access Journals (Sweden)

    F. Lari

    2013-05-01

    Full Text Available BACKGROUND Chronic Heart Failure (CHF represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

  12. Successful treatment of laryngomalacia and bilateral vocal cord paralysis with continuous positive airway pressure

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    Sovtić Aleksandar

    2010-01-01

    Full Text Available Introduction Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. Case report In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA. The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP for a year. The level of pressure had to be set at 7cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. Discussion In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. Conclusion In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.

  13. Effect of Continuous Positive Airway Pressure on Adiponectin in Patients with Obstructive Sleep Apnea: A Meta-Analysis.

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    Li-Da Chen

    Full Text Available Obstructive sleep apnea (OSA has been suggested to be associated with low levels of adiponectin. Continuous positive airway pressure (CPAP is the gold standard treatment for OSA; however, previous studies assessing the effect of CPAP on adiponectin in patients with OSA yielded conflicting results. The present meta-analysis was performed to determine whether CPAP therapy could increase adiponectin levels.Two reviewers independently searched PubMed, Cochrane library, Embase and Web of Science before February 2015. Information on characteristics of subjects, study design and pre- and post-CPAP treatment of serum adiponectin was extracted for analysis. Standardized mean difference (SMD was used to analyze the summary estimates for CPAP therapy.Eleven studies involving 240 patients were included in this meta-analysis, including ten observational studies and one randomized controlled study. The meta-analysis showed that there was no change of adiponectin levels before and after CPAP treatment in OSA patients (SMD = 0.059, 95% confidence interval (CI = -0.250 to 0.368, z = 0.37, p = 0.710. Subgroup analyses indicated that the results were not affected by age, baseline body mass index, severity of OSA, CPAP therapy duration, sample size and racial differences.This meta-analysis suggested that CPAP therapy has no impact on adiponectin in OSA patients, without significant changes in body weight. Further large-scale, well-designed long-term interventional investigations are needed to clarify this issue.

  14. Effect of Acute Intermittent CPAP Depressurization during Sleep in Obese Patients.

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    Jonathan C Jun

    Full Text Available Obstructive Sleep Apnea (OSA describes intermittent collapse of the airway during sleep, for which continuous positive airway pressure (CPAP is often prescribed for treatment. Prior studies suggest that discontinuation of CPAP leads to a gradual, rather than immediate return of baseline severity of OSA. The objective of this study was to determine the extent of OSA recurrence during short intervals of CPAP depressurization during sleep.Nine obese (BMI = 40.4 ± 3.5 subjects with severe OSA (AHI = 88.9 ± 6.8 adherent to CPAP were studied during one night in the sleep laboratory. Nasal CPAP was delivered at therapeutic (11.1 ± 0.6 cm H20 or atmospheric pressure, in alternating fashion for 1-hour periods during the night. We compared sleep architecture and metrics of OSA during CPAP-on and CPAP-off periods.8/9 subjects tolerated CPAP withdrawal. The average AHI during CPAP-on and CPAP-off periods was 3.6 ± 0.6 and 15.8 ± 3.6 respectively (p<0.05. The average 3% ODI during CPAP-on and CPAP-off was 4.7 ± 2 and 20.4 ± 4.7 respectively (p<0.05. CPAP depressurization also induced more awake (p<0.05 and stage N1 (p<0.01 sleep, and less stage REM (p<0.05 with a trend towards decreased stage N3 (p = 0.064.Acute intermittent depressurization of CPAP during sleep led to deterioration of sleep architecture but only partial re-emergence of OSA. These observations suggest carryover effects of CPAP.

  15. Bubble CPAP - a primary respiratory support for respiratory distress syndrome in newborns.

    Science.gov (United States)

    Urs, Prashanth S; Khan, Firdose; Maiya, P P

    2009-05-01

    In preterm infants with respiratory distress syndrome (RDS), the application of continuous positive airway pressure (CPAP) is associated with benefits in terms of reduced respiratory failure and reduced mortality. We conducted this prospective study to evaluate the effectiveness of bubble-CPAP as primary mode of respiratory support. Bubble CPAP was found to be safe and effective means of treating mild and moderate grade RDS, it was also observed to be more successful in babies born to mothers who had received antenatal steroids.

  16. Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management.

    Science.gov (United States)

    Chapman, Julia L; Serinel, Yasmina; Marshall, Nathaniel S; Grunstein, Ronald R

    2016-09-01

    Excessive daytime sleepiness (EDS) is common in obstructive sleep apnea (OSA), but it is also common in the general population. When sleepiness remains after continuous positive airway pressure (CPAP) treatment of OSA, comorbid conditions or permanent brain injury before CPAP therapy may be the cause of the residual sleepiness. There is currently no broad approach to treating residual EDS in patients with OSA. Individual assessment must be made of comorbid conditions and medications, and of lifestyle factors that may be contributing to the sleepiness. Modafinil and armodafinil are the only pharmacologic agents indicated for residual sleepiness in these patients.

  17. Effects of oral appliances and CPAP on the left ventricle and natriuretic peptides

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Voors, Adriaan A.; Wijkstra, Peter J.; Stegenga, Boudewijn; van der Hoeven, Johannes H.; Tol, Cornelis G.; de Bont, Lambert G. M.

    2008-01-01

    Background: In patients without cardiac disease, obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with systolic and diastolic dysfunction and left ventricular hypertrophy. Although continuous positive airway pressure ( CPAP) therapy has been demonstrated to improve left ventricular st

  18. Effects of nasal continuous positive airway pressure therapy on partners' sexual lives.

    Science.gov (United States)

    Acar, Mustafa; Kaya, Coskun; Catli, Tolgahan; Hancı, Deniz; Bolluk, Ozge; Aydin, Yunus

    2016-01-01

    To assess sexual functioning in male and female partners before and after nasal continuous positive airway pressure (CPAP) therapy in men with obstructive sleep apnea (OSA). Twenty-one male patients with moderate to severe OSA and erectile dysfunction, and their female partner, were recruited into this prospective study. Males diagnosed with OSA were treated with nasal CPAP therapy for 12 weeks. Women were assessed for sexual functioning using the Female Sexual Function Index (FSFI), and for mood status using the Beck Depression Inventory (BDI), before and after their male partner underwent nasal CPAP therapy. Sexual functioning was assessed in men using the International Index of Erectile Function (IIEF), before and after nasal CPAP therapy. After nasal CPAP therapy for OSA in men, IIEF scores were significantly higher than pre-treatment scores. Total pre- and post-treatment IIEF scores (mean ± standard deviation) were 50.28 ± 15.88 and 65.42 ± 7.47, respectively, P sexual functioning in both the male and female partners. Moreover, our findings indicate that improved sexual function in women after their male partner underwent nasal CPAP also had psychological benefits.

  19. Boussignac CPAP in acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Federico Lari

    2013-03-01

    Full Text Available Introduction: The application of continuous positive airway pressure (CPAP is one of the most important therapeutic interventions used in patients with acute respiratory failure (ARF secondary to acute cardiogenic pulmonary edema (ACPE. Thanks to its positive effects on both hemodynamics and ventilation, CPAP improves clinical and blood-gas parameters. Compared with standard oxygen therapy, use of CPAP is associated with decreased mortality and reduced need for intubation in these patients. Aim of the study: This review examines the principles of CPAP, techniques and equipment used to deliver it, and clinical applications. Special emphasis is placed on CPAP delivered with the Boussignac device. Discussion and conclusions: In emergency departments, this simple, lightweight, disposable device has proved to be well tolerated and similar to Venturi-like flow generators in terms of effectiveness. These findings suggest that Boussignac CPAP might be useful for managing ARF in non-critical care areas where other more complicated CPAP equipment (Venturi-like flow generators and ventilators are not available (for example, in general medical wards.

  20. Continuous positive airway pressure ameliorated severe pulmonary hypertension associated with obstructive sleep apnea.

    Directory of Open Access Journals (Sweden)

    Ogawa,Aiko

    2006-06-01

    Full Text Available

    A 52-year-old obese woman was admitted to our institution for evaluation of dyspnea and pulmonary hypertension (PH. Polysomnography revealed severe obstructive sleep apnea (OSA with an apnea hypopnea index of 99.8. Treatment with nocturnal continuous positive airway pressure (CPAP resulted in correction of daytime hypoxemia, hypercapnia, and near-normalization of pulmonary artery pressure. To our knowledge, this is the most severe case of OSA-associated PH (approximately70 mmHg reported to date, and it was successfully treated with nocturnal CPAP. This case demonstrates that OSA should be considered and polysomnography performed in all patients with PH, irrespective of severity, and that nocturnal CPAP has therapeutic effects on both OSA and daytime PH.

  1. Is inconsistent pre-treatment bedtime related to CPAP non-adherence?

    Science.gov (United States)

    Sawyer, Amy M; King, Tonya S; Sawyer, Douglas A; Rizzo, Albert

    2014-12-01

    Lack of adherence to continuous positive airway pressure therapy (CPAP) limits the effectiveness of treatment of obstructive sleep apnea (OSA). We hypothesized that an irregular bedtime would be negatively related to regular use of CPAP treatment. If so, modifying bedtime schedule may address the persistent problem of inconsistent CPAP use in adults with OSA. In a prospective longitudinal study, we examined whether inconsistent self-reported bedtime before initiation of CPAP treatment, operationalized as bedtime variability, was (1) different among those adherent (≥4 hours per night) and non-adherent to CPAP treatment at 1 week and 1 month; and/or (2) was related to 1-week and 1-month CPAP use when other variables were accounted for. Consecutively recruited newly diagnosed OSA adults (n = 79) completed sleep diaries prior to CPAP treatment. One-week and 1-month objective CPAP use data were collected. Pre-treatment bedtime variability was different among CPAP non-adherers and adherers at 1 month and was a significant predictor of non-adherence at 1 month in multi-variable analyses. The odds of 1-month CPAP non-adherence were 3.5 times greater in those whose pre-treatment bedtimes varied by >75 minutes. Addressing sleep schedule prior to CPAP initiation may be an opportunity to improve CPAP adherence.

  2. Effects of continuous positive airway pressure on upper airway inspiratory dynamics in awake patients with sleep-disordered breathing.

    Science.gov (United States)

    Vérin, E; Similowski, T; Sériès, F

    2003-01-01

    Continuous positive airway pressure (CPAP) is the main treatment of the obstructive sleep apnoea syndrome (OSAS). We assessed its effects on the upper airway (UA) dynamics in response to bilateral anterior magnetic phrenic nerve stimulation (BAMPS) in 17 awake untreated OSAS patients (15 males; 52 +/- 7 years) whose effective CPAP (P(eff)) had been determined beforehand by a conventional titration sleep study. All twitch-related inspirations were flow-limited, flow first rising to a maximum (V(Imax)), then decreasing to a minimum (V(Imin)), and then increasing again (M-shaped pattern). Up to V(Imin), the relationship between driving pressure (P(d)) and flow (V) could adequately be fitted to a polynomial regression model (V = k(1)P(d) + k(2)P(d)(2); r(2) = 0.71-0.98, P < 0.0001). At atmospheric pressure V(Imax) was 700 +/- 377 ml s(-1), V(Imin) was 458 +/- 306 ml s(-1), k(1) was 154.5 +/- 63.9 ml s(-1) (cmH(2)O)(-1), and k(2) was 10.7 +/- 7.3 ml s(-1) (cmH(2)O)(-1). CPAP significantly increased V(Imax) and V(Imin) (peak values 1007 +/- 332 ml and 837 +/- 264 ml s(-1), respectively) as well as k(1) and k(2) (peak values 300.9 +/- 178.2 ml s(-1) (cmH(2)O)(-1) and 55.2 +/- 65.3 ml s(-1) (cmH(2)O)(-1), respectively). With increasing CPAP, k(1)/k(2) increased up to a peak value before decreasing. We defined as P(eff,stim) the CPAP value corresponding to the highest k(1)/k(2) value. P(eff,stim) was correlated with P(eff) (P(eff) = 7.0 +/- 2.0; P(eff,stim) = 6.4 +/- 2.6 cmH(2)O; r = 0.886; 95 % CI 0.696-0.960, P < 0.001). We conclude that CPAP improves UA dynamics in OSAS and that the therapeutic CPAP to apply can be predicted during wakefulness using BAMPS.

  3. Simulated driving in obstructive sleep apnoea-hypopnoea : effects of oral appliances and continuous positive airway pressure

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stegenga, Boudewijn; Bakker, Marije; Brouwer, Wiebo H.; de Bont, Lambert G. M.; Wijkstra, Peter J.; van der Hoeven, Johannes H.

    2007-01-01

    Impaired simulated driving performance has been demonstrated in obstructive sleep apnoea-hypopnoea syndrome (OSAHS) patients. Although continuous positive airway pressure (CPAP) generally improves simulated driving performance, the effects of oral-appliance (OA) therapy are unknown. The aims of this

  4. Influence of upper body position on middle cerebral artery blood velocity during continuous positive airway pressure breathing

    DEFF Research Database (Denmark)

    Højlund Rasmussen, J; Mantoni, T; Belhage, B;

    2007-01-01

    in 11 healthy subjects during CPAP at different body positions (15 degrees head-down tilt, supine, 15 degrees, 30 degrees and 45 degrees upper body elevation). In the supine position, 10 cmH(2)O of CPAP reduced MCA V(mean) by 9 +/- 3% and increased cHbT by 4 +/- 2 micromol/L (mean +/- SEM); (P ....05). In the head-down position, CPAP increased cHbT to 13 +/- 2 micromol/L but left MCA V(mean) unchanged. Upper body elevation by 15 degrees attenuated the CPAP associated reduction in MCA V(mean) (-7 +/- 2%), while cHbT returned to baseline (1 +/- 2 micromol/L). With larger elevation of the upper body MCA V......Continuous positive airway pressure (CPAP) is a treatment modality for pulmonary oxygenation difficulties. CPAP impairs venous return to the heart and, in turn, affects cerebral blood flow (CBF) and augments cerebral blood volume (CBV). We considered that during CPAP, elevation of the upper body...

  5. 持续气道正压通气治疗重度阻塞型睡眠呼吸暂停综合征的探讨%Prediction of the Level of Continuous Positive Airway Pressure in the Managemert of Severe Obstrutive Sleep Apnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    周建群; 郭兮恒; 胥振扬; 刘莉

    2002-01-01

    Objective To evaluate the effect of continuous positive airway pressure (CPAP) on the management ofsevere of obstructive sleep hypoxemia. Methods 25 patients with severe OSAS were enrolled in the study, the respiratorydisturbance index (RDI),the percentage of time spent at SaO2 below 90% (TS90),deoxygenation index (DOI) of both beforeand after the CPAP treatment. The actual level of CPAP (Pm) were calculated. Results RDI, TS90, DOI were improvedsignificantly after CPAP treatment, there was a close positive linear correlation between DOI and Pm. Conclusions It wassuggested that CPAP has a good effect on severe OSAS, DOI maybe valuable in predicting Pm in the management of severeOSAS.

  6. Significance of depression in obstructive sleep apnea patients and the relationship between the comorbidity and continuous positive airway pressure treatment

    Institute of Scientific and Technical Information of China (English)

    FENG Jing; CHEN Bao-yuan; Ambrose An-Po Chiang

    2010-01-01

    Obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder and characterized by recurrent collapse of the upper airway,causes repeated arousals from sleep, decreased oxygen saturation of the blood, and excessive daytime sleepiness.Patients with OSA are at increased risk of cardiovascular and cerebrovascular disease, type 2 diabetes, cognitive impairment, and depression.1,2 Currently, continuous positive airway pressure (CPAP) had been identified as the standard treatment for patients with OSA. CPAP shows significant improvements in objective and subjective sleepiness and several quality3 of life assessments, cognitive function and depression.3 However,reports of non-adherence to CPAP therapy range from 29% to 83%, and one of the reasons of non-adherence is the comorbidity of depression.4

  7. Practical use, effects and complications of prehospital treatment of acute cardiogenic pulmonary edema using the Boussignac CPAP system

    NARCIS (Netherlands)

    E.E. Spijker (Eva Eiske); M. De Bont (Maarten); M. Bax; M. Sandel (Maro)

    2013-01-01

    textabstractBackground: Early use of continuous positive airway pressure (CPAP) has been shown to be beneficial within the setting of acute cardiogenic pulmonary edema (ACPE). The Boussignac CPAP system (BCPAP) was therefore introduced into the protocols of emergency medical services (EMS) in a larg

  8. Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    Side-effects directly due to the nasal mask are common in patients with obstructive sleep apnoea syndrome (OSAS) commencing continuous positive airway pressure (CPAP). Recently, nasal pillows have been designed to overcome these issues. Limited evidence exists of the benefits and effectiveness of these devices. Twenty-one patients (19 male, 49+\\/-10years) with the established diagnosis of OSAS [apnoea\\/hypopnoea index (AHI): 52+\\/-22] and who had a successful CPAP titration were commenced on CPAP therapy (10+\\/-2cmH2O), and randomized to 4weeks of a nasal pillow (P) and a standard nasal mask (M) in a crossover design. Outcome measures were objective compliance, AHI, quality of life, Epworth Sleepiness Score (ESS) and CPAP side-effects. There was no difference in compliance (M versus P: 5.1+\\/-1.9h versus 5.0+\\/-1.7h; P=0.701) and AHI (2.6+\\/-2.7 versus 3.0+\\/-2.9; P=0.509). Quality of life and ESS improved with CPAP, but there was no difference in the extent of improvement between both devices. Usage of nasal pillows resulted in less reported pressure on the face and more subjects found the nasal pillow the more comfortable device. However, there was no clear overall preference for either device at the end of the study (mask=57%, pillow=43%; P=0.513). The applied CPAP pressure did not correlate with compliance, AHI and ESS. Furthermore, no differences in outcome parameters were noted comparing groups with CPAP pressure <10 and >\\/=10cm H(2) O. Nasal pillows are equally effective in CPAP therapy, but do not generally lead to improved compliance.

  9. [Legionella pneumonia after the use of CPAP equipment].

    Science.gov (United States)

    Stolk, Jaap M; Russcher, Anne; van Elzakker, Erika P M; Schippers, Emile F

    2016-01-01

    Continuous positive airway pressure (CPAP) equipment can be colonised by Legionellae and might cause Legionella pneumonia in the user. However, there is no reported case of Legionella pneumonia related to CPAP equipment in which an identical Legionella was found in both the patient and the CPAP equipment. A 51-year-old man came to the Emergency Department with fever, confusion and dyspnoea that had been present for 3 days. His medical history included obstructive sleep apnoea, for which he had been using CPAP therapy at home for 10 weeks. The CPAP equipment showed signs of poor maintenance. Chest X-ray revealed a pulmonary consolidation. Laboratory investigation resulted in a positive urine antigen test for Legionella. Water from the CPAP equipment and sputum from the patient revealed Legionella pneumophila. Serotyping and sequence-based typing showed an identical L. pneumophila serotype 1 ST37. It is important to be aware that CPAP equipment can be colonised with Legionellae and might cause Legionella pneumonia. It is therefore necessary to ask about CPAP therapy in a patient with community-acquired pneumonia.

  10. Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state

    Institute of Scientific and Technical Information of China (English)

    张希龙; 殷凯生; 王虹; 苏梅; 杨玉

    2003-01-01

    Objectives To characterize the prethrombotic state (PTS) in elderly Chinese patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and the effect of nasal continuous positive airway pressure (nCPAP) ventilation on their PTS.Methods Forty-one elderly patients with moderate and severe OSAHS were enrolled into the OSAHS group and underwent nCPAP treatment. Their blood samples were drawn at 6:00 am and 4:00 pm before and during nCPAP treatment, respectively, to test hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), plasma fibrinogen (fng), prothrombin time (PT) and activated partial thromboplastin time (APTT). All blood factors were also tested in a control group consisting of 32 healthy elderly Chinese with neither OSAHS nor cerebrocardiac vascular disease. Results In the OSAHS group there was a significantly higher hemocrit, WBV, fng, and a significantly shorter PT and APTT at 6:00 am compared to 4:00 pm before nCPAP treatment, while there was no significant difference among all blood test factors between 6:00 am and 4:00 pm on day 30 of the nCPAP treatment. In the OSAHS group, the hemocrit, WBV, PAG and plasma fng were significantly lower and the PT and APTT were significantly longer at 6:00 am on day 30 of the nCPAP treatment compared to 6:00 am before the nCPAP treatment. A significantly lower hemocrit, but a much longer PT and APTT were observed at 4:00 pm on day 30 of the treatment, compared with 4:00 pm before the treatment. No significant difference among the blood test factors was found between 6:00 am and 4:00 pm blood in the control group or between the control and OSAHS groups after 30 days of nCPAP treatment.Conclusion In elderly Chinese OSAHS patients, PTS could be effectively eliminated by nCPAP treatment.

  11. The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Capasso, Robson; Ruoff, Chad M.; Guilleminault, Christian; Kushida, Clete A.; Certal, Victor

    2015-01-01

    Background: The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined. Study Objectives: To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea. Methods: MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed. Results: Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations, which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference of −2.66 cwp (95% confidence intervals, −3.65 to −1.67); P < 0.00001. Eleven studies (153 patients) described subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (< 6 mo of follow-up). Conclusion: Isolated nasal surgery in patients with obstructive sleep apnea and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients. Citation: Camacho M, Riaz M, Capasso R, Ruoff CM, Guilleminault C, Kushida CA, Certal V. The effect of nasal surgery on continuous positive airway pressure device use and therapeutic treatment

  12. Sleep apnoea and the hypothalamic-pituitary-adrenal axis in men and women: effects of continuous positive airway pressure.

    Science.gov (United States)

    Kritikou, Ilia; Basta, Maria; Vgontzas, Alexandros N; Pejovic, Slobodanka; Fernandez-Mendoza, Julio; Liao, Duanping; Bixler, Edward O; Gaines, Jordan; Chrousos, George P

    2016-02-01

    Previous findings on the association of obstructive sleep apnoea (OSA) and the hypothalamic-pituitary-adrenal (HPA) axis are inconsistent, partly due to the confounding effect of obesity and infrequent sampling. Our goal was to examine whether in a relatively nonobese population, OSA is associated with elevated cortisol levels and to assess the effects of a 2-month placebo-controlled continuous positive airway pressure (sham-CPAP) use.72 subjects (35 middle-aged males and post-menopausal females with OSA, and 37 male and female controls) were studied in the sleep laboratory for four nights. 24-h blood sampling was performed every hour on the fourth day and night in the sleep laboratory at baseline, after sham-CPAP and after CPAP treatment.In both apnoeic men and women, OSA was associated with significantly higher 24-h cortisol levels compared with controls, whereas CPAP lowered cortisol levels significantly, close to those of controls.These results suggest that OSA in nonobese men and slightly obese women is associated with HPA axis activation, similar albeit stronger compared with obese individuals with sleep apnoea. Short-term CPAP use decreased cortisol levels significantly compared with baseline, indicating that CPAP may have a protective effect against comorbidities frequently associated with chronic activation of the HPA axis, e.g. hypertension.

  13. Effect of Nasal Obstruction on Continuous Positive Airway Pressure Treatment: Computational Fluid Dynamics Analyses.

    Directory of Open Access Journals (Sweden)

    Tadashi Wakayama

    Full Text Available Nasal obstruction is a common problem in continuous positive airway pressure (CPAP therapy for obstructive sleep apnea and limits treatment compliance. The purpose of this study is to model the effects of nasal obstruction on airflow parameters under CPAP using computational fluid dynamics (CFD, and to clarify quantitatively the relation between airflow velocity and pressure loss coefficient in subjects with and without nasal obstruction.We conducted an observational cross-sectional study of 16 Japanese adult subjects, of whom 9 had nasal obstruction and 7 did not (control group. Three-dimensional reconstructed models of the nasal cavity and nasopharynx with a CPAP mask fitted to the nostrils were created from each subject's CT scans. The digital models were meshed with tetrahedral cells and stereolithography formats were created. CPAP airflow simulations were conducted using CFD software. Airflow streamlines and velocity contours in the nasal cavities and nasopharynx were compared between groups. Simulation models were confirmed to agree with actual measurements of nasal flow rate and with pressure and flow rate in the CPAP machine.Under 10 cmH2O CPAP, average maximum airflow velocity during inspiration was 17.6 ± 5.6 m/s in the nasal obstruction group but only 11.8 ± 1.4 m/s in the control group. The average pressure drop in the nasopharynx relative to inlet static pressure was 2.44 ± 1.41 cmH2O in the nasal obstruction group but only 1.17 ± 0.29 cmH2O in the control group. The nasal obstruction and control groups were clearly separated by a velocity threshold of 13.5 m/s, and pressure loss coefficient threshold of approximately 10.0. In contrast, there was no significant difference in expiratory pressure in the nasopharynx between the groups.This is the first CFD analysis of the effect of nasal obstruction on CPAP treatment. A strong correlation between the inspiratory pressure loss coefficient and maximum airflow velocity was found.

  14. Effects of nasal continuous positive airway pressure treatment on insulin resistance and ghrelin levels in non-diabetic apnoeic patients with coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    YANG Dan; LIU Zhi-hong; ZHAO Qing; LUO Qin

    2013-01-01

    Background Obesity is a common risk factor for several diseases.Obesity related hormone and increased insulin resistance (IR) may contribute to the effects of obstructive sleep apnoea on cardiovascular consequences.We investigated ghrelin and IR in non-diabetic apnoeic patients with stable coronary heart disease and assessed the effects of continuous positive airway pressure (CPAP).Methods Plasma ghrelin,glucose and insulin were measured in 22 patients with CPAP and 22 matched controls without CPAP at baseline and three months.Indexes including homeostasis model assessment IR (HOMA IR),HOMA S and HOMA β were calculated for the assessment of IR,insulin sensitivity and pancreatic β cell function.Results At three months follow-up,plasma ghrelin levels and HOMA IR in CPAP group were significantly decreased (,P=0.002 and 0.046,respectively) while those in control group increased significantly (P=0.012 and 0.009,respectively).Significant moderate correlations were found between ghrelin vs.HOMA IR and ghrelin vs.HOMA S after CPAP,however,for those without CPAP,no significant associations were observed.Conclusions Short-term effective continuous positive airway pressure had a significant effect on lowering plasma ghrelin levels and IR,but not body fat.Further large scale and longer term studies are warranted to corroborate these findings.

  15. Determinants of CPAP Adherence in Hispanics with Obstructive Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Montserrat Diaz-Abad

    2014-01-01

    Full Text Available Purpose. We hypothesized that socioeconomic factors and a language barrier would impact adherence with continuous positive airway pressure (CPAP among Hispanics with obstructive sleep apnea (OSA. Methods. Patients with OSA who were prescribed CPAP for at least 1 year and completed a questionnaire evaluating demographic data, socioeconomic status, and CPAP knowledge and adherence participated in the study. Results. Seventy-nine patients (26 males; 53±11 yrs; body mass index (BMI=45±9 kg/m2 with apnea-hypopnea index (AHI 33±30 events/hr completed the study. Included were 25 Hispanics, 39 African Americans, and 15 Caucasians, with no difference in age, AHI, CPAP use, or BMI between the groups. While there was a difference in educational level (P=0.006, income level (P<0.001, and employment status (P=0.03 between the groups, these did not influence CPAP adherence. Instead, overall improvement in quality of life and health status and perceived benefit from CPAP influenced adherence, both for the group as a whole (P=0.03, P=0.004, and P=0.001, resp., as well as in Hispanics (P=0.02, P=0.02, P=0.03, resp.. Conclusion. In Hispanic patients with OSA, perceived benefit with therapy, rather than socioeconomic status or a language barrier, appears to be the most important factor in determining CPAP adherence.

  16. Sexual function and obstructive sleep apnea-hypopnea : A randomized clinical trial evaluating the effects of oral-appliance and continuous positive airway pressure therapy

    NARCIS (Netherlands)

    Hoekema, Aarnoud; Stel, Anna-Lucia; Stegenga, Boudewijn; van der Hoeven, Johannes H.; Wijkstra, Peter J.; van Driel, Mels F.; de Bont, Lambert G. M.

    2007-01-01

    Introduction. The obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with sexual dysfunction. Although successful treatment with continuous positive airway pressure (CPAP) has been demonstrated to improve sexual function, the effects of oral-appliance therapy are unknown. Aim. The aims

  17. A 64-year old man who sustained many episodes of acute cardiogenic pulmonary edema successfully treated with Boussignac continuous positive airway pressure : A case report

    NARCIS (Netherlands)

    Dieperink, Willem; van der Horst, Iwan C. C.; Nannenberg-Koops, Jaqueline W.; Brouwer, Henk W.; Jaarsma, T.; Nieuwland, Wybe; Zijlstra, Felix; Nijsten, Maarten W. N.

    2007-01-01

    Continuous positive airway pressure (CPAP) is standard treatment for patients with acute cardiogenic pulmonary edema. We describe a patient who had 21 episodes of acute cardiogenic pulmonary edema due to very poor patient compliance. This 64-year old man had end-stage congestive heart failure based

  18. Effect of continuous positive airway pressure treatment on pulmonary artery pressure in patients with isolated obstructive sleep apnea: a meta-analysis.

    Science.gov (United States)

    Imran, Tasnim F; Ghazipura, Marya; Liu, Spencer; Hossain, Tanzib; Ashtyani, Hormoz; Kim, Bernard; Michael Gaziano, J; Djoussé, Luc

    2016-09-01

    Pulmonary hypertension (PH) can occur in patients with obstructive sleep apnea (OSA) in the absence of cardiac or lung disease. Data on the development and severity of PH, and the effect of continuous positive airway pressure (CPAP) therapy on pulmonary artery (PA) pressures in these patients have been inconsistent in the literature. We sought to determine whether CPAP therapy affects PA pressures in patients with isolated OSA in this meta-analysis. We searched PubMed, Medline, EMBASE and other databases from January 1980 to August 2015. Studies of patients with OSA, defined as an apnea-hypopnea index >10 events/h, and PH, defined as PA pressure >25 mmHg were included. Two reviewers independently extracted data and assessed risk of bias. A total of 222 patients from seven studies (341.53 person-years) had reported PA pressures before and after treatment with CPAP therapy. 77 % of participants were men, with a mean age of 52.5 years, a mean apnea-hypopnea index of 58 events/h, and mean PA pressure of 39.3 ± 6.3 mmHg. CPAP treatment duration ranged from 3 to 70 months. Using fixed effects meta-analysis, CPAP therapy was associated with a decrease in PA pressure of 13.3 mmHg (95 % CI 12.7-14.0) in our study population. This meta-analysis found that CPAP therapy is associated with a significantly lower PA pressure in patients with isolated OSA and PH.

  19. Effect of continuous positive airway pressure on arterial stiffness in patients with obstructive sleep apnea and hypertension: a meta-analysis.

    Science.gov (United States)

    Lin, Xin; Chen, Gongping; Qi, Jiachao; Chen, Xiaofang; Zhao, Jiangming; Lin, Qichang

    2016-12-01

    Arterial stiffness has been recognized as a predictor of cardiovascular and all-cause mortality in hypertensive patients. However, the impact of continuous positive airway pressure (CPAP) on arterial stiffness in patients with OSA and hypertension remains inconclusive. We performed a meta-analysis to determine whether effective CPAP therapy could decrease arterial stiffness. Two reviewers independently searched PubMed, Embase, Web of Science and Cochrane Library prior to March 5, 2015. Information on characteristics of subjects, study design and pre- and post-CPAP treatment of arterial stiffness was extracted for analysis. Standardized mean difference (SMD) was used to analyze the summary estimates for CPAP therapy. Three articles with 186 patients were included in this meta-analysis, including two observational studies and one randomized controlled study. The meta-analysis showed that CPAP was associated with a statistically significant decrease in arterial stiffness in patients with OSA and hypertension (SMD = -0.65, 95 % confidence interval (CI) = -1.14 to -0.16, z = 2.60, p = 0.009). Our meta-analysis suggested that CPAP among OSA and hypertensive patients was significantly associated with a decrease in arterial stiffness. Further prospective large-scale multicenter RCTs are needed to explore the precise impact of CPAP therapy on arterial stiffness in patients with OSA and hypertension.

  20. Gaseous distention of the hypopharynx and cervical esophagus with nasal CPAP: a mimicker of pharyngeal perforation and esophageal atresia

    Energy Technology Data Exchange (ETDEWEB)

    Walor, David; Berdon, Walter; Holt, Peter D.; Fox, Matthew [Columbia University Medical Center, Department of Radiology, New York, NY (United States); Children' s Hospital of New York, New York, NY (United States); Anderson, Nicole [Columbia University Medical Center, Department of Neonatology, New York, NY (United States); Children' s Hospital of New York, New York, NY (United States)

    2005-12-01

    Nasal continuous positive airway pressure (CPAP) has been used since 1975 as the initial treatment for respiratory distress syndrome (RDS) in very premature infants. Gaseous distention of the abdomen (CPAP belly) is a common secondary effect of CPAP. Gaseous distention of the hypopharynx is also common. To determine the incidence of hypopharyngeal distention in infants on CPAP. We performed a retrospective review of the chest radiographs of 57 premature infants treated with CPAP during a 4-week period to find the presence and degree of hypopharyngeal distention. Of the 57 radiographs, 14 (25%) revealed gaseous distention of the hypopharynx and/or cervical esophagus. On occasion, this raised concern for pharyngeal perforation or esophageal atresia. Awareness that CPAP-related hypopharyngeal distention is common should help radiologists avoid erroneous consideration of esophageal atresia or hypopharyngeal perforation. (orig.)

  1. Selective indication for positive airway pressure (PAP in sleep-related breathing disorders with obstruction

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    Stasche, Norbert

    2006-10-01

    Full Text Available Positive airway pressure (PAP is the therapy of choice for most sleep-related breathing disorders (SRBD. A variety of PAP devices using positive airway pressure (CPAP, BiPAP, APAP, ASV must be carefully considered before application. This overview aims to provide criteria for choosing the optimal PAP device according to severity and type of sleep-related breathing disorder. In addition, the range of therapeutic applications, constraints and side effects as well as alternative methods to PAP will be discussed. This review is based on an analysis of current literature and clinical experience. The data is presented from an ENT-sleep-laboratory perspective and is designed to help the ENT practitioner initiate treatment and provide support. Different titration methods, current devices and possible applications will be described. In addition to constant pressure devices (CPAP, most commonly used for symptomatic obstructive sleep apnoea (OSA without complicating conditions, BiPAP models will be introduced. These allow two different positive pressure settings and are thus especially suitable for patients with cardiopulmonary diseases or patients with pressure intolerance, increasing compliance in this subgroup considerably. Compliance can also be increased in patients during first night of therapy, patients with highly variable pressure demands or position-dependent OSA, by using self-regulating Auto-adjust PAP devices (Automatic positive airway pressure, APAP. Patients with Cheyne-Stokes breathing, a subtype of central sleep apnoea, benefit from adaptive servo-ventilation (ASV, which analyzes breathing patterns continually and adjusts the actual ventilation pressure accordingly. This not only reduces daytime sleepiness, but can also influence heart disease positively. Therapy with positive airway pressure is very effective in eliminating obstruction-related sleep diseases and symptoms. However, because therapy is generally applied for life, the optimal

  2. Effectiveness of continuous positive airway pressure in lowering blood pressure in patients with obstructive sleep apnea: a critical review of the literature

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    Fatureto-Borges F

    2016-03-01

    Full Text Available Fernanda Fatureto-Borges,1 Geraldo Lorenzi-Filho,2 Luciano F Drager1,3 1Hypertension Unit, Heart Institute (InCor, 2Sleep Laboratory, Pulmonary Division, 3Hypertension Unit, Renal Division, University of Sao Paulo Medical School, Sao Paulo, Brazil Abstract: Obstructive sleep apnea (OSA is an extremely common comorbid condition in patients with hypertension, with a prevalence of ~50%. There is growing evidence suggesting that OSA is a secondary cause of hypertension, associated with both poor blood pressure (BP control and target organ damage in patients with hypertension. The application of continuous positive airway pressure (CPAP during sleep is the gold standard treatment of moderate- to-severe OSA and very effective in abolishing obstructive respiratory events. However, several meta-analyses showed that the overall impact of CPAP on BP is modest (~2 mmHg. There are several potential reasons for this disappointing finding, including the heterogeneity of patients studied (normotensive patients, controlled, and uncontrolled patients with hypertension, nonideal CPAP compliance, clinical presentation (there is some evidence that the positive impact of CPAP on lowering BP is more evident in sleepy patients, and the multifactorial nature of hypertension. In this review, we performed a critical analysis of the literature evaluating the impact of CPAP on BP in several subgroups of patients. We finally discussed perspectives in this important research area, including the urgent need to identify predictors of BP response to CPAP and the importance of precision medicine in this scenario. Keywords: cardiovascular disease, CPAP, hypertension, sleep apnea, treatment

  3. Effect of continuous positive airway pressure therapy on hypothalamic-pituitary-adrenal axis function and 24-h blood pressure profile in obese men with obstructive sleep apnea syndrome.

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    Carneiro, Gláucia; Togeiro, Sônia Maria; Hayashi, Lílian F; Ribeiro-Filho, Fernando Flexa; Ribeiro, Artur Beltrame; Tufik, Sérgio; Zanella, Maria Teresa

    2008-08-01

    Obstructive sleep apnea syndrome (OSAS) increases the risk of cardiovascular events. Sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis activation may be the mechanism of this relationship. The aim of this study was to evaluate HPA axis and ambulatory blood pressure monitoring in obese men with and without OSAS and to determine whether nasal continuous positive airway pressure therapy (nCPAP) influenced responses. Twenty-four-hour ambulatory blood pressure monitoring and overnight cortisol suppression test with 0.25 mg of dexamethasone were performed in 16 obese men with OSAS and 13 obese men controls. Nine men with severe apnea were reevaluated 3 mo after nCPAP therapy. Body mass index and blood pressure of OSAS patients and obese controls were similar. In OSAS patients, the percentage of fall in systolic blood pressure at night (P = 0.027) and salivary cortisol suppression postdexamethasone (P = 0.038) were lower, whereas heart rate (P = 0.022) was higher compared with obese controls. After nCPAP therapy, patients showed a reduction in heart rate (P = 0.036) and a greater cortisol suppression after dexamethasone (P = 0.001). No difference in arterial blood pressure (P = 0.183) was observed after 3 mo of nCPAP therapy. Improvement in cortisol suppression was positively correlated with an improvement in apnea-hypopnea index during nCPAP therapy (r = 0.799, P = 0.010). In conclusion, men with OSAS present increased postdexamethasone cortisol levels and heart rate, which were recovered by nCPAP.

  4. Withdrawal of Continuous Positive Airway Pressure Therapy after Malar Advancement and Le Fort II Distraction in a Case of Apert Syndrome with Obstructive Sleep Apnea

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    Nobuto Onda

    2015-01-01

    Full Text Available Apert syndrome is a congenital syndrome characterized by craniosynostosis and craniofacial dysostosis, among other features, and is reported to cause obstructive sleep apnea (OSA because of upper airway narrowing associated with midfacial dysplasia. We recently encountered a case involving a patient with Apert syndrome complicated by OSA who began to receive continuous positive airway pressure (CPAP therapy at the age of 4. OSA resolved after maxillofacial surgery performed at the age of 11, and CPAP was eventually withdrawn. In pediatric patients with maxillofacial dysplasia complicated by OSA, a long-term treatment plan including CPAP in addition to maxillofacial plastic and reconstructive surgery should be considered in view of the effects of OSA on growth.

  5. Very Preterm Infants Failing CPAP Show Signs of Fatigue Immediately after Birth.

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    Melissa L Siew

    Full Text Available To investigate the differences in breathing pattern and effort in infants at birth who failed or succeeded on continuous positive airway pressure (CPAP during the first 48 hours after birth.Respiratory function recordings of 32 preterm infants were reviewed of which 15 infants with a gestational age of 28.6 (0.7 weeks failed CPAP and 17 infants with a GA of 30.1 (0.4 weeks did not fail CPAP. Frequency, duration and tidal volumes (VT of expiratory holds (EHs, peak inspiratory flows, CPAP-level and FiO2-levels were analysed.EH incidence increased 9 ml/kg with higher peak inspiratory flows than CPAP-fail infants (71.8 ± 15.8 vs. 15.5 ± 5.2 ml/kg.s, p <0.05. CPAP-fail infants required higher FiO2 (0.31 ± 0.03 vs. 0.21 ± 0.01, higher CPAP pressures (6.62 ± 0.3 vs. 5.67 ± 0.26 cmH2O and more positive pressure-delivered breaths (45 ± 12 vs. 19 ± 9% (p <0.05.At 9-12 minutes after birth, CPAP-fail infants more commonly used lower VTs and required higher peak inspiratory flow rates while receiving greater respiratory support. VT was less variable and larger VT was infrequently used reflecting early signs of fatigue.

  6. Effects of 12 months continuous positive airway pressure on sympathetic activity related brainstem function and structure in obstructive sleep apnea.

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    Luke Anthony Henderson

    2016-03-01

    Full Text Available Muscle sympathetic nerve activity (MSNA is greatly elevated in patients with obstructive sleep apnoea (OSA during normoxic daytime wakefulness. Increased MSNA is a precursor to hypertension and elevated cardiovascular morbidity and mortality. However, the mechanisms underlying the high MSNA in OSA are not well understood. In this study we used concurrent microneurography and magnetic resonance imaging to explore MSNA-related brainstem activity changes and anatomical changes in 15 control and 15 subjects with OSA prior to and following 6 and 12 months of continuous positive airway pressure (CPAP treatment. We found that 6 and 12 months of CPAP treatment significantly reduced the elevated resting MSNA in individuals with OSA. Furthermore, this MSNA reduction was associated with restoration of MSNA-related activity and structural changes in the medullary raphe, rostral ventrolateral medulla, dorsolateral pons and ventral midbrain. This restoration occurred after 6 months of CPAP treatment and was maintained following 12 months CPAP. These findings show that continual CPAP treatment is an effective long-term treatment for elevated MNSA likely due to its effects on restoring brainstem structure and function.

  7. Extreme REM Rebound during Continuous Positive Airway Pressure Titration for Obstructive Sleep Apnea in a Depressed Patient

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    Anna Lo Bue

    2014-01-01

    Full Text Available A 20% increase in REM sleep duration has been proposed as a threshold to identify REM rebound in patients with obstructive sleep apnea (OSA who start continuous positive airway pressure (CPAP treatment. We describe the case of one patient with OSA who showed an unexpectedly high degree of REM rebound during titration of CPAP. A 34-year-old man was diagnosed with OSA. He remained untreated for many years, during which he developed systemic hypertension, depression, and severe daytime somnolence. When he was reevaluated sixteen years later, his Epworth sleepiness score was 18, and his OSA had greatly worsened (apnea/hypopnea index: 47, lowest nocturnal saturation: 57%. He underwent a successful CPAP titration during nocturnal polysomnography. Electroencephalographic analysis of the sleep recording revealed a huge amount of REM sleep, accounting for 72% of the total sleep time. When asked, the patient referred that he had suddenly interrupted paroxetine assumption three days before the polysomnography. The very large REM rebound observed in this patient could be due to additional effects of initiation of CPAP therapy and suspension of antidepressive treatment. This case does not report any dangerous consequence, but sudden antidepressive withdrawal could be dangerous for patients with OSA who develop hypoventilation during REM sleep with CPAP application.

  8. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

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    Goldstein, Jeffrey D. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Lawrence, Yaacov R. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Segel, Michael J.; Peled, Nir [Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Symon, Zvi, E-mail: symonz@sheba.health.gov.il [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2015-10-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

  9. CPAP Tips

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    Full Text Available ... 765 views 5:58 Airing: The world's first micro- CPAP for sleep apnea - Duration: 4:26. Airing ... views 6:41 Airing: the first hoseless, maskless, micro-CPAP by Three P's Entertainment - Duration: 4:39. ...

  10. The effect of short-term withdrawal from continuous positive airway pressure therapy on sympathetic activity and markers of vascular inflammation in subjects with obstructive sleep apnoea.

    Science.gov (United States)

    Phillips, Craig L; Yang, Qiao; Williams, Andrew; Roth, Michael; Yee, Brendon J; Hedner, Jan A; Berend, Norbert; Grunstein, Ronald R

    2007-06-01

    Obstructive sleep apnoea (OSA) is commonly associated with cardiovascular disease and sympathetic activation. However, it is unclear whether this association is independent of obesity and to what extent treatment with nasal continuous positive airway pressure (CPAP) alleviates the vascular inflammation that underpins cardiovascular disease. We therefore evaluated whether short-term withdrawal from CPAP therapy in subjects with moderate-severe OSA would result in increased levels of sympathetic activity and circulating inflammatory cytokines independent of weight. Vascular inflammatory markers (hsCRP, hsIL-6 and hsTNF-alpha) were assessed in 20 subjects after one and seven nights of withdrawal from CPAP together with the hypoxia-responsive angiogenic marker VEGF and urinary catecholamines. Compared with baseline on CPAP, withdrawal from therapy resulted in an immediate return of OSA with an increase in RDI to 26.7 +/- 5.2 and 39.0 +/- 5.9 events per hour after one and seven nights without CPAP, respectively (both P 0.1). In conclusion, 1 week of CPAP withdrawal was associated with a return of OSA and a marked increase in sympathetic activity without a concomitant elevation of vascular inflammatory markers.

  11. Obstructive sleep apnea syndrome, continuous positive airway pressure and treatment of hypertension.

    Science.gov (United States)

    Floras, John S

    2015-09-15

    Obstructive sleep apnea (OSA), present in ~15% of the general population, increases the risks of stroke, heart failure, and premature death. Importantly, individuals with cardiovascular disease have a higher prevalence yet they often have few symptoms to alert clinicians to its presence. OSA with an apnea-hypopnea index (AHI) ≥15 events/hour is present in ≥30% of patients with primary hypertension and in up to 80% of those with drug resistant hypertension, suggesting that the neural, hormonal, inflammatory and vascular cascades triggered by OSA may elevate blood pressure chronically. The purpose of this review is to summarize: (1) the epidemiology of OSA and its relation to cardiovascular risk; (2) potential mechanisms by which OSA could promote conditions known to increase the risk of hypertension or contribute to its development and progression; (3) evidence for and against a pro-hypertensive effect of OSA; and, (4) the impact of treatment with continuous positive airway pressure (CPAP) on blood pressure and blood pressure-related morbidities. The prevailing view that the effect of treatment on blood pressure is modest arises from the inability of most contemporary technology to measure accurately the true impact of CPAP on OSA-entrained surges in nocturnal blood pressure. Moreover the exclusive focus on blood pressure, as if this is the principal determinant of cardiovascular event rates in this population, is naïve. The capacity to reduce cardiovascular risk by treating OSA with CPAP likely transcends a simple blood pressure effect; formal testing of this hypothesis will require adequately powered randomized clinical trials.

  12. Significant improvement of olfactory performance in sleep apnea patients after three months of nasal CPAP therapy – Observational study and randomized trial

    Science.gov (United States)

    Boerner, Bettina; Tini, Gabrielo M.; Fachinger, Patrick; Graber, Sereina M.; Irani, Sarosh

    2017-01-01

    Objectives The olfactory function highly impacts quality of life (QoL). Continuous positive airway pressure is an effective treatment for obstructive sleep apnea (OSA) and is often applied by nasal masks (nCPAP). The influence of nCPAP on the olfactory performance of OSA patients is unknown. The aim of this study was to assess the sense of smell before initiation of nCPAP and after three months treatment, in moderate and severe OSA patients. Methods The sense of smell was assessed in 35 patients suffering from daytime sleepiness and moderate to severe OSA (apnea/hypopnea index ≥ 15/h), with the aid of a validated test battery (Sniffin’ Sticks) before initiation of nCPAP therapy and after three months of treatment. Additionally, adherent subjects were included in a double-blind randomized three weeks CPAP-withdrawal trial (sub-therapeutic CPAP pressure). Results Twenty five of the 35 patients used the nCPAP therapy for more than four hours per night, and for more than 70% of nights (adherent group). The olfactory performance of these patients improved significantly (p = 0.007) after three months of nCPAP therapy. When considering the entire group of patients, olfaction also improved significantly (p = 0.001). In the randomized phase the sense of smell of six patients deteriorated under sub-therapeutic CPAP pressure (p = 0.046) whereas five patients in the maintenance CPAP group showed no significant difference (p = 0.501). Conclusions Olfactory performance improved significantly after three months of nCPAP therapy in patients suffering from moderate and severe OSA. It seems that this effect of nCPAP is reversible under sub-therapeutic CPAP pressure. Trial registration ISRCTN11128866 PMID:28158212

  13. Effect of CPAP therapy on endothelial function in obstructive sleep apnoea: A systematic review and meta-analysis.

    Science.gov (United States)

    Schwarz, Esther I; Puhan, Milo A; Schlatzer, Christian; Stradling, John R; Kohler, Malcolm

    2015-08-01

    Obstructive sleep apnoea (OSA) is a prevalent sleep-related breathing disorder associated with adverse cardiovascular outcome. Endothelial dysfunction is one of the proposed mechanistic links between OSA and the increased cardiovascular risk. Treatment with continuous positive airway pressure (CPAP) may reverse this detrimental pathophysiological consequence of OSA. Most studies on the effect of CPAP on endothelial function in OSA are limited by their low sample size. The objective of this systematic review was to assess the effect CPAP therapy on endothelial function in patients with OSA. We conducted a systematic review and meta-analysis searching literature databases up to August 2013 for randomized controlled trials (RCTs) on the effect of CPAP on endothelial function in OSA, assessed by flow-mediated dilatation (FMD) and other validated techniques. The primary outcome for the meta-analysis (DerSimonian/Laird random-effects method) was the treatment effect on FMD. Eight RCTs comparing the effects of therapeutic CPAP versus subtherapeutic CPAP (or no intervention) on endothelial function involving 245 OSA patients were included in the systematic review. The studies are consistent in effect direction, showing an improvement of endothelial function by CPAP. Four RCTs involving 150 patients could be used for the meta-analysis. Compared to the control group, CPAP therapy (range 2-24 weeks) significantly increased absolute % FMD by 3.87% (95% confidence interval: 1.93-5.80, P CPAP therapy improves endothelial function significantly and to a clinically important extent.

  14. Effect of ethanol on the efficacy of nasal continuous positive airway pressure as a treatment for obstructive sleep apnea.

    Science.gov (United States)

    Berry, R B; Desa, M M; Light, R W

    1991-02-01

    The effect of ethanol ingestion on the efficacy of nasal continuous positive airway pressure (nasal CPAP) as a treatment for the obstructive sleep apnea (OSA) syndrome was studied in ten obese male subjects undergoing this therapy. On the first night of polysomnography, the lowest level of CPAP that maintained airway patency was determined (critical level). On the second (control) night (C), subjects slept the entire night on this level of CPAP. On the third night (E), subjects ingested either 1.5 ml/kg (part A, N = 6) or 2.0 ml/kg (part B, N = 4) of 50 percent ethanol (100 proof vodka) over one half-hour starting 1 h before bedtime. A serum ethanol level was obtained at bedtime (part A: 63.7 +/- 17.3 mg/dl; part B: 108.6 +/- 20.6 mg/dl), and subjects were monitored on the critical level of CPAP. Comparison of nights C and E for parts A + B showed no difference in total sleep time (TST) or the amount of different sleep stages as an absolute time or a percentage of TST except that there was more stage 2 (as a percent of TST) on E nights. The apnea + hypopnea index and C and E nights did not differ and was quite low (3.6 +/- 3.7/h vs 1.9 +/- 2.7/h). Similarly, ethanol ingestion did not increase the number of desaturations to at or below 90 and 85 percent, or lower the mean arterial oxygen saturation in NREM or REM sleep. Analysis of parts A and B separately also showed no differences with respect to the apnea + hypopnea index or the number of desaturations on control and ethanol nights. We conclude that acute moderate ethanol ingestion does not decrease the efficacy of an optimum level of nasal CPAP.

  15. CPAP Tips

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    Full Text Available ... navigation Sign in Search Loading... Close Yeah, keep it Undo Close This video is unavailable. Watch Queue ... Why CPAP Sucks and What to Do About It - Duration: 8:46. apapuser 242,319 views 8: ...

  16. Obstructive sleep apnea syndrome and cognitive impairment: effects of CPAP

    Directory of Open Access Journals (Sweden)

    Alessandra Giordano

    2011-10-01

    Full Text Available Obstructive Sleep Apnea Syndrome (OSAS is a sleep disorder characterised by repetitive episodes of upper airway obstruction (apnea or reduced airflow (hypopnoea despite persistent respiratory effort. Apnea is defined as the cessation of breathing for at least 10 seconds during sleep, while hypopnoea is defined as at least 30% reduction in airflow for 10 seconds associated with oxygen desaturation and sleep fragmentation. The presence in the general population is about 4%. The principal symptoms are: excessive daytime sleepiness (EDS, snoring, dry throat, morning headache, night sweats, gastro-esophageal reflux, and increased blood pressure.Long term complications can be: increased cardio-cerebrovascular risk and cognitive impairment such as deficiency in attention, vigilance, visual abilities, thought, speech, perception and short term memory.Continuous Positive Airway Pressure (CPAP is currently the best non-invasive therapy for OSAS.CPAP guarantees the opening of upper airways using pulmonary reflexive mechanisms increasing lung volume during exhalation and resistance reduction, decreasing electromyografical muscular activity around airways.The causes of cognitive impairments and their possible reversibility after CPAP treatment have been analysed in numerous studies. The findings, albeit controversial, show that memory, attention and executive functions are the most compromised cognitive functions.The necessity of increasing the patient compliance with ventilotherapy is evident, in order to prevent cognitive deterioration and, when possible, rehabilitate the compromised functions, a difficult task for executive functions.

  17. Efficacy of Home Single-Channel Nasal Pressure for Recommending Continuous Positive Airway Pressure Treatment in Sleep Apnea

    Science.gov (United States)

    Masa, Juan F.; Duran-Cantolla, Joaquin; Capote, Francisco; Cabello, Marta; Abad, Jorge; Garcia-Rio, Francisco; Ferrer, Antoni; Fortuna, Ana M.; Gonzalez-Mangado, Nicolas; de la Peña, Monica; Aizpuru, Felipe; Barbe, Ferran; Montserrat, Jose M.; Larrateguy, Luis D.; de Castro, Jorge Rey; Garcia-Ledesma, Estefania; Corral, Jaime; Martin-Vicente, Maria J.; Martinez-Null, Cristina; Egea, Carlos; Cancelo, Laura; García-Díaz, Emilio; Carmona-Bernal, Carmen; Sánchez-Armengol, Ángeles; Mayos, Merche; Miralda, Rosa M; Troncoso, Maria F.; Gonzalez, Monica; Martinez-Martinez, Marian; Cantalejo, Olga; Piérola, Javier; Vigil, Laura; Embid, Cristina; del Mar Centelles, Mireia; Prieto, Teresa Ramírez; Rojo, Blas; Lores, Vanesa

    2015-01-01

    Introduction: Unlike other prevalent diseases, obstructive sleep apnea (OSA) has no simple tool for diagnosis and therapeutic decision-making in primary healthcare. Home single-channel nasal pressure (HNP) may be an alternative to polysomnography for diagnosis but its use in therapeutic decisions has yet to be explored. Objectives: To ascertain whether an automatically scored HNP apnea-hypopnea index (AHI), used alone to recommend continuous positive airway pressure (CPAP) treatment, agrees with decisions made by a specialist using polysomnography and several clinical variables. Methods: Patients referred by primary care physicians for OSA suspicion underwent randomized polysomnography and HNP. We analyzed the total sample and both more and less symptomatic subgroups for Bland and Altman plots to explore AHI agreement; receiver operating characteristic curves to establish area under the curve (AUC) measurements for CPAP recommendation; and therapeutic decision efficacy for several HNP AHI cutoff points. Results: Of the 787 randomized patients, 35 (4%) were lost, 378 (48%) formed the more symptomatic and 374 (48%) the less symptomatic subgroups. AHI bias and agreement limits were 5.8 ± 39.6 for the total sample, 5.3 ± 38.7 for the more symptomatic, and 6 ± 40.2 for the less symptomatic subgroups. The AUC were 0.826 for the total sample, 0.903 for the more symptomatic, and 0.772 for the less symptomatic subgroups. In the more symptomatic subgroup, 70% of patients could be correctly treated with CPAP. Conclusion: Automatic home single-channel nasal pressure scoring can correctly recommend CPAP treatment in most of more symptomatic patients with OSA suspicion. Our results suggest that this device may be an interesting tool in initial OSA management for primary care physicians, although future studies in a primary care setting are necessary. Clinical Trials Information: Clinicaltrial.gov identifier: NCT01347398. Citation: Masa JF, Duran-Cantolla J, Capote F, Cabello

  18. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial.

    Science.gov (United States)

    Muxfeldt, Elizabeth S; Margallo, Victor; Costa, Leonardo M S; Guimarães, Gleison; Cavalcante, Aline H; Azevedo, João C M; de Souza, Fabio; Cardoso, Claudia R L; Salles, Gil F

    2015-04-01

    The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, -11.3 to +3.1 mm Hg; P=0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, -1.6% to +5.8%; P=0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.

  19. Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: a meta-analysis

    NARCIS (Netherlands)

    W.A. Kylstra; J.A. Aaronson; W.F. Hofman; B.A. Schmand

    2012-01-01

    The generally held clinical view is that treatment with continuous positive airway pressure (CPAP) improves cognition in patients with obstructive sleep apnea (OSA). However, the cognitive domains in which recovery is found differ between studies. A meta-analysis was conducted to quantify the effect

  20. Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: a meta-analysis

    NARCIS (Netherlands)

    W.A. Kylstra; J.A. Aaronson; W.F. Hofman; B.A. Schmand

    2013-01-01

    The generally held clinical view is that treatment with continuous positive airway pressure (CPAP) improves cognition in patients with obstructive sleep apnea (OSA). However, the cognitive domains in which recovery is found differ between studies. A meta-analysis was conducted to quantify the effect

  1. CPAP and High-Flow Nasal Cannula Oxygen in Bronchiolitis.

    Science.gov (United States)

    Sinha, Ian P; McBride, Antonia K S; Smith, Rachel; Fernandes, Ricardo M

    2015-09-01

    Severe respiratory failure develops in some infants with bronchiolitis because of a complex pathophysiologic process involving increased airways resistance, alveolar atelectasis, muscle fatigue, and hypoxemia due to mismatch between ventilation and perfusion. Nasal CPAP and high-flow nasal cannula (HFNC) oxygen may improve the work of breathing and oxygenation. Although the mechanisms behind these noninvasive modalities of respiratory support are not well understood, they may help infants by way of distending pressure and delivery of high concentrations of warmed and humidified oxygen. Observational studies of varying quality have suggested that CPAP and HFNC may confer direct physiologic benefits to infants with bronchiolitis and that their use has reduced the need for intubation. No trials to our knowledge, however, have compared CPAP with HFNC in bronchiolitis. Two randomized trials compared CPAP with oxygen delivered by low-flow nasal cannula or face mask and found some improvements in blood gas results and some physiologic parameters, but these trials were unable to demonstrate a reduction in the need for intubation. Two trials evaluated HFNC in bronchiolitis (one comparing it with headbox oxygen, the other with nebulized hypertonic saline), with the results not seeming to suggest important clinical or physiologic benefits. In this article, we review the pathophysiology of respiratory failure in bronchiolitis, discuss these trials in detail, and consider how future research studies may be designed to best evaluate CPAP and HFNC in bronchiolitis.

  2. EXTUBATE: A randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Victor Suresh

    2011-12-01

    Full Text Available Abstract Background Respiratory distress syndrome remains a significant problem among premature infants. Mechanical ventilation through an endotracheal tube remains the mainstay of respiratory support but may be associated with lung injury and the development of chronic lung disease of prematurity. Efforts are needed to reduce the duration of mechanical ventilation in favour of less invasive forms of respiratory support and to improve rates of successful extubation. Non-invasive respiratory support has been demonstrated to be less injurious to the premature lung. Standard practice is to use nasal continuous positive airway pressure (n-CPAP following extubation to support the baby's breathing. Many clinicians also use nasal biphasic positive airway pressure (n-BiPAP in efforts to improve rates of successful extubation. However, there is currently no evidence that this confers any advantage over conventional nasal continuous positive airway pressure. Methods We propose an unblinded multi-centre randomised trial comparing n-CPAP with n-BiPAP in babies born before 30 weeks' gestation and less than two weeks old. Babies with congenital abnormalities and severe intra-ventricular haemorrhage will be excluded. 540 babies admitted to neonatal centres in England will be randomised at the time of first extubation attempt. The primary aim of this study is to compare the rate of extubation failure within 48 hours following the first attempt at extubation. The secondary aims are to compare the effect of n-BiPAP and n-CPAP on the following outcomes: 1. Maintenance of successful extubation for 7 days post extubation 2. Oxygen requirement at 28 days of age and at 36 weeks' corrected gestational age 3. Total days on ventilator, n-CPAP/n-BiPAP 4. Number of ventilator days following first extubation attempt 5. pH and partial pressure of carbon dioxide in the first post extubation blood gas 6. Duration of hospital stay 7. Rate of abdominal distension requiring

  3. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea.

    Science.gov (United States)

    McEvoy, R Doug; Antic, Nick A; Heeley, Emma; Luo, Yuanming; Ou, Qiong; Zhang, Xilong; Mediano, Olga; Chen, Rui; Drager, Luciano F; Liu, Zhihong; Chen, Guofang; Du, Baoliang; McArdle, Nigel; Mukherjee, Sutapa; Tripathi, Manjari; Billot, Laurent; Li, Qiang; Lorenzi-Filho, Geraldo; Barbe, Ferran; Redline, Susan; Wang, Jiguang; Arima, Hisatomi; Neal, Bruce; White, David P; Grunstein, Ron R; Zhong, Nanshan; Anderson, Craig S

    2016-09-01

    Background Obstructive sleep apnea is associated with an increased risk of cardiovascular events; whether treatment with continuous positive airway pressure (CPAP) prevents major cardiovascular events is uncertain. Methods After a 1-week run-in period during which the participants used sham CPAP, we randomly assigned 2717 eligible adults between 45 and 75 years of age who had moderate-to-severe obstructive sleep apnea and coronary or cerebrovascular disease to receive CPAP treatment plus usual care (CPAP group) or usual care alone (usual-care group). The primary composite end point was death from cardiovascular causes, myocardial infarction, stroke, or hospitalization for unstable angina, heart failure, or transient ischemic attack. Secondary end points included other cardiovascular outcomes, health-related quality of life, snoring symptoms, daytime sleepiness, and mood. Results Most of the participants were men who had moderate-to-severe obstructive sleep apnea and minimal sleepiness. In the CPAP group, the mean duration of adherence to CPAP therapy was 3.3 hours per night, and the mean apnea-hypopnea index (the number of apnea or hypopnea events per hour of recording) decreased from 29.0 events per hour at baseline to 3.7 events per hour during follow-up. After a mean follow-up of 3.7 years, a primary end-point event had occurred in 229 participants in the CPAP group (17.0%) and in 207 participants in the usual-care group (15.4%) (hazard ratio with CPAP, 1.10; 95% confidence interval, 0.91 to 1.32; P=0.34). No significant effect on any individual or other composite cardiovascular end point was observed. CPAP significantly reduced snoring and daytime sleepiness and improved health-related quality of life and mood. Conclusions Therapy with CPAP plus usual care, as compared with usual care alone, did not prevent cardiovascular events in patients with moderate-to-severe obstructive sleep apnea and established cardiovascular disease. (Funded by the National Health and

  4. Auto-titrating versus fixed continuous positive airway pressure for the treatment of obstructive sleep apnea: a systematic review with meta-analyses

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    Ip Stanley

    2012-03-01

    Full Text Available Abstract Background Obstructive sleep apnea is a relatively common disorder that can lead to lost productivity and cardiovascular disease. The form of positive airway treatment that should be offered is unclear. Methods MEDLINE and the Cochrane Central Trials registry were searched for English language randomized controlled trials comparing auto-titrating positive airway pressure (APAP with continuous positive airway pressure (CPAP in adults with obstructive sleep apnea (inception through 9/2010. Six researchers extracted information on study design, potential bias, patient characteristics, interventions and outcomes. Data for each study were extracted by one reviewer and confirmed by another. Random effects model meta-analyses were performed for selected outcomes. Results Twenty-four randomized controlled trials met the inclusion criteria. In individual studies, APAP and fixed CPAP resulted in similar changes from baseline in the apnea-hypopnea index, most other sleep study measures and quality of life. By meta-analysis, APAP improved compliance by 11 minutes per night (95% CI, 3 to 19 minutes and reduced sleepiness as measured by the Epworth Sleepiness Scale by 0.5 points (95% CI, 0.8 to 0.2 point reduction compared with fixed CPAP. Fixed CPAP improved minimum oxygen saturation by 1.3% more than APAP (95% CI, 0.4 to 2.2%. Studies had relatively short follow-up and generally excluded patients with significant comorbidities. No study reported on objective clinical outcomes. Conclusions Statistically significant differences were found but clinical importance is unclear. Because the treatment effects are similar between APAP and CPAP, the therapy of choice may depend on other factors such as patient preference, specific reasons for non-compliance and cost.

  5. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis

    Science.gov (United States)

    Iftikhar, Imran H.; Valentine, Christopher W.; Bittencourt, Lia R.A.; Cohen, Debbie L.; Fedson, Annette C.; Gíslason, Thorarinn; Penzel, Thomas; Phillips, Craig L.; Yu-sheng, Lin; Pack, Allan I.; Magalang, Ulysses J.

    2015-01-01

    Objective To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA). Methods Design – meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions – CPAP treatment. Results A total of six studies met the inclusion criteria for preintervention to postintervention analyses. The pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were −7.21 mmHg [95% confidence interval (CI): −9.04 to −5.38; P <0.001; I2 58%) and −4.99 mmHg (95% CI: −6.01 to −3.96; P <0.001; I2 31%), respectively. The pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of −6.74 mmHg [95% CI: −9.98 to −3.49; P <0.001; I2 61%] and −5.94 mmHg (95% CI: −9.40 to −2.47; P =0.001; I2 76%), respectively, in favor of the CPAP group. Conclusion The pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. The effects sizes are larger than those previously reported in patients with OSA without resistant hypertension. PMID:25243523

  6. Impact of a New Nasal Pillows Mask on Patients' Acceptance, Compliance, and Willingness to Remain on CPAP Therapy.

    Science.gov (United States)

    Wimms, Alison; Ketheeswaran, Sahisha; Ziegenbein, Claus; Jennings, Laura; Woehrle, Holger

    2016-01-01

    Aim. Continuous positive airway pressure (CPAP) masks are a key factor in patient compliance. This program assessed the performance of a new nasal pillows mask (NPM) on a variety of new and established obstructive sleep apnea (OSA) patients using CPAP therapy. Methods. Five programs were developed to assess the new NPM [AirFit P10, ResMed] on naïve patients; patients established on another NPM; patients using a nasal mask; patients with low CPAP compliance; and patients who wished to stop using CPAP therapy. Results. A total of 212 patients were included. In naïve patients, CPAP usage after 3 months was 5.9 ± 1.7 hours/night, compared with the control group at 4.6 ± 2.4 hours/night (p CPAP, 60% continued with therapy using the new NPM. Conclusion. The new NPM mask performed well in a variety of clinical groups of OSA patients receiving CPAP therapy and shows that technical advances in CPAP masks can improve patient compliance.

  7. Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure.

    LENUS (Irish Health Repository)

    Ryan, Silke

    2012-02-01

    BACKGROUND: Nasal side effects are common in patients with obstructive sleep apnea syndrome (OSAS) starting on nasal continuous positive airway pressure (CPAP) therapy. We tested the hypothesis that heated humidification or nasal topical steroids improve compliance, nasal side effects and quality of life in this patient group. METHODS: 125 patients with the established diagnosis of OSAS (apnea\\/hypopnea index > or = 10\\/h), who tolerated CPAP via a nasal mask, and who had a successful CPAP titration were randomized to 4 weeks of dry CPAP, humidified CPAP or CPAP with additional topical nasal steroid application (fluticasone, GlaxoWellcome). Groups were similar in all demographic variables and in frequency of nasal symptoms at baseline. Outcome measures were objective compliance, quality of life (short form 36), subjective sleepiness (Epworth Sleepiness Scale score) and nasal symptoms such as runny, dry or blocked nose, sneezing and headaches; all variables assessed using a validated questionnaire and by direct interview. RESULTS: There was no difference in compliance between groups after 4 weeks (dry: 5.21 +\\/- 1.66 h\\/night, fluticasone: 5.66 +\\/- 1.68, humidifier: 5.21 +\\/- 1.84; p = 0.444). Quality of life and subjective sleepiness improved in all groups, but there were no differences in the extent of improvement. Nasal Symptoms were less frequently reported in the humidifier group (28%) than in the remaining groups (dry: 70%, fluticasone: 53%, p = 0.002). However, the addition of fluticasone resulted in increased frequency of sneezing. CONCLUSION: The addition of a humidifier, but not nasal steroids decreases the frequency of nasal symptoms in unselected OSAS patients initiating CPAP therapy; however compliance and quality of life remain unaltered.

  8. Nurse-led intensive interventions improve adherence to continuous positive airway pressure therapy and quality of life in obstructive sleep apnea patients

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    Chen XF

    2015-11-01

    Full Text Available Xiaofen Chen,1 Weiting Chen,1 Weijie Hu,2 Kui Huang,3 Jing Huang,4 Yu Zhou5 1Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 2People Hospital of Tiantai, Taizhou, 3Department of Orthodontics, Hospital of Stomatology, Wenzhou Medical University, Wenzhou, 4The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 5Department of Orthodontics, Hospital of Stomatology, Wenzhou Medical University, Wenzhou, People’s Republic of China Background: Continuous positive airway pressure (CPAP is widely recommended for the treatment of sleep apnea/hypopnea syndrome (SAHS, but its usage by patients is very low. The aim of this study was to assess intensive educational programs and nursing support for the improvement of CPAP use and outcomes in SAHS patients.Methods: Eighty new SAHS patients were randomized to receive nurse-led intensive interventions or usual support at hospital and home. The main outcome measure was CPAP use; changes in sleeping, symptoms, mood, and quality of life were also assessed after 12 months of treatment.Results: All outcome measures were improved after treatment in both groups. However, patients receiving intensive support with significantly higher CPAP use (higher daily CPAP usage by 2.2 hours/day had greater improvements in SAHS symptoms and mood (P<0.05. The intervention group further showed an improvement in the Short Form-36 domains of mental and physical health (P<0.05.Conclusion: The CPAP usage and quality of life can be significantly improved by nurse-led intensive program in obstructive sleep apnea patients. Keywords: CPAP, quality of life, SAHS, compliance

  9. Sleep-related breathing disorders. 5. Nasal continuous positive airway pressure treatment for obstructive sleep apnoea.

    Science.gov (United States)

    Grunstein, R R

    1995-10-01

    CPAP should be considered the first line of treatment in patients with moderate to severe obstructive sleep apnoea. In our centre in Sydney this generally means patients with more than 20 apnoea/hypopnoeas per hour with repeated dips in oxyhaemoglobin saturation and usually some symptomatology. Despite this first line role of nasal CPAP, recent objective studies question whether earlier enthusiastic reports on adherence to CPAP are correct. The role of technical innovations in new CPAP machines in improving usage remains to be tested. The "drop out" rate from physician selection for a CPAP trial to highly compliant user is certainly more than 50% of patients. What happens to these patients? Data from some studies suggest that surgical treatments are used, at least in the USA, but in all probability many of these patients remain untreated. The challenge in the next decade is either to improve CPAP devices to increase usage in this group or to develop other treatment options. The role of intensive inhospital "acclimatisation" to CPAP also has yet to be objectively tested. It is unclear whether "intelligent" CPAP will make huge inroads in increasing the number of patients who accept CPAP trials, prescriptions, or compliance. It will have minimal impact on patients with mask problems or claustrophobia or those who feel that CPAP is inconvenient. There is a high likelihood that it will reduce technologist workload during CPAP titration studies. "Intelligent" CPAP may help to reduce total overnight mouth leakage and therefore reduce nasal side effects. The current expense of developing such devices will mean that they are unlikely to supersede much cheaper standard "one pressure" CPAP machines in the next few years.

  10. Effect of preoperative continuous positive airway pressure duration on outcomes after maxillofacial surgery for obstructive sleep apnoea.

    Science.gov (United States)

    Islam, Shofiq; Taylor, Christopher; Ormiston, Ian W

    2015-02-01

    Continuous positive airway pressure (CPAP) remains the first-line treatment for obstructive sleep apnoea (OSA), and is known to result in various physiological changes. The objective of this study was to evaluate the association between duration of preoperative CPAP therapy and outcome after maxillomandibular advancement (MMA) for OSA. We retrospectively analysed consecutive patients treated at our institution, and divided them into 2 groups based on duration of treatment with CPAP: short-term (up to 12 months) and long-term use (12 months or more). We controlled for baseline demographic and clinical characteristics. We compared postoperative scores for the apnoea/hypopnoea index (AHI) and the Epworth sleepiness scale (ESS), and lowest recorded oxygen saturation between groups. In 43 patients data were available on the preoperative use of CPAP, and in 37 of them preoperative and postoperative polysomnographic data were also available for inclusion. Most had bimaxillary advancement with genioplasty. Differences between the groups in mean reduction in the AHI and lowest oxygen saturation were not significant, and operative success rates were comparable. After operation, the reduction in ESS scores was significantly greater in the long-term group than in the short-term group (mean (SD) 8(3) compared with 2 (2), respectively, p<0.001). Our results suggest that the duration of use of CPAP preoperatively does not significantly influence objective outcome measures. The reduction in AHI scores after MMA was equivalent in both groups. The long-term group seemed to fare better than the short-term group on subjective outcome measures.

  11. Armodafinil improves wakefulness and long-term episodic memory in nCPAP-adherent patients with excessive sleepiness associated with obstructive sleep apnea

    OpenAIRE

    Roth, Thomas; Rippon, Gregory A.; Arora, Sanjay

    2007-01-01

    Residual excessive sleepiness (ES) and impaired cognition can occur despite effective and regular nasal continuous positive airway pressure (nCPAP) therapy in some patients with obstructive sleep apnea (OSA). A pooled analysis of two 12-week, randomized, double-blind studies in nCPAP-adherent patients with ES associated with OSA evaluated the effect of armodafinil on wakefulness and cognition. Three hundred and ninety-one patients received armodafinil (150 or 250 mg) and 260 patients received...

  12. Efficacy and safety of CPAP in low- and middle-income countries.

    Science.gov (United States)

    Thukral, A; Sankar, M J; Chandrasekaran, A; Agarwal, R; Paul, V K

    2016-05-01

    We conducted a systematic review to evaluate the (1) feasibility and efficacy and (2) safety and cost effectiveness of continuous positive airway pressure (CPAP) therapy in low- and middle-income countries (LMIC). We searched the following electronic bibliographic databases-MEDLINE, Cochrane CENTRAL, CINAHL, EMBASE and WHOLIS-up to December 2014 and included all studies that enrolled neonates requiring CPAP therapy for any indication. We did not find any randomized trials from LMICs that have evaluated the efficacy of CPAP therapy. Pooled analysis of four observational studies showed 66% reduction in in-hospital mortality following CPAP in preterm neonates (odds ratio 0.34, 95% confidence interval (CI) 0.14 to 0.82). One study reported 50% reduction in the need for mechanical ventilation following the introduction of bubble CPAP (relative risk 0.5, 95% CI 0.37 to 0.66). The proportion of neonates who failed CPAP and required mechanical ventilation varied from 20 to 40% (eight studies). The incidence of air leaks varied from 0 to 7.2% (nine studies). One study reported a significant reduction in the cost of surfactant usage with the introduction of CPAP. Available evidence suggests that CPAP is a safe and effective mode of therapy in preterm neonates with respiratory distress in LMICs. It reduces the in-hospital mortality and the need for ventilation thereby minimizing the need for up-transfer to a referral hospital. But given the overall paucity of studies and the low quality evidence underscores the need for large high-quality studies on the safety, efficacy and cost effectiveness of CPAP therapy in these settings.

  13. The predictive value of Muller's maneuvre for CPAP titration in OSAHS patients.

    Science.gov (United States)

    Bosi, Marcello; De Vito, Andrea; Vicini, Claudio; Poletti, Venerino

    2013-08-01

    To investigate the role of awake upper airways (UA) endoscopy assessment as a parameter of prediction for CPAP titration in OSAHS patient therapy. Retrospective analysis of UA endoscopic assessment with Mueller's maneuvre and the application of the nose oropharynx hypopharynx score (NOHs) was conducted to obtain a numeric score representing the grade of severity of UA obstruction. Other commonly used predictive parameters for CPAP titration were also included in the study: anthropometric [BMI, neck circumference (NC)] and polysomnographic parameters (AHI, ODI). 3 groups of patients were identified: (1) 67/90 patients requiring intermediate CPAP values, (2) 13/90 patients requiring high CPAP values, and (3) 10/90 patients requiring low pressure values. BMI (p = 0.0013) was the only monitored parameter to show significant statistical value as a CPAP titration predictor. However, higher values of anthropometric parameters (NOHs ≥9, BMI >35, NC >45) showed a sensitivity of 69.2% as a single parameter and 76.9% as combined parameters, and specificity between 66.2 and 72.7% as a single parameter and 43.4% as combined parameters, unequivocally identifying patients requiring high therapeutic CPAP value. A lower cut-off of anthropometric parameters (NOHs ≤6, BMI ≤29, NC <42) showed sensitivity between 40 and 60% as a single parameter and of 90% as combined parameters, and specificity between 68.7 and 80.2% as a single parameter which increased to 93.7% as combined parameters, identifying patients requiring a low therapeutic CPAP value. The results show that anthropometric and polygraphic parameters have no significant independent predictive value for CPAP titration, with the exception of BMI. However, anthropometric parameters showed good levels of sensitivity and specificity in OSAHS patients requiring high or low levels of CPAP therapy.

  14. Retrospective, nonrandomized controlled study on autoadjusting, dual-pressure positive airway pressure therapy for a consecutive series of complex insomnia disorder patients

    Science.gov (United States)

    Krakow, Barry; McIver, Natalia D; Ulibarri, Victor A; Nadorff, Michael R

    2017-01-01

    Purpose Emerging evidence shows that positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) in chronic insomnia patients (proposed “complex insomnia” disorder) leads to substantial decreases in insomnia severity. Although continuous PAP (CPAP) is the pressure mode most widely researched, intolerance to fixed pressurized air is rarely investigated or described in comorbidity patients. This retrospective study examined dual pressure, autoadjusting PAP modes in chronic, complex insomnia disorder patients. Patients and methods Chronic insomnia disorder patients (mean [SD] insomnia severity index [ISI] =19.11 [3.34]) objectively diagnosed with OSA or UARS and using either autobilevel PAP device or adaptive servoventilation (ASV) device after failing CPAP therapy (frequently due to intolerance to pressurized air, poor outcomes, or emergence of CSA) were divided into PAP users (≥20 h/wk) and partial users (insomnia patients, PAP users (n=246) averaged 6.10 (1.78) nightly hours and 42.71 (12.48) weekly hours and partial users (n=56) averaged 1.67 (0.76) nightly hours and 11.70 (5.31) weekly hours. For mean (SD) decreases in total ISI scores, a significant (group × time) interaction was observed (F[1,300]=13.566; Pinsomnia symptoms (r=−0.256, PInsomnia severity significantly decreased in patients using autoadjusting PAP devices, but the study design restricts interpretation to an association. Future research must elucidate the interaction between insomnia and OSA/UARS as well as the adverse influence of pressure intolerance on PAP adaptation in complex insomnia patients. Randomized controlled studies must determine whether advanced PAP modes provide benefits over standard CPAP modes in these comorbidity patients. PMID:28331381

  15. Adaptação do Bird Mark 7 para oferta de pressão positiva contínua nas vias aéreas em ventilação não-invasiva: estudo em modelo mecânico Adapting the Bird Mark 7 to deliver noninvasive continuous positive airway pressure: a bench study

    Directory of Open Access Journals (Sweden)

    Beatriz Mayumi Kikuti

    2008-03-01

    Full Text Available OBJETIVO: Testar a eficiência da adaptação do ventilador Bird Mark 7 para oferecer pressão positiva contínua nas vias aéreas, conhecida como continuous positive airway pressure (CPAP em inglês, em ventilação não-invasiva. MÉTODOS: Estudo experimental utilizando um modelo mecânico do sistema respiratório. O Bird Mark 7 foi alimentado com 400 e 500 kPa e foi testado em CPAP de 5, 10 e 15 cmH2O. Para avaliar a eficiência da adaptação foram analisados os seguintes variáveis: diferença entre a CPAP pré-determinada e a CPAP realmente atingida (CPAPreal; área da pressão da via aérea sob o nível de CPAP ajustado (ÁREA CPAP; e volume corrente gerado. RESULTADOS: A adaptação do Bird Mark 7 para oferecer CPAP em ventilação não-invasiva conseguiu atingir o volume corrente esperado em todas as situações de esforço inspiratório (normal ou elevado, pressão de alimentação (400 ou 500 kPa e valor de CPAP (5, 10 ou 15 cmH2O. Para os CPAPs de 5 e 10 cmH2O, o CPAPreal foi muito próximo do pré-determinado, e a ÁREA CPAP teve valor próximo de zero. Para o CPAP de 15 cmH2O, o CPAPreal ficou abaixo do pré-determinado, e a ÁREA CPAP teve valor elevado. CONCLUSÃO: A eficiência da adaptação do Bird Mark 7 para oferecer CPAP em ventilação não-invasiva foi boa para os valores de CPAP de 5 e 10 cmH2O e insuficiente para CPAP de 15 cmH2O. Se adaptado como em nosso estudo, o Bird Mark 7 pode ser uma opção para oferta de CPAP até 10 cmH2O em locais onde equipamentos de ventilação não-invasiva são escassos ou inexistentes.OBJECTIVE: To test the efficiency of the Bird Mark 7 ventilator adapted to deliver continuous positive airway pressure (CPAP in noninvasive positive pressure ventilation. METHODS: This was an experimental study using a mechanical model of the respiratory system. A Bird Mark 7 ventilator was supplied with 400 and 500 kPa and tested at CPAP of 5, 10 and 15 cmH2O. The following variables were analyzed

  16. Heart rate variability in non-apneic snorers and controls before and after continuous positive airway pressure

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    Mateika Jason H

    2005-07-01

    Full Text Available Abstract Background We hypothesized that sympathetic nervous system activity (SNSA is increased and parasympathetic nervous system activity (PNSA is decreased during non-rapid eye movement (NREM sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control. Methods To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP. Results Our results showed that SNSA was increased and PNSA was decreased in non-apneic snorers during NREM compared to control. However, these changes were only evident during the study in which snoring was eliminated with nCPAP. Conversely, during periods of snoring SNSA and PNSA were similar to measures obtained from the control group. Additionally, within the control group, SNSA and PNSA did not vary before and after nCPAP application. Conclusion Our findings suggest that long-lasting alterations in autonomic function may exist in snoring subjects that are otherwise healthy. Moreover, we speculate that because of competing inputs (i.e. inhibitory versus excitatory inputs to the autonomic nervous system during snoring, the full impact of snoring on autonomic function is most evident during non-snoring periods.

  17. Oxidative stress mediated arterial dysfunction in patients with obstructive sleep apnoea and the effect of continuous positive airway pressure treatment

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    Del Ben Maria

    2012-07-01

    Full Text Available Abstract Background Several studies suggest an increase of oxidative stress and a reduction of endothelial function in obstructive sleep apnoea syndrome (OSAS. We assessed the association between OSAS, endothelial dysfunction and oxidative stress. Further aim was to evaluate the effect of nasal continuous positive airway pressure (nCPAP on oxidative stress and arterial dysfunction. Methods We studied 138 consecutive patients with heavy snoring and possible OSAS. Patients underwent unattended overnight home polysomnography. Ten patients with severe OSAS were revaluated after 6 months of nCPAP therapy. To assess oxidative stress in vivo, we measured urinary 8-iso-PGF2α and serum levels of soluble NOX2-derived peptide (sNOX2-dp. Serum levels of nitrite/nitrate (NOx were also determined. Flow-mediated brachial artery dilation (FMD was measured to asses endothelial function. Results Patients with severe OSAS had higher urinary 8-iso-PGF2α (p Conclusions The results of our study indicate that patients with OSAS and cardiometabolic comorbidities have increased oxidative stress and arterial dysfunction that are partially reversed by nCPAP treatment.

  18. CPAP Treatment Partly Normalizes Sleep Spindle Features in Obstructive Sleep Apnea

    Science.gov (United States)

    Saunamäki, Tiia; Huupponen, Eero; Loponen, Juho

    2017-01-01

    Objective. Obstructive sleep apnea (OSA) decreases sleep spindle density and frequency. We evaluated the effects of continuous positive airway pressure (CPAP) treatment on different features of sleep spindles. Methods. Twenty OSA patients underwent two night polysomnographies in a diagnostic phase and one night polysomnography after 6 months of CPAP treatment. The control group comprised 20 healthy controls. Sleep spindles were analyzed by a previously developed automated method. Unilateral and bilateral spindles were identified in central and frontopolar brain locations. Spindle density and frequency were determined for the first and last half of the NREM time. Results. The density of bilateral central spindles, which did not change in the untreated OSA patients, increased towards the morning hours during CPAP treatment and in the controls. Central spindles did not become faster with sleep in OSA patients and the central spindles remained slow in the left hemisphere even with CPAP. Conclusion. CPAP treatment normalized spindle features only partially. The changes may be associated with deficits in thalamocortical spindle generating loops. Significance. This study shows that some sleep spindle changes persist after CPAP treatment in OSA patients. The association of these changes to daytime symptoms in OSA patients needs to be further evaluated. PMID:28261503

  19. The Tongue Muscle Training (ZMT® in nCPAP Patients with Obstructive Sleep Apnea Syndrome (OSAS

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    Gessmann H.-W.

    2013-06-01

    Full Text Available Obstructive Sleep Apnea Syndrome is treated not only with the help of nCPAP but by other means which help to support the sufficient level of pharyngeal airways. In course of our experiment we investigated changes in parameters of breath during night sleep in patients with high indices of obstructive Sleep Apnea Syndrome after the tongue muscle training. 40 patients with OSAS treated only with the help of nCPAP underwent a 5-week course of electrical stimulation of upper pharyngeal muscles. This type of treatment was supposed to result in dilatation of pharyngeal airways and cure of occlusion and obstruction. Parameters of breath during the night sleep before- and after the treatment were detected with the help of somno-poligraphic investigations and compared. Indices of apnea and hypopnea decreased in 26 of 40 patients, which is more than half of the probands. We recommended the patients with a diagnosed OSAS without a risk of recurrence to add tongue muscle training to nCPAP. In case the course of nCPAP therapy is launched it helped achieve sufficient improvement of parameters affecting breath during the night sleep and in many cases decrease respiratory pressure of nCPAP therapy or its complete cessation.

  20. Development and evaluation of a self-efficacy instrument for Japanese sleep apnea patients receiving continuous positive airway pressure treatment

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    Saito A

    2015-01-01

    Full Text Available Ayako Saito,1 Shigeko Kojima,2 Fumihiko Sasaki,3 Masamichi Hayashi,4 Yuki Mieno,4 Hiroki Sakakibara,5 Shuji Hashimoto1 1Department of Hygiene, School of Medicine, Fujita Health University, Toyoake, Japan; 2Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, Handa, Japan; 3SDB Research Laboratory, Takaoka Clinic, Nagoya, Japan; 4Department of Internal Medicine, Division of Respiratory Medicine and Clinical Allergy, Fujita Health University, Toyoake, Japan; 5Tokushige Kokyuki Clinic, Nagoya, Japan Abstract: The purpose of this study was to develop and evaluate a self-efficacy instrument for Japanese obstructive sleep apnea (OSA patients treated with continuous positive airway pressure (CPAP. Analyzed subjects were 653 Japanese OSA patients (619 males and 34 females treated with CPAP at a sleep laboratory in a respiratory clinic in a Japanese city. Based on Bandura's social cognitive theory, the CPAP Self-Efficacy Questionnaire for Sleep Apnea in Japanese (CSESA-J was developed by a focus group of experts, using a group interview of OSA patients for the items of two previous self-efficacy scales for Western sleep apnea patients receiving CPAP treatment. CSESA-J has two subscales, one for self-efficacy and the other for outcome expectancy, and consists of a total of 15 items. Content validity was confirmed by the focus group. Confirmatory factor analysis showed that the factor loadings of self-efficacy and outcome expectancy were 0.47–0.76 and 0.41–0.92, respectively, for the corresponding items. CSESA-J had a significant but weak positive association with the General Self-Efficacy Scale, and a strong positive association with “Self-efficacy scale on health behavior in patients with chronic disease.” Cronbach’s alpha coefficient was 0.85 for the self-efficacy subscale and 0.89 for the outcome expectancy subscale. The intraclass correlation coefficient using data from the first and second measurements with

  1. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery

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    C.B.F. Pantoni

    2011-01-01

    Full Text Available The application of continuous positive airway pressure (CPAP produces important hemodynamic alterations, which can influence breathing pattern (BP and heart rate variability (HRV. The aim of this study was to evaluate the effects of different levels of CPAP on postoperative BP and HRV after coronary artery bypass grafting (CABG surgery and the impact of CABG surgery on these variables. Eighteen patients undergoing CABG were evaluated postoperatively during spontaneous breathing (SB and application of four levels of CPAP applied in random order: sham (3 cmH2O, 5 cmH2O, 8 cmH2O, and 12 cmH2O. HRV was analyzed in time and frequency domains and by nonlinear methods and BP was analyzed in different variables (breathing frequency, inspiratory tidal volume, inspiratory and expiratory time, total breath time, fractional inspiratory time, percent rib cage inspiratory contribution to tidal volume, phase relation during inspiration, phase relation during expiration. There was significant postoperative impairment in HRV and BP after CABG surgery compared to the preoperative period and improvement of DFAα1, DFAα2 and SD2 indexes, and ventilatory variables during postoperative CPAP application, with a greater effect when 8 and 12 cmH2O were applied. A positive correlation (P < 0.05 and r = 0.64; Spearman was found between DFAα1 and inspiratory time to the delta of 12 cmH2O and SB of HRV and respiratory values. Acute application of CPAP was able to alter cardiac autonomic nervous system control and BP of patients undergoing CABG surgery and 8 and 12 cmH2O of CPAP provided the best performance of pulmonary and cardiac autonomic functions.

  2. Boussignac continuous positive airway pressure for the management of acute cardiogenic pulmonary edema: prospective study with a retrospective control group

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    Aarts Leon PHJ

    2007-12-01

    Full Text Available Abstract Background Continuous positive airway pressure (CPAP treatment for acute cardiogenic pulmonary edema can have important benefits in acute cardiac care. However, coronary care units are usually not equipped and their personnel not adequately trained for applying CPAP with mechanical ventilators. Therefore we investigated in the coronary care unit setting the feasibility and outcome of the simple Boussignac mask-CPAP (BCPAP system that does not need a mechanical ventilator. Methods BCPAP was introduced in a coronary care unit where staff had no CPAP experience. All consecutive patients transported to our hospital with acute cardiogenic pulmonary edema, a respiratory rate > 25 breaths/min and a peripheral arterial oxygen saturation of Results During the 2-year prospective BCPAP study period 108 patients were admitted with acute cardiogenic pulmonary edema. Eighty-four of these patients (78% were treated at the coronary care unit of which 66 (61% were treated with BCPAP. During the control period 66 patients were admitted over a 1-year period of whom 31 (47% needed respiratory support in the intensive care unit. BCPAP treatment was associated with a reduced hospital length of stay and fewer transfers to the intensive care unit for intubation and mechanical ventilation. Overall estimated savings of approximately € 3,800 per patient were achieved with the BCPAP strategy compared to conventional treatment. Conclusion At the coronary care unit, BCPAP was feasible, medically effective, and cost-effective in the treatment of acute cardiogenic pulmonary edema. Endpoints included mortality, coronary care unit and hospital length of stay, need of ventilatory support, and cost (savings.

  3. Distending Pressure Did Not Activate Acute Phase or Inflammatory Responses in the Airways and Lungs of Fetal, Preterm Lambs.

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    Rebecca Y Petersen

    Full Text Available Mechanical ventilation at birth causes airway injury and lung inflammation in preterm sheep. Continuous positive airway pressure (CPAP is being increasingly used clinically to transition preterm infants at birth.To test if distending pressures will activate acute phase reactants and inflammatory changes in the airways of fetal, preterm lambs.The head and chest of fetal lambs at 128±1 day GA were surgically exteriorized. With placental circulation intact, fetal lambs were then randomized to one of five 15 minute interventions: PEEP of 0, 4, 8, 12, or 16 cmH2O. Recruitment volumes were recorded. Fetal lambs remained on placental support for 30 min after the intervention. The twins of each 0 cmH2O animal served as controls. Fetal lung fluid (FLF, bronchoalveolar lavage fluid (BAL, right mainstem bronchi and peripheral lung tissue were evaluated for inflammation.Recruitment volume increased from 0.4±0.04 mL/kg at 4 cmH2O to 2.4±0.3 mL/kg at 16 cmH2O. The lambs were surfactant deficient, and all pressures were below the opening inflection pressure on pressure-volume curve. mRNA expression of early response genes and pro-inflammatory cytokines did not increase in airway tissue or lung tissue at any pressure compared to controls. FLF and BAL also did not have increases in early response proteins. No histologic changes or Egr-1 activation was present at the pressures used.Distending pressures as high as 16 cmH2O did not recruit lung volume at birth and did not increase markers of injury in the lung or airways in non-breathing preterm fetal sheep.

  4. Sexual function in male patients with obstructive sleep apnoea after 1 year of CPAP treatment

    DEFF Research Database (Denmark)

    Petersen, Marian Christin; Kristensen, Ellids; Berg, Søren;

    2012-01-01

    year of CPAP treatment, a total of 207 CPAP-compliant male patients (age 26-77) received a survey with questions drawn from two self-administered questionnaires on sexuality - Life Satisfaction 11 (LiSat-11) and brief sexual function inventory (BSFI). For assessment of daytime sleepiness, we used...... the Epworth sleepiness scale (ESS). RESULTS: Response rate was 76%. We found no significant changes in satisfaction with relation to partner or life as a whole, but satisfaction with sexual life (LiSat-11) and both general and functional aspects of sexuality (BSFI) were significantly improved after 1 year......OBJECTIVE: Our objective was to investigate what impact 1 year of effective nocturnal continuous positive airway pressure (CPAP) treatment had on general and functional aspects of sexuality in male patients with a confirmed diagnosis of obstructive sleep apnoea (OSA). METHODS: Before and after 1...

  5. Sleep apnea syndrome: central sleep apnea and pulmonary hypertension worsened during treatment with auto-CPAP, but improved by adaptive servo-ventilation.

    Science.gov (United States)

    Ono, Hiroshi; Fujimoto, Hiroyuki; Kobayashi, Yoshinori; Kudoh, Shoji; Gemma, Akihiko

    2010-01-01

    In this 71-year-old man diagnosed as obstructive sleep apnea syndrome initially, the apnea-hypopnea index in polysomnography was 31.3/hour. He started auto-adjusted continuous positive airway pressure (auto-CPAP) treatment in July 2005 but developed congestive heart failure in December 2007. Pulmonary arterial pressure (PAP), estimated by echocardiography, was 71 mmHg. In January 2008, during simplified sleep examination with a breath-movement sensor under auto-CPAP, many central-type apneas were recognized. After replacing auto-CPAP with adaptive servo-ventilation (ASV), the apnea-hypopnea index was 5.3/hour and PAP became 36 mmHg after 3 months. It was thought that the increase of PAP was due to long-term inadequate use of auto-CPAP.

  6. Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension

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    Gür Sükrü

    2006-02-01

    Full Text Available Abstract Objectives Obstructive sleep apnoea (OSA might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP therapy on right ventricular myocardial performance index (MPI in OSA patients without hypertension. Methods 49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index ≥ 15 patients, right ventricular free wall diameter (RVFWD was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy. Results Mean age was 46.5 ± 4.9 year. Patients had high body mass index (BMI: 30.6 ± 4,0 kg/m2, but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 ± 2.1 mm significantly decreased after CPAP therapy (6.2 ± 1.7 mm, p Conclusion CPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI in OSA patients without hypertension.

  7. Monitoring Progress and Adherence with Positive Airway Pressure Therapy for Obstructive Sleep Apnea: The Roles of Telemedicine and Mobile Health Applications.

    Science.gov (United States)

    Hwang, Dennis

    2016-06-01

    Technology is changing the way health care is delivered and how patients are approaching their own health. Given the challenge within sleep medicine of optimizing adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA), implementation of telemedicine-based mechanisms is a critical component toward developing a comprehensive and cost-effective solution for OSA management. Key elements include the use of electronic messaging, remote monitoring, automated care mechanisms, and patient self-management platforms. Current practical sleep-related telemedicine platforms include Web-based educational programs, automated CPAP follow-up platforms that promote self-management, and peer-based patient-driven Internet support forums.

  8. Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as an Initial Respiratory Support in Preterm Infants with Respiratory Distress: a Randomized, Controlled Non-Inferiority Trial.

    Science.gov (United States)

    Shin, Jeonghee; Park, Kyuhee; Lee, Eun Hee; Choi, Byung Min

    2017-04-01

    Heated, humidified, high-flow nasal cannula (HHFNC) is frequently used as a noninvasive respiratory support for preterm infants with respiratory distress. But there are limited studies that compares HHFNC with nasal continuous positive airway pressure (nCPAP) only as the initial treatment of respiratory distress in preterm infants immediately after birth. The aim of this study is to assess the effectiveness and safety of HHFNC compared to nCPAP for the initial treatment of preterm infants with respiratory distress. Preterm infants at between 30 and 35 weeks of gestational age were randomized to HHFNC or nCPAP when they showed respiratory distress in less than 24 hours of age postnatally. Preterm infants who needed invasive respiratory supports were excluded. Primary outcome was the incidence of treatment failure (defined as need for the intubation or mechanical ventilation). Eighty-five infants were analyzed. Sixteen of 42 infants randomized to HHFNC showed treatment failure compared to 9 of 43 infants using nCPAP (Risk difference 17.17 [-1.90-36.23]; P = 0.099). In terms of the reason for treatment failure, the frequency of hypoxia was significantly higher in the HHFNC group than in the nCPAP group (P = 0.020). There was no difference between the 2 groups in terms of respiratory and clinical outcomes and complications. Although HHFNC is safe compared to nCPAP, it is not certain that HHFNC is effective compared to nCPAP non-inferiorly as an initial respiratory support in preterm infants with respiratory distress.

  9. Effect of continuous positive airway pressure ventilation on nocturnal ST-segment changes in patients with sleep-disordered breathing

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective To determine whether sleep-disordered breathing (SDB) may lead to nocturnal myocardial ischemia and whether the severity of this ischemia may be relieved by nasal continuous positive airway pressure (CPAP). Methods Overnight polysomnogram examination and simultaneous 3-channel Holter monitoring were performed on 76 patients with moderate to severe SDB and no history of coronary heart disease. All the cases were treated with CPAP for one night. ST depression was defined as a ST segment decrease of more than 1 mm from baseline and lasting 1 min or more. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Results Twenty-eight patients (37%) showed ST segment depression during their sleep. Before CPAP treatment, the respiratory disturbance index (RDI) and arousal index were significantly higher during periods of ST depression than when ST segments were isoelectric, whereas no significant difference was found in blood oxygen saturation (SaO2). After the CPAP treatment of patients with ST depression, the duration of ST depression was significantly reduced from 36.8±18.9 to 11.4±13.2 min/h (P<0.05). ST depression-related indexes, including RDI, arousal index and the percentage of sleep time spent at SaO2 below 90% (TS90/ TST), were all significantly decreased, with RDI from 63.4±23.8 to 8.1±6.6 /h, arousal index from 51.2±18.9 to 9.6±5.4 /h, and TS90/ TST from 50.6±21.4 to 12.9±14.7% (P<0.05). Conclusion ST-segment depression is rather common in patients with moderate to severe SDB, and CPAP treatment can significantly reduce the duration of ST depression. ST depression in these patients may reflect the myocardial ischemia that really exists and the non-ischemic changes associated with recurrent SDB.

  10. Early nCPAP versus intubation in very low birth weight infants

    Directory of Open Access Journals (Sweden)

    Pedro Neves Tavares

    2013-06-01

    Full Text Available For many years endotracheal intubation and mechanical ventilation have been the standard of care for very low birth weight infants but, in the last decade, nasal continuous positive airway pressure (nCPAP has been described in many studies as an option for the treatment of preterm infants with respiratory distress syndrome. In fact, recent studies have shown that early nCPAP is not associated with higher rates of morbidity and mortality and does not imply more days of ventilation support when compared to traditional ventilation techniques. The authors conducted a study to compare the outcomes (in terms of mortality, morbidity and need for medical support of very low birth weight infants treated with nCPAP or endotracheal intubation and mechanical ventilation. One hundred and four newborns were enrolled in this study, 44 (42.3% were treated with nCPAP and 60 (57.7% with endotracheal intubation followed by mechanical ventilation. A subgroup analysis of newborns with gestational age between 28 and 31 weeks was also performed. It included 57 newborns with similar demographic characteristics, 29 (50.9% treated with nCPAP and 28 (49.1% with endotracheal intubation followed by mechanical ventilation. No statistically significant differences were found in the frequency of death or bronchopulmonary dysplasia. Statistically significant differences were found in the prevalence of hyaline membrane disease (p = 0.033 and surfactant administration (p = 0.021 with lower rates in the nCPAP group. No other differences were found in the prevalence of other morbidities or in the need for medical support after birth. These results suggests that nCPAP might be chosen as primary ventilatory support choice in very low birth weight preterm, when there are no contraindications to its use.

  11. Efficacy of a low-cost bubble CPAP system in treatment of respiratory distress in a neonatal ward in Malawi.

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    Kondwani Kawaza

    Full Text Available BACKGROUND: Respiratory failure is a leading cause of neonatal mortality in the developing world. Bubble continuous positive airway pressure (bCPAP is a safe, effective intervention for infants with respiratory distress and is widely used in developed countries. Because of its high cost, bCPAP is not widely utilized in low-resource settings. We evaluated the performance of a new bCPAP system to treat severe respiratory distress in a low resource setting, comparing it to nasal oxygen therapy, the current standard of care. METHODS: We conducted a non-randomized convenience sample study to test the efficacy of a low-cost bCPAP system treating newborns with severe respiratory distress in the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi. Neonates weighing >1,000 g and presenting with severe respiratory distress who fulfilled inclusion criteria received nasal bCPAP if a device was available; if not, they received standard care. Clinical assessments were made during treatment and outcomes compared for the two groups. FINDINGS: 87 neonates (62 bCPAP, 25 controls were recruited. Survival rate for neonates receiving bCPAP was 71.0% (44/62 compared with 44.0% (11/25 for controls. 65.5% (19/29 of very low birth weight neonates receiving bCPAP survived to discharge compared to 15.4% (1/13 of controls. 64.6% (31/48 of neonates with respiratory distress syndrome (RDS receiving bCPAP survived to discharge, compared to 23.5% (4/17 of controls. 61.5% (16/26 of neonates with sepsis receiving bCPAP survived to discharge, while none of the seven neonates with sepsis in the control group survived. INTERPRETATION: Use of a low-cost bCPAP system to treat neonatal respiratory distress resulted in 27% absolute improvement in survival. The beneficial effect was greater for neonates with very low birth weight, RDS, or sepsis. Implementing appropriate bCPAP devices could reduce neonatal mortality in developing countries.

  12. Upper Airway Elasticity Estimation in Pediatric Down Syndrome Sleep Apnea Patients Using Collapsible Tube Theory.

    Science.gov (United States)

    Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J; Shott, Sally R; Amin, Raouf S; Gutmark, Ephraim J

    2016-05-01

    Elasticity of the soft tissues surrounding the upper airway lumen is one of the important factors contributing to upper airway disorders such as snoring and obstructive sleep apnea. The objective of this study is to calculate patient specific elasticity of the pharynx from magnetic resonance (MR) images using a 'tube law', i.e., the relationship between airway cross-sectional area and transmural pressure difference. MR imaging was performed under anesthesia in children with Down syndrome (DS) and obstructive sleep apnea (OSA). An airway segmentation algorithm was employed to evaluate changes in airway cross-sectional area dilated by continuous positive airway pressure (CPAP). A pressure-area relation was used to make localized estimates of airway wall stiffness for each patient. Optimized values of patient specific Young's modulus for tissue in the velopharynx and oropharynx, were estimated from finite element simulations of airway collapse. Patient specific deformation of the airway wall under CPAP was found to exhibit either a non-linear 'hardening' or 'softening' behavior. The localized airway and tissue elasticity were found to increase with increasing severity of OSA. Elasticity based patient phenotyping can potentially assist clinicians in decision making on CPAP and airway or tissue elasticity can supplement well-known clinical measures of OSA severity.

  13. Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

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    Daniela Franco Rizzo Komatsu

    Full Text Available Summary Objective: To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV and continuous positive airway pressure (nCPAP. Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA ≤ 36 weeks and birth weight (BW > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6% presented extubation failure in comparison to 11 (30.5% of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

  14. Effect of Continuous Positive Airway Pressure Therapy on Glycemic Excursions and Insulin Sensitivity in Patients with Obstructive Sleep Apnea-hypopnea Syndrome and Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    Li-Xin Guo; Xin Zhao; Qi Pan; Xue Sun; Hui Li; Xiao-Xia Wang; Li-Na Zhang

    2015-01-01

    Background:For patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and type 2 diabetes mellitus (T2DM),the night sleep interruption and intermittent hypoxia due to apnea or hypopnea may induce glycemic excursions and reduce insulin sensitivity.This study aimed to investigate the effect of continuous positive airway pressure (CPAP) therapy in patients with OSAHS and T2DM.Methods:Continuous glucose monitoring system (CGMS) was used in 40 patients with T2DM and newly diagnosed OSAHS.The measurements were repeated after 30 days of CPAP treatment.Subsequently,insulin sensitivity and glycohemoglobin (HbA1c) were measured and compared to the pretreatment data.Results:After CPAP therapy,the CGMS indicators showed that the 24-h mean blood glucose (MBG) and the night time MBG were significantly reduced (P < 0.05 and P =0.03,respectively).The mean ambulatory glucose excursions (MAGEs) and the mean of daily differences were also significantly reduced (P < 0.05 and P =0.002,respectively) compared to pretreatment levels.During the night,MAGE also significantly decreased (P =0.049).The differences between the highest and lowest levels of blood glucose over 24 h and during the night were significantly lower than prior to CPAP treatment (P < 0.05 and P =0.024,respectively).The 24 h and night time durations of high blood glucose (>7.8 mmol/L and > 11.1 mmol/L) decreased (P < 0.05 and P < 0.05,respectively) after the treatment.Inaddition,HbA1c levels were also lower than those before treatment (P < 0.05),and the homeostasis model assessment index of insulin resistance was also significantly lower than before CPAP treatment (P =0.034).Conclusions:CPAP therapy may have a beneficial effect on improving not only blood glucose but also upon insulin sensitivity in T2DM patients with OSAHS.This suggests that CPAP may be an effective treatment for T2DM in addition to intensive diabetes management.

  15. Long-term adherence to CPAP treatment in patients with obstructive sleep apnea: importance of educational program

    Directory of Open Access Journals (Sweden)

    La Piana GE

    2011-11-01

    Full Text Available Giuseppe Emanuele La Piana1, Alessandro Scartabellati1, Lodovico Chiesa1, Luca Ronchi1, Paola Raimondi1, Miriam A Carro1, Silvia Zibetti1, Stefano Aiolfi2 1Pulmonary Rehabilitation Unit, S. Marta Hospital, Rivolta D'Adda; 2Unit of Pneumology, AO Ospedale Maggiore di Crema, Crema, Italy Background: Lack of adherence with continuous positive airway pressure (CPAP therapy is the major cause of treatment failure in patients with obstructive sleep apnea syndrome. We evaluated the effectiveness of our intensive educational program on adherence in the short term and the long term. Methods: The educational program consisted of: intensive training, whereby each patient performed individual and collective sessions of three hours receiving information about obstructive sleep apnea syndrome, familiarizing themselves with CPAP tools, on six consecutive days; long-term training; and support meetings, with reassessment at three months and one year. Results: In 202 patients with obstructive sleep apnea syndrome, the mean (standard deviation apnea/hypopnea index was 45 ± 22, the Epworth Sleepiness Scale score was 14 ± 5, and the average titration pressure was 10 ± 2 cm H2O. At three months, 166 patients (82% used CPAP for an average of 7.3 hours per night. At one year, 162 (80% used CPAP for about seven hours per night. At two years, 92 patients (43% used CPAP for about five hours per night. The level of satisfaction remained higher in patients in ventilation. Conclusion: Our data show strong adherence to CPAP at three months and one year, with a decrease at two years. The initial educational program seems to play an important role in adherence. This effect is lost in the long term, suggesting that periodic reinforcement of educational support would be helpful. Keywords: adherence, continuous positive airway pressure, obstructive sleep apnea syndrome, educational program

  16. Walking with continuous positive airway pressure

    NARCIS (Netherlands)

    Dieperink, W.; Goorhuis, JF; de Weerd, W; Hazenberg, A; Zijistra, JG; Nijsten, MWN

    2006-01-01

    A ventilator-dependent child had been in the paediatric intensive care unit (PICU) ever since birth. As a result, she had fallen behind considerably in her development. After 18 months, continuous positive airway tracheostomy tube with a novel lightweight device device, the child was discharged home

  17. The importance of administration of early surfactant and nasal continuous positive airway pressure in newborns with respiratory distress syndrome

    Science.gov (United States)

    Ceylan, Abdullah; Gezer, Suat; Demir, Nihat; Tuncer, Oğuz; Peker, Erdal; Kırımi, Ercan

    2014-01-01

    Aim: Mechanical ventilation is an invasive method and causes to important problems in the respiratory tract and lung parenchyma. The objective of our study was to investigate if administration of early surfactant and nasal continuous positive airway pressure (nCPAP) was superior to delayed surfactant administration and mechanical ventilation. Material and Methods: The study was conducted in the Van 100th Year University, Medical Faculty Hospital, Neonatal Intensive Care Unit. One hundred and nine infants with respiratory distrss syndrome (RDS) with a gestational age of 32 weeks and/or below were included in the study. Surfactant was given to 61 infants in the delivery room or intensive care unit and subsequently nCPAP was administered. Surfactant was administered in 48 infants in the control group and mechanical ventilation was inititated subsequently. Informed consent was obtained from the relatives of all patients and ethics committee approval was also obtained (Approval number: 03.02.2011/15). Results: There was no statistically significant difference between the two groups in terms of gestational age, birth weight, gender, height and head circumference measurements (p>0.05). The mean hospitalization time in the patients in the study group was 24.4±17.8 days, whereas the mean time of nCPAP was 28.4 (4–120) hours. In the study group, intracranial hemorrhage was found with a rate of 27.85%, bronchopulmonary dysplasia was found with a rate of 4.91%, pneumothorax was found with a rate of 3.27%, necrotizing enterocolitis was found with a rate of 3.27%, patent ductus arteriosus was found with a rate of 16.39, sepsis was found with a rate of 22.95% and retinopathy of prematurity was found with a rate of 1.63%. No statistically significant difference was found between the study and control groups in terms of the rates of complications. During the follow-up period, 17 (27.86%) patients were lost. The length of stay on mechanical ventilation in the study group was

  18. Erectile Dysfunction and Sexual Hormone Levels in Men With Obstructive Sleep Apnea: Efficacy of Continuous Positive Airway Pressure.

    Science.gov (United States)

    Zhang, Xiao-Bin; Lin, Qi-Chang; Zeng, Hui-Qing; Jiang, Xing-Tang; Chen, Bo; Chen, Xiao

    2016-01-01

    In this study, the prevalence of erectile dysfunction (ED) and serum sexual hormone levels were evaluated in men with obstructive sleep apnea (OSA). In these patients, the efficacy of continuous positive airway pressure (CPAP) was determined. The 207 men (mean age 44.0 ± 11.1 years) enrolled in the study were stratified within four groups based on their apnea-hypopnea index score: simple snoring (n = 32), mild OSA (n = 29), moderate OSA (n = 38), and severe OSA (n = 108). The International Index of Erectile Dysfunction-5 (IIEF-5) score was obtained from each patient, and blood samples for the analysis of sexual hormones (prolactin, luteotropin, follicle-stimulating hormone, estradiol, progestin, and testosterone) were drawn in the morning after polysomnography. The IIEF-5 test and serum sexual hormone measurements were repeated after 3 months of CPAP treatment in 53 men with severe OSA. The prevalence of ED was 60.6 % in OSA patients overall and 72.2 % in those with severe OSA. Compared with the simple snoring group, patients with severe OSA had significantly lower testosterone levels (14.06 ± 5.62 vs. 17.02 ± 4.68, p = .018) and lower IIEF-5 scores (16.33 ± 6.50 vs. 24.09 ± 1.94, p = .001). The differences in the other sexual hormones between groups were not significant. After 3 months of CPAP treatment, there were no significant changes in sexual hormone levels, but the IIEF-5 score had improved significantly (18.21 ± 4.05 vs. 19.21 ± 3.86, p = .001). Severe OSA patients have low testosterone concentration and high ED prevalence. IIEF-5 scores increased significantly after CPAP treatment, but there was no effect on serum testosterone levels.

  19. The impact of nocturnal CPAP-treatment on sexuality and closeness in patients with obstructive sleep apnea.

    OpenAIRE

    Petersen, Marian

    2012-01-01

    Sleep has a major impact on our wellbeing and how we perform.OSA has an estimated prevalence of 2 % in women and 4 % in male and is characterized by repetitive complete (apnoea) or partial (hypopnoea) cessation of breathing. I wondered how the patients managed sexuality and closeness when suffering from OSA and in particular how the Continuous Positive Airways Pressure (CPAP) treatment affected their sexuality and closeness. A review of the literature showed there was little published informa...

  20. Genioglossus muscle responses to upper airway pressure changes: afferent pathways.

    Science.gov (United States)

    Mathew, O P; Abu-Osba, Y K; Thach, B T

    1982-02-01

    The afferent pathway of an upper airway reflex in which genioglossus muscle electromyographic (GG EMG) activity is influenced by pharyngeal pressure changes was investigated in 20 anesthetized rabbits. We took advantage of the fact that the upper airway was separated into two compartments by pharyngeal closure occurring when the animals breathe through a tracheostomy. This allowed pressure to be delivered selectively either to the nose and nasopharynx or to the larynx and hypopharynx. Midcervical vagotomy did not eliminate the GG EMG response to pressure stimuli. On the other hand high cervical vagotomy or superior laryngeal nerve section eliminated the response in the laryngeal compartment, but not in the nasopharyngeal compartment. Topical anesthesia of the mucosa of the nose, pharynx, and larynx abolished the response in both compartments. Therefore we conclude that more than one afferent pathway exists for this upper airway pressure reflex; the primary afferent pathway from the laryngeal compartment is the superior laryngeal branch of the vagus nerve, whereas the primary afferent pathway for the nasopharynx is nonvagal. Trigeminal nerve, glossopharyngeal nerve, and/or nervus intermedius carry nonvagal afferents from the nasopharynx and nose. The topical anesthetic and nerve section studies suggest that superficial receptors mediate this response. The occurrence of swallowing in response to upper airway pressure changes and its elimination by topical anesthesia or superior mechanoreceptors may mediate both genioglossus respiratory responses and swallowing responses.

  1. Effect of continuous positive airway pressure treatment on vascular endothelial function in patients with obstructive sleep apnea hypopnea syndrome and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    张希龙; 殷凯生; 毛辉; 王虹; 杨玉

    2004-01-01

    Background Continuous positive airway pressure (CPAP) treatment has been proven to be effective in improving the symptoms of coexisting coronary heart disease (CHD) in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). However, it is still unclear whether such improvements are linked to changes in vascular endothelial function. This research was carried out to investigate the effects of CPAP treatment on vascular endothelial function in patients with OSAHS and CHD.Methods Thirty-six patients with moderate or severe OSAHS and CHD undergoing three months of CPAP treatment were recruited for this study. The changes in their morning plasma nitric oxide (NO) and endothelin (ET) levels, NO/ET ratio, total ischemic burden (TIB) of the myocardium, apnea hypopnea index (AHI), and minimal and mean pulse oxygen saturation (SpO2) were compared and analyzed before and during CPAP treatment. Results Compared with the plasma levels of ET [(51.39±11.69) ng/L] and NO [(36.67±11.86) μmol/L], NO/ET (0.71±0.14), AHI (32.4±7.9), minimal SpO2 [(68.9±11.4)%], and myocardial TIB [(66.29±16.37) mm*min] before treatment, there were significant decreases in ET [(33.41±10.03) ng/L] (P<0.05), increases in NO [(59.89±10.26) μmol/L] and NO/ET (1.79±0.38) (P<0.01), decreases in AHI (1.9±0.5), and increases in minimal SpO2 [(90.6±1.8) %] (all P<0.01) and myocardial TIB [(36.42±10.87) mm*min] (P<0.05) after three months of CPAP treatment.Conclusion CPAP treatment may play an important role in the improvement and protection of vascular endothelial dysfunction and myocardial ischemia in OSAHS patients with CHD.

  2. Sildenafil versus continuous positive airway pressure for erectile dysfunction in men with obstructive sleep apnea: a comparative study of their efficacy and safety and the patient's satisfaction with treatment%比较西地那非与连续气道正压通气治疗阻塞性睡眠呼吸暂停患者的勃起功能障碍:疗效、安全性和患者满意度

    Institute of Scientific and Technical Information of China (English)

    Petros Perimenis; Kyriakos Karkoulias; Angelis Konstantinopoulos; Paraskevi P. Perimeni; George Katsenis; Anastasios Athanasopoulos; Konstantinos Spyropoulos

    2007-01-01

    Aim: To assess the efficacy of sildenafil and continuous positive airway pressure (CPAP) in the treatment of concurrent erectile dysfunction (ED) with obstructive sleep apnea (OSA), and to gauge the level of treatment satisfaction in patients and their partners. Methods: Forty men were treated for 12 weeks with sildenafil 100 mg (20 men) or CPAP during nighttime sleep (20 men). Treatment efficacy was assessed by the rate of successful intercourse attempts,and satisfaction with treatment was assessed by patients' and partners' answers to question 1 of the Erectile Dysfunction Inventory of Treatment Satisfaction. Results: Under sildenafil, 128 of 249 (51.4%) intercourse attempts were successful; under CPAP, 51 of 193 (26.9%) attempts were successful (Cp < 0.001). Erectile function was improved in both groups. After sildenafil and CPAP treatment, the mean International Index for Erectile Function domain scores were 14.3 and 10.8, respectively (Bp = 0.025), compared to 7.8 and 7 at baseline, respectively. CPAP and sildenafil were well tolerated. Sporadic episodes of nasal dryness under CPAP and transient headache and flushing under sildenafil were not significant. Fifty percent of patients treated with sildenafil and 25% with CPAP were satisfied with the treatment, and their partners were equally satisfied. The satisfaction scores for both patients and partners under sildenafil were superior to those under CPAP (Cp < 0.002). Conclusion: Both sildenafil 100 mg and CPAP, used separately, had positive therapeutic impact but sildenafil was superior. Patients and their partners were more satisfied with sildenafil for the treatment of ED. However, because of the high proportion of dissatisfied men and partners, new therapeutic agents or a combination of the two methods must be studied further.

  3. Impact of acetazolamide and CPAP on cortical activity in obstructive sleep apnea patients.

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    Katrin Stadelmann

    Full Text Available STUDY OBJECTIVES: 1 To investigate the impact of acetazolamide, a drug commonly prescribed for altitude sickness, on cortical oscillations in patients with obstructive sleep apnea syndrome (OSAS. 2 To examine alterations in the sleep EEG after short-term discontinuation of continuous positive airway pressure (CPAP therapy. DESIGN: Data from two double-blind, placebo-controlled randomized cross-over design studies were analyzed. SETTING: Polysomnographic recordings in sleep laboratory at 490 m and at moderate altitudes in the Swiss Alps: 1630 or 1860 m and 2590 m. PATIENTS: Study 1: 39 OSAS patients. Study 2: 41 OSAS patients. INTERVENTIONS: Study 1: OSAS patients withdrawn from treatment with CPAP. Study 2: OSAS patients treated with autoCPAP. Treatment with acetazolamide (500-750 mg or placebo at moderate altitudes. MEASUREMENTS AND RESULTS: An evening dose of 500 mg acetazolamide reduced slow-wave activity (SWA; approximately 10% and increased spindle activity (approximately 10% during non-REM sleep. In addition, alpha activity during wake after lights out was increased. An evening dose of 250 mg did not affect these cortical oscillations. Discontinuation of CPAP therapy revealed a reduction in SWA (5-10% and increase in beta activity (approximately 25%. CONCLUSIONS: The higher evening dose of 500 mg acetazolamide showed the "spectral fingerprint" of Benzodiazepines, while 250 mg acetazolamide had no impact on cortical oscillations. However, both doses had beneficial effects on oxygen saturation and sleep quality.

  4. Use of CPAP and surfactant therapy in newborns with respiratory distress syndrome.

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    Murki, Srinivas; Deorari, Ashok; Vidyasagar, Dharmapuri

    2014-05-01

    Respiratory distress syndrome (RDS) is a major disease burden in the developing countries. Current evidence supports early continuous positive airway pressure (CPAP) use and early selective surfactant administration as the most efficacious interventions in the management of RDS, both in developed and developing countries. In developing countries, it is recommended to increase institutional deliveries and increase the coverage of antenatal steroids in women in preterm labor as preventive measures. Establishing intervention of CPAP and surfactant therapies in the Level II special care newborn units (SCNUs) and Level III units requires focus on training nursing staff and pediatricians across the board. These approaches would pave the way in optimizing the care of the preterm infants with RDS and decrease their mortality and morbidity significantly.

  5. Evaluation of short-term use of nocturnal nasal continuous positive airway pressure for a clinical profile and exercise capacity in adult patients with obstructive sleep apnea-hypopnea syndrome

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    Amrit K Goel

    2015-01-01

    Full Text Available Background and Aim: The obstructive sleep apnea-hypopnea syndrome (OSAHS is a common chronic respiratory disease, characterized by repetitive complete or partial collapse of the upper airway during sleep. The clinical spectrum extends between stoppage of breathing, snoring, daytime somnolence, and fatigue, to serious cardiovascular disease, stroke, metabolic syndrome, increased morbidity, and mortality. We aim to evaluate the short-term use of nasal continuous positive airway pressure (nCPAP therapy for the clinical profile and exercise capacity of patients with OSAHS. Patient Selection: Twenty patients diagnosed with moderate-to-severe OSAHS were enrolled in the study (study group - 15; clinically and PSG-matched control group - 5. Materials and Methods: Each patient was clinically evaluated for sleep-related symptoms, and also assessed with spirometry, the six-minute walk test (6MWT, and a symptom-limited incremental cardiopulmonary exercise test (CPET. The study group patients were administered nCPAP therapy for eight hours each night for four weeks, while the control group patients were just observed. They were re-assessed after four weeks and the data were statistically analyzed between the two groups. Results: The study group patients showed a significant (P- < 0.05 improvement in the OSAHS symptoms-the Epworth sleepiness score, six-minute walk distance; duration of exercise, power output, peak oxygen uptake, anaerobic threshold, diastolic blood pressure, dyspnea, and fatigue-in comparison with the control group patients. The improvement in exercise capacity following nCPAP therapy was attributed to the relief of disabling the OSAHS symptoms and improved cardiovascular, ventilator, and musculoskeletal functions. Conclusion: All OSAHS patients must be treated with nCPAP.

  6. Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control

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    Javid Ahmad Malik

    2017-01-01

    Full Text Available Background: Obstructive sleep apnea (OSA and type 2 diabetes mellitus (T2DM are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. Objectives: To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c. Methods: We performed polysomnography (PSG studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. Results: In our 62 diabetic patients, 59 (95.2% had abnormal PSG. Based on Apnea–Hypopnea Index (AHI score, 3 (5.1% patients had mild, 28 (47.5% had moderate, and 28 (47.5% had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001. Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI, hypertension, diabetes, and cardiovascular disease (P < 0.05; however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. Conclusion: Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics.

  7. Obstructive sleep apnea in Type 2 diabetes and impact of continuous positive airway pressure therapy on glycemic control

    Science.gov (United States)

    Malik, Javid Ahmad; Masoodi, Shariq Rashid; Shoib, Sheikh

    2017-01-01

    Background: Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) are two interacting epidemics both with high prevalence and morbidity. Both epidemiologic and clinical studies suggest that the majority of patients with T2DM also have OSA and untreated OSA in these patients results in poor glycemic control leading to acceleration of diabetes-related complications. Objectives: To assess the prevalence and severity of OSA in T2DM patients and to assess the impact of OSA treatment on presenting symptoms and hemoglobin A1c (HbA1c). Methods: We performed polysomnography (PSG) studies and measured HbA1c in 62 consecutive patients with T2DM that were referred from various subspecialty clinics from July 2011 to August 2013. Results: In our 62 diabetic patients, 59 (95.2%) had abnormal PSG. Based on Apnea–Hypopnea Index (AHI) score, 3 (5.1%) patients had mild, 28 (47.5%) had moderate, and 28 (47.5%) had severe OSA. The mean AHI of diabetic patients was significantly more than nondiabetic patients, i.e., 25.7 versus 19.7 (P = 0.001). Variables that significantly correlated with the presence of OSA include age, gender, body mass index (BMI), hypertension, diabetes, and cardiovascular disease (P < 0.05); however, on logistic regression only BMI, hypertension, and nocturia correlated with OSA. Overall, 59% of diabetic patients showed improvement in their glycemic control as measured by HbA1c with continuous positive airway pressure (CPAP) treatment. Significant, moderate, and mild categories of treatment response were respectively observed in 7%, 20%, and 32% of patients. Conclusion: Treatment of OSA with CPAP reduces HbA1c in a significant number of diabetics. PMID:28217508

  8. High Adherence to CPAP Treatment Does Not Prevent the Continuation of Weight Gain among Severely Obese OSAS Patients

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    Myllylä, Minna; Kurki, Samu; Anttalainen, Ulla; Saaresranta, Tarja; Laitinen, Tarja

    2016-01-01

    Study Objectives: Obstructive sleep apnea syndrome (OSAS) patients benefit from continuous positive airway pressure (CPAP) treatment in a dose-response manner. We determined adherence and weight control, as well as their predictors, among long-term CPAP users. Methods: Cohort of 1,023 OSAS patients had used CPAP on average of 6.6 ± 1.2 years. BMI was determined at baseline and at follow-up visits. There were 7.4 ± 1.7 BMI and 6.5 ± 1.8 CPAP usage measurements per patient on average. Using the Bayesian hierarchical model, we determined the patients' individual trends of BMI and adherence development. Patients with significantly increasing or decreasing trends were identified at the posterior probability level of > 90%. Results: The mean age in the cohort was 55.6 ± 9.8 years, BMI 33.5 ± 6.4 kg/m2, apnea-hypopnea index 33.7 ± 23.1, and CPAP usage 6.0 ± 1.8 h/day. The majority of patients had no significant change in BMI (mean annual weight gain 0.04 ± 0.29 kg/m2) or CPAP adherence (mean annual increase 11.4 ± 7.0 min/day). However, at the individual level, 10% of the patients showed significant annual weight gain (0.63 ± 0.35 kg/m2) during the 5-year follow-up period. At baseline these patients were already more severely obese (mean BMI 40.0 ± 5.9 kg/m2) despite being younger (mean 50.9 ± 9.5 years) than the rest of the cohort. Conclusions: In the majority of CPAP-treated OSAS patients, weight did not significantly change but gained slightly slower than in age-matched population in general. However, in 10% of patients, high adherence to CPAP treatment did not prevent the continuation of weight gain. These patients present a high-risk group for OSAS-related multimorbidity later in life. Citation: Myllylä M, Kurki S, Anttalainen U, Saaresranta T, Laitinen T. High adherence to CPAP treatment does not prevent the continuation of weight gain among severely obese OSAS patients. J Clin Sleep Med 2016;12(4):519–528. PMID:26888588

  9. Comparing Pressures Required to Abolish Snoring and Sleep Apnea

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    V Hoffstein

    2001-01-01

    Full Text Available OBJECTIVE: Snoring and obstructive sleep apnea share similar pathogenesis and similar response to treatment with continuous positive airway pressure (CPAP. The purpose of this study was to compare pressures required to abolish apneas (POSA with pressures required to abolish snoring (PSNOR.

  10. Curative effect of continuous positive airway pressure on treatment of patients with obstructive sleep apnea hypopnea syndrome and hypertension: A Meta-analysis

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    Bi-fang MIAO

    2016-12-01

    Full Text Available Objective  To systematically evaluate the curative effect of continuous positive airway pressure (CPAP on treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS and hypertension. Methods  The data were retrieved of randomized controlled trials (RCTs about the curative effect of CPAP on treatment of patients with OSAHS and hypertension from PubMed, Cochrane Library, CNKI, VIP, CBM and WanFang database from inception to Oct. 2015. Literature screening, data extraction and risk bias assessment were performed by two independent reviewers, and meta-analysis was then carried out by using RevMan 5.3 software. Results  A total of 16 RCTs involving 2101 patients were included. Meta-analysis revealed that, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the daytime systolic pressure [MD=–12.60, 95%CI(–17.68 to –7.52, P<0.00001], nighttime systolic pressure [MD=–21.90, 95%CI(–25.94 to –17.86, P<0.00001] and nighttime diastolic pressure [MD=–11.90, 95%CI(–15.44 to –8.36, P<0.00001], while created no significant difference in daytime diastolic pressure, 24-h mean systolic pressure and 24-h mean diastolic pressure in a following-up less than 12 weeks. Whereas in the following-up no less than 12 weeks, compared with the antihypertensive drug therapy alone, CPAP plus antihypertensive drug therapy significantly reduced the 24-h mean systolic pressure [MD=–7.88, 95%CI(–12.09 to –3.66, P=0.00002], 24-h mean diastolic pressure [MD=–5.14, 95%CI(–6.00 to –4.28, P<0.00001], daytime systolic pressure [MD=–5.89, 95%CI(–8.79 to –2.98, P<0.0001], daytime diastolic pressure [MD=–4.34, 95%CI(–6.32 to –2.36, P<0.0001]; nighttime systolic pressure [MD=–7.06, 95%CI(–11.12 to –2.99, P=0.0007] and nighttime diastolic pressure [MD=–4.49, 95%CI (–7.39 to –1.58, P=0.006]. Conclusions  The current evidences suggest that on the basis

  11. Impact of CPAP on physical exercise tolerance and sympathetic-vagal balance in patients with chronic heart failure

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    Hugo V. Reis

    2014-06-01

    Full Text Available Background: Chronic heart failure (CHF leads to exercise intolerance. However, non-invasive ventilation is able to improve functional capacity of patients with CHF. Objectives: The aim of this study was to evaluate the effectiveness of continuous positive airway pressure (CPAP on physical exercise tolerance and heart rate variability (HRV in patients with CHF. Method : Seven men with CHF (62±8 years and left ventricle ejection fraction of 41±8% were submitted to an incremental symptom-limited exercise test (IT on the cicloergometer. On separate days, patients were randomized to perform four constant work rate exercise tests to maximal tolerance with and without CPAP (5 cmH2O in the following conditions: i at 50% of peak work rate of IT; and ii at 75% of peak work rate of IT. At rest and during these conditions, instantaneous heart rate (HR was recorded using a cardiofrequencimeter and HRV was analyzed in time domain (SDNN and RMSSD indexes. For statistical procedures, Wilcoxon test or Kruskall-Wallis test with Dunn's post-hoc were used accordingly. In addition, categorical variables were analysed through Fischer's test (p<0.05. Results: There were significant improvements in exercise tolerance at 75% of peak work rate of IT with CPAP (405±52 vs. 438±58 s. RMSSD indexes were lower during exercise tests compared to CPAP at rest and with 50% of peak work rate of IT. Conclusion: These data suggest that CPAP appears to be a useful strategy to improve functional capacity in patients with CHF. However, the positive impact of CPAP did not generate significant changes in the HRV during physical exercises.

  12. Efficiency of Continuous Positive Airway Pressure or High-Frequency Jet Ventilation by Means a Nasooral Mask in the Treatment of Pulmonary Edema

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    J. Salantay

    2008-01-01

    Full Text Available Objective: to compare the efficiency of continuous positive airway pressure (CPAP and high-frequency jet ventilation by means of a mask (HFJV-M in the treatment of cardiogenic edema of the lung. Design: a retrospective study. Setting: Department of Anesthesiology and Intensive Medicine, Hospital NsP, Vranov, Slovakia. Subjects and methods. A hundred and ninety-six patients with varying cardiogenic edema of the lung were divided into 3 groups according to the severity of pulmonary edema (PE. By taking into account comparable pharmacotherapy, mean airway pressure, and FiO2, the authors compared the efficiency of CPAP (n=64 and HFJV-M (n=101 from the rate of changes in respiration rate, blood oxygenation, acid-base balance, and the duration of ventilation support and the length of stay in the intensive care unit (ICU. The results were assessed by the unpaired Student’s test. The procedure of artificial ventilation via HFJV-M was approved by the Professional and Ethics Committee, Ministry of Health in the Republic of Slovakia, in 1989 for clinical application. Results. Comparison of CPAP or HFJV-M used in mild PE that was called Phase 1 of PE revealed no statistically significant differences in the parameters being assessed. In severer forms of PE characterized as Phases 2 and 3, the use of HFJV-M in the first 3 hours of ventilation maintenance caused a rapider reduction in spontaneous respiration rate from 25—33 per min to 18—22 per min (p>0.01. The application of HFJV-M also showed a statistically significant difference in the correction rate of PaO2, pH, and oxygenation index (PaO2/FIO2 (p>0.01 predominantly within the first 2 hours of therapy. Comparison of the mean duration of necessary ventilation maintenance (CPAP versus HFJV-M: 10.9 versus 6.8 hours and the mean length of stay in the ICU (CPAP versus HFJV-N: 2.7 versus 2 days revealed a statistically significant difference (p>0.01 and p>0.05, respectively. Only 6.6% of the HFJV-M group

  13. The effects of CPAP treatment on task positive and default mode networks in obstructive sleep apnea patients: an fMRI study.

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    Olga Prilipko

    Full Text Available INTRODUCTION: Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS considering Task Positive and Default Mode networks (TPN and DMN. METHODS: An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active or sub-therapeutic (sham CPAP treatment. RESULTS: Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back. CONCLUSION: OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the

  14. Effects of Continuous Positive Airway Pressure on Cognitive Deficits in Middle-aged Patients with Obstructive Sleep Apnea Syndrome: A Meta-analysis of Randomized Controlled Trials

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    Yue-Ying Pan; Yan Deng; Xiu Xu; Ya-Ping Liu; Hui-Guo Liu

    2015-01-01

    Background:Current views on continuous positive airway pressure (CPAP) treatment to improve the cognitive deficits of patients with obstructive sleep apnea syndrome (OSAS) are controversial,so we performed a meta-analysis.Methods:A comprehensive literature search was tmdertaken in PubMed,CINAHL,Medline,PsycInfo,EMBASE,Cochrane Library,CNKI,WanFang,VIP,and CBMdisc for studies published from June 1971 to July 2014.The outcome measures included neuropsychological tests of the 7 cognitive domains detailed below.Results:After screening the titles and abstracts and thoroughly reading the full text,we obtained 13 studies with little risk of bias that incorporated 1744 middle-aged obese participants with mild to severe OSAS.The studies were published from 1994 to 2012.Treatment durations varied from 1 to 24 weeks.The effect sizes of attention,vigilance,processing speed,working memory,memory,verbal fluency,and visuoconstructive skills domains were-0.10 (P =0.24),-0.12 (P =0.04),-0.08 (P =0.16),0.00 (P =0.95),-0.04 (P =0.30),-0.06 (P =0.34),and-0.01 (P =0.92),respectively.Conclusions:Cognition partially improved in patients with OSAS after CPAP treatment.The only domain with significant improvement was vigilance.Rigorous randomized controlled trials need to be performed to obtain clear results.

  15. Impact of untreated obstructive sleep apnea on left and right ventricular myocardial function and effects of CPAP therapy.

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    Christoph Hammerstingl

    Full Text Available BACKGROUND: Obstructive sleep apnea (OSA has deteriorating effect on LV function, whereas its impact on RV function is controversial. We aimed to determine the effect of OSA and continuous positive airway pressure (CPAP treatment on left and right ventricular (LV, RV function using transthoracic echocardiography (TTE and 2 dimensional speckle tracking (2D ST analysis of RV deformation capability. METHODS AND RESULTS: 82 patients with OSA and need for CPAP therapy were prospectively enrolled and underwent TTE at study inclusion and after 6 months of follow up (FU. Multivariate regression analysis revealed an independent association between baseline apical right ventricular longitudinal strain (RV-Sl, BMI and the severity of OSA (apical RV-Sl: P = 0.0002, BMI: P = 0.02. After CPAP therapy, LV functional parameters (LVEF: P30:54.1 ± 12.4%, 68.2 ± 13.6%[P30: -6.3 ± 5.7%, -17.9 ± 11.2% [P<0.0001]. CONCLUSIONS: OSA seems to have deteriorating effect on LV and RV function. We found a beneficial effect of CPAP on LV and RV functional parameters predominately in patients with severe OSA. 2D speckle tracking might be of value to determine early changes in global and regional right ventricular function.

  16. 持续气道正压通气对胸腹腔镜下食管癌根治术患者单肺通气时肺内分流和氧合的影响%Effects of continuous positive airway pressure on oxygenation and shunt fraction during one-lung ventilation in thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma

    Institute of Scientific and Technical Information of China (English)

    李琪英; 闵苏

    2011-01-01

    目的 观察胸腹腔镜下食管癌根治术患者单肺通气(one lung ventilation,OLV)时非通气侧肺持续气道正压(continuous positive airway pressure,CPAP)通气对肺内分流和氧合的影响.方法 80例择期行胸腹腔镜下食管癌根治术患者,ASA分级Ⅰ-Ⅱ级,采用随机数字表法分为4组(n=20):对照组(单肺通气时非通气侧支气管导管与大气相通)及CPAP 2 cmH2O组、CPAP 5 cmH2O组、CPAP 8 cmH2O组(单肺通气时非通气侧肺分别给予2、5、8 cmH2O的CPAP处理).分别于单肺通气前(T1)、单肺通气30 min(T2)、60 min(T3)、90 min(T4)、120 min(T5)采血行血气分析,根据公式计算肺内分流率(Qs/Qt).结果 对照组和CPAP2 cmH2O组T2-T5各时点Qs/Qt较T1明显增高,动脉血氧分压[p(O2)]明显降低(P<0.05);CPAP 5 cmH2O组和CPAP 8 cmH2O组T2-T5各时点Qa/Qt较T1亦有增加,p(O2)亦有降低,但差异无显著性(P>0.05);T2~T5各时点,CPAP 5 cmH2O组、CPAP 8 cmH2O组Qs/Qt明显低于对照组和CPAP 2 cmH2O组,p(O2)明显高于对照组和CPAP 2 cmH2O组(P<0.05),而CPAP 5 cmH2O组与CPAP 8 cmH2O组在上述各时点Qs/Qt、p(O2)无统计学差异(P>0.05).胸外科医师对对照组、CPAP 2 cmH2O组、CPAP 5 cmH2O组手术侧肺萎陷满意度优于CPAP 8 cmH2O组,各组手术时间无差异(P>0.05).结论 胸腹腔镜下食管癌根治术患者单肺通气时对非通气侧肺实施5 cmH2O和8 cmH2O的CPAP可减少肺内分流,明显提高p(O2),防止低氧血症的发生;5cmH2O的CPAP有利于术野暴露,满足手术操作.%Objective To evaluate the effects of continuous positive airway pressure (CPAP) for nonventilated lung on the intrapulmonary shunt fraction and oxygenation during one-lung ventilation (OLV) in patients who received thoracoscopy and laparoscopy-assisted radical treatment of esophageal carcinoma. Methods Eighty ASA class Ⅰ -Ⅱ esophageal carcinoma patients scheduled for esophagectomy under thoracoscopy and laparoscopy were enrolled and randomly

  17. 经鼻持续气道正压给氧多中心临床试验研究%A multi-center clinical trial of oxygen administration with nasal continuous positive airway pressure

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    持续气道正压给氧临床试验协作组

    2008-01-01

    目的 评价经鼻持续气道正压(CPAP)给氧的效果.方法 2003年1月至2007年12月首都儿科研究所(牵头)和北京市9家郊区县医院对107例因肺部疾患导致低氧血症新生儿和婴幼儿进行多中心临床试验,通过脉搏血氧仪并结合临床观察对国产的CPAP氧疗仪和普通给氧方法 (面罩、头罩)在改善血氧饱和度的效果方面进行评价.结果 CPAP治疗组46例,普通给氧组61例.应用CPAP后新生儿组在给氧后0.5 h及2 h血氧饱和度为(88.6±7.9)%及(94.4±5.0)%,普通给氧组为(82.4±5.7)%及(90.3±4.5)%,两组间差异有显著性(P<0.05).婴幼儿组在CPAP给氧后1 h血氧饱和度为(95.7±2.6)%,普通给氧组为(87.3±15.8)%,两组间差异有显著性(P<0.05).给氧后紫绀和呼吸困难程度的改善,CPAP组优于普通给氧组.结论 经鼻CPAP氧疗仪是适用于基层、安全、有效、效果优于普通给氧方法 的给氧工具.%Objective To evaluate the effect of nasal continuous positive airway pressure (CPAP).Methods A randomized controlled multi-center clinical trial was conducted during January 2003 to December 2007 in 107 newborns and infants with hypoxemia due to pulmonary diseases.These patients were hospitalized in Capital Institute of Pediatrics and 9 local hospitals.The changes of arterial oxygen saturation and clinical signs were studied after CPAP treatment and conventional oxygen therapy.Results CPAP group recruited 46 cases,conventional oxygen therapy group included 61 cases.After CPAP treatment,oxygen saturation values in newborns at 0.5 and 2 hour were (88.6±7.9)% and (94.4±5.0)%,and there was significant difference as compared with those in conventional oxygen therapy group [(82.4±5.7)% and (90.3±4.5)%].Oxygen saturation value of infants with CPAP at 1 hour was (95.7±2.6)%,and there was significant difference as compared with that in conventional oxygen therapy group[(87.3±15.8)%].Oxygen therapy alleviated the severity of cyanosis and dyspnea

  18. A manic episode after CPAP in a patient with obstructive sleep apnoea

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    Margarida Lobo

    2014-10-01

    Full Text Available Obstructive slee apnoea (OSA is a common sleep disorder. It has been recognized a link between OSA and depression , which is most of the times resistant to treatment. Other aspects of OSA are metabolic: insulin resistance, hypertension and obesity. A common treatment for OSA is Continuous Positive Airway Pressure (CPAP. This treatment may reverse the cognitive and affective dysfunction but in some cases with residual impairment. The author reports a case of a 48 years old man with family history of bipolar disorder but no past history of psychiatric disorders. A diagnosis of OSA led to the use of CPAP. Ten days later he started hypomanic symptoms and 15 days later he was strongly manic. He was hospitalized and treated with olanzapine, lorazepam and divalproate. CPAP treatment was interrupted. After recovery the patient became depressed and, since then, although he doesn't meet the criteria for major depression, depressive symptoms persisted even with olanzapine and lamotrigibne. Meanwhile he was diagnosed with diabettes mellitus 2 and olanzapine was discontinued and he was put on ziprasidone. The author discusses the contribution of the OSA and treatment with CPAC to the appearance and maintenance of the affective disorder in a patient with family susceptibility. The discussion also includes the metabolic aspects of OSA that can be worsened with the medication to control the affective disorder.

  19. Validation of airway resistance models for predicting pressure loss through anatomically realistic conducting airway replicas of adults and children.

    Science.gov (United States)

    Borojeni, Azadeh A T; Noga, Michelle L; Martin, Andrew R; Finlay, Warren H

    2015-07-16

    This work describes in vitro measurement of the total pressure loss at varying flow rate through anatomically realistic conducting airway replicas of 10 children, 4 to 8 years old, and 5 adults. Experimental results were compared with analytical predictions made using published airway resistance models. For the adult replicas, the model proposed by van Ertbruggen et al. (2005. J. Appl. Physiol. 98, 970-980) most accurately predicted central conducting airway resistance for inspiratory flow rates ranging from 15 to 90 L/min. Models proposed by Pedley et al. (1970. J. Respir. Physiol. 9, 371-386) and by Katz et al. (2011. J. Biomech. 44, 1137-1143) also provided reasonable estimates, but with a tendency to over predict measured pressure loss for both models. For child replicas, the Pedley and Katz models both provided good estimation of measured pressure loss at flow rates representative of resting tidal breathing, but under predicted measured values at high inspiratory flow rate (60 L/min). The van Ertbruggen model, developed based on flow simulations performed in an adult airway model, tended to under predict measured pressure loss through the child replicas across the range of flow rates studied (2 to 60 L/min). These results are intended to provide guidance for selection of analytical pressure loss models for use in predicting airway resistance and ventilation distribution in adults and children.

  20. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome: a randomized, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems.

    Science.gov (United States)

    Nikolopoulou, Maria; Byraki, Anna; Ahlberg, Jari; Heymans, Martijn W; Hamburger, H L; De Lange, Jan; Lobbezoo, Frank; Aarab, Ghizlane

    2017-03-10

    Obstructive sleep apnea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomized placebo-controlled trial sixty-four OSAS patients (52.0± 9.6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design. All participants filled out the validated Dutch Sleep Disorders Questionnaire (SDQ) twice: one before treatment and one after six months of treatment. With 88 questions, thirteen scales were constructed, representing common sleep disorders and sleep-related problems. Linear mixed model analyses were performed to study differences between the groups for the different SDQ scales over time. The MAD group showed significant improvements over time in symptoms corresponding with "insomnia", "excessive daytime sleepiness", "psychiatric sleep disorder", "periodic limb movements", "sleep apnea", "sleep paralysis", "daytime dysfunction", "hypnagogic hallucinations/dreaming", "restless sleep", "negative conditioning", and "automatic behaviour" (range of P values: 0.000-0.014). These improvements in symptoms were, however, not significantly different from the improvements in symptoms observed in the nCPAP and placebo groups (range of P values: 0.090-0.897). It can be concluded that there is no significant difference between MAD and nCPAP in their positive effects on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. These beneficial effects may be a result of placebo effects. This article is protected by copyright. All rights reserved.

  1. Influence of Nasal Continues Positive Airway Pressure on Retention of Carbon Dioxide in Newborn%新生儿经鼻持续气管正压通气对二氧化碳潴留的影响

    Institute of Scientific and Technical Information of China (English)

    吴玫; 陈大鹏; 熊英; 陈超

    2012-01-01

    Objective To investigate the influence of nasal continues positive airway pressure (nCPAP) on retention of carbon dioxide(CO2) in newborns.Methods From June to December 2009,a total of 46 newborns who had nCPAP treatment for 72 hours in West China Second University Hospital,Sichuan University were included in nCPAP group.Meanwhile,another 20 cases of neonates with jaundice were selected as control group.The artery blood gas was detected by STEPHAN CPCP-B just before nCPAP treatment and at 30 min,6 h,12 h,24 h,36 h after nCPAP treatment in nCPAP group.The same method determined the artery blood gas in control group.The blood gas analysis results between nCPAP group before nCPAP treatment and control group,and between nCPAP group at different time slots and control group were analyzed by statistical methods.The procedure of this study was consistent with ethical standard which was established by the committee of investigation in human beings of West China Second University Hospital,Sichuan University.And it was approved by this committee.Guardians were informed of grouping and their written informed consent was obtained before clinical studies.There had no significance differences between two groups among gestational age at delivery,day age,and gender (P>0.05).Results There had significant difference between nCPAP group before nCPAP treatment and control group in pH value and partial pressure of oxygen in artery (Pao2) (P<0.01),but partial pressure of CO2 in artery (PaCO2 ),levels of ( HCO3ˉ ),standard bicarbonate (SB) and base excess (BE) had no significant difference (P>0.05).The blood gas results of nCPAP group at different treatment time slots and control group showed that even using nCPAP in newborns with normal Paco2 for 72 h,there were no signs of retention of CO2 (P>0.05).Conclusions Using nCPAP in newborn with normal PaCO2 for 72 h may not cause serous retention of CO2.%目的 探讨新生儿使用经鼻持续气管正压通气(nCPAP)前

  2. Effect of continuous positive airway pressure during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect%单肺通气期间连续气道正压通气对胸腔镜房间隔缺损修补术患者肺功能的影响

    Institute of Scientific and Technical Information of China (English)

    王磊; 陈宇; 钱燕宁; 丁正年; 孙杰

    2010-01-01

    目的 探讨单肺通气期间连续气道正压通气(CPAP)对胸腔镜房间隔缺损修补术患者肺功能的影响.方法 拟行房间隔缺损修补术的患者20例,年龄16~30岁,体重41~64 kg,性别不限,ASA分级Ⅱ级,随机分为2组(n=10):对照组和CPAP组.两组单肺通气时VT 8 ml/kg,呼吸频率12~16次/min,吸呼比1:2,维持PET CO2 35~40 mm Hg.CPAP组单肺通气期间,非通气侧肺采用CPAP,压力为6 cm H2O.术中监测氧合指数、肺顺应性和气道压,记录拔管时间、单肺通气期间心血管事件和低氧血症的发生情况.结果 与对照组比较,CPAP组氧合指数和肺顺应性升高,拔管时间缩短,低氧血症发生率低(P<0.01),两组患者气道压力在正常范围且未发生心血管事件.结论 单肺通气期间行CPAP(6 cm H2O)可改善胸腔镜房间隔缺损修补术患者的肺功能.%Objective To investigate the effect of continuous positive airway pressure(CPAP)during one lung ventilation on pulmonary function in patients undergoing video-assisted thoracoscopic repair of atrial septal defect.Methods Twenty ASA Ⅱ patients of both sexes,aged 16-30 yr,weighing 41-64 kg,scheduled for video-assisted thoracoscopic repair of atrial septal defect,were randomly divided into 2 groups(n = 10 each): control group and CPAP group.One lung ventilation(VT 8 ml/kg,RR 12-16 bpm,I:E 1:2,PETCO2 35-40 mm Hg)was perform in both groups.CPAP(6 cm H2O)was perform during one lung ventilation in group CPAP.The oxygenation index,pulmonary compliance and airway pressure were recorded during operation.The cardiovascular events,hyoxemia and extubation time were recorded.Results The oxygenation index and pulmonary compliance were significantly higher,extubation time was shorter,and the incidence of hyoxemia was lower in CPAP group than in control group(P < 0.01).The airway pressure was in the normal range in both groups.No cardiovascular events was found in both groups.Conclusion CPAP(6cm H2O)during one lung

  3. Advances in the treatment of premature child syndrome CPAP respiratory distress%CPAP 对早产儿呼吸窘迫综合征的治疗进展

    Institute of Scientific and Technical Information of China (English)

    蒋道菊; 池永学

    2014-01-01

    in the era of gentle ventilation ,continuous positive airway pressure (cPaP) has been proven over the years to be an effective mode of noninvasive ventilatory support and as such has gained widespread use around the world in the management of a variety of neonatal respiratory diseases, particulary respiratory distress syndrome (rds).it is relatively cheap and easy to apply and certainly feasible for routine use in underdeveloped world.there is good to fair quality supportive evidence from several studies that the use of primary cPaP can reduce the need for intubation and mechanical ventilation in premature infants and could avoid ventilator induced lung injury and decrease bronchopulmonary dysplasia(BPd).cPaP has also been shown to be effective in the treatment of respiratory distress syndrome (rds) even in very low birth weight infants. in this review, we will attempt to describe different ways in which cPaP can be applied,other advantages of clinical indications for cPaP will also be explored. although it is unclear that primary use of cPaP can reduce overall neonatal mortality and morbidity ,it is becoming increasingly clear that early cPaP use is less invasive baby friendly and decreases the need and frequency of the use of surfactants.%在提倡减少肺损伤的时代,持续气道正压通气(continuous positive airway pressure ,cPaP)作为无创通气技术近年来已经被证实有效,因此,其对新生儿呼吸系统疾病,尤其是新生儿呼吸窘迫综合征(respiratory distress syndrome ,rds)的治疗在全世界范围得到推广。此外,cPaP 便宜、操作简便、易于在发展中国家实施。有研究证实 cPaP可以减少早产儿的气管插管及机械通气,故可避免呼吸机相关性肺损伤及降低支气管肺发育不良(bronchopulmonary dysplasia,BPd),且证实其甚至对极低体重出生儿 rds 有效。本文就 cPaP 对早产儿 rds 的不同应用方式做一简单综述, cPaP 的其它优点

  4. Comparative evaluation of intraocular pressure changes subsequent to insertion of laryngeal mask airway and endotracheal tube.

    Directory of Open Access Journals (Sweden)

    Ghai B

    2001-07-01

    Full Text Available AIMS: To evaluate the intraocular pressure and haemodynamic changes subsequent to insertion of laryngeal mask airway and endotracheal tube. SUBJECTS AND METHODS: The study was conducted in 50 adult patients. A standard general anaesthesia was administered to all the patients. After 3 minutes of induction of anaesthesia baseline measurements of heart rate, non-invasive blood pressure and intraocular pressure were taken following which patients were divided into two groups: laryngeal mask airway was inserted in group 1 and tracheal tube in group 2. These measurements were repeated at 15-30 second, every minute thereafter up to 5 minutes after airway instrumentation. RESULTS: A statistically significant rise in heart rate, systolic blood pressure, diastolic blood pressure and intraocular pressure was seen in both the groups subsequent to insertion of laryngeal mask airway or endotracheal tube. Mean maximum increase was statistically more after endotracheal intubation than after laryngeal mask airway insertion. The duration of statistically significant pressure responses was also longer after endotracheal intubation. CONCLUSION: Laryngeal mask airway is an acceptable alternative technique for ocular surgeries, offering advantages in terms of intraocular pressure and cardiovascular stability compared to tracheal intubation.

  5. Armodafinil improves wakefulness and long-term episodic memory in nCPAP-adherent patients with excessive sleepiness associated with obstructive sleep apnea.

    Science.gov (United States)

    Roth, Thomas; Rippon, Gregory A; Arora, Sanjay

    2008-03-01

    Residual excessive sleepiness (ES) and impaired cognition can occur despite effective and regular nasal continuous positive airway pressure (nCPAP) therapy in some patients with obstructive sleep apnea (OSA). A pooled analysis of two 12-week, randomized, double-blind studies in nCPAP-adherent patients with ES associated with OSA evaluated the effect of armodafinil on wakefulness and cognition. Three hundred and ninety-one patients received armodafinil (150 or 250 mg) and 260 patients received placebo once daily for 12 weeks. Efficacy assessments included the Maintenance of Wakefulness Test (MWT), Cognitive Drug Research cognitive performance battery, Epworth Sleepiness Scale, and Brief Fatigue Inventory. Adverse events were monitored. Armodafinil increased mean MWT sleep latency from baseline to final visit by 2.0 min vs a decrease of 1.5 min with placebo (P armodafinil significantly improved quality of episodic secondary memory (P Armodafinil did not adversely affect desired nighttime sleep, and nCPAP use remained high (approximately 7 h/night). Adjunct treatment with armodafinil significantly improved wakefulness, long-term memory, and patients' ability to engage in activities of daily living in nCPAP-adherent individuals with ES associated with OSA. Armodafinil also reduced patient-reported fatigue and was well tolerated.

  6. Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    Kieran, Emily A

    2012-11-01

    To determine whether nasal continuous positive airway pressure (NCPAP) given with nasal prongs compared with nasal mask reduces the rate of intubation and mechanical ventilation in preterm infants within 72 hours of starting therapy.

  7. Severe upper airway obstruction during sleep.

    Science.gov (United States)

    Bonekat, H William; Hardin, Kimberly A

    2003-10-01

    Few disorders may manifest with predominantly sleep-related obstructive breathing. Obstructive sleep apnea (OSA) is a common disorder, varies in severity and is associated with significant cardiovascular and neurocognitive morbidity. It is estimated that between 8 and 18 million people in the United States have at least mild OSA. Although the exact mechanism of OSA is not well-delineated, multiple factors contribute to the development of upper airway obstruction and include anatomic, mechanical, neurologic, and inflammatory changes in the pharynx. OSA may occur concomitantly with asthma. Approximately 74% of asthmatics experience nocturnal symptoms of airflow obstruction secondary to reactive airways disease. Similar cytokine, chemokine, and histologic changes are seen in both disorders. Sleep deprivation, chronic upper airway edema, and inflammation associated with OSA may further exacerbate nocturnal asthma symptoms. Allergic rhinitis may contribute to both OSA and asthma. Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA. Treatment with CPAP therapy has also been shown to improve both daytime and nighttime peak expiratory flow rates in patients with concomitant OSA and asthma. It is important for allergists to be aware of how OSA may complicate diagnosis and treatment of asthma and allergic rhinitis. A thorough sleep history and high clinical suspicion for OSA is indicated, particularly in asthma patients who are refractory to standard medication treatments.

  8. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA

    Directory of Open Access Journals (Sweden)

    Yesim Bayraktar

    2013-06-01

    Full Text Available Negative pressure pulmonary edema (NPPE following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving.In this article we aimed to report  a case of negative pressure pulmonary edema, resolved succesfully after treatment, following use of laryngeal mask airway (LMA.

  9. Volumetric Brain Morphometry Changes in patients with Obstructive Sleep Apnea Syndrome : effects of CPAP treatment and literature review.

    Directory of Open Access Journals (Sweden)

    Nelly T Huynh

    2014-04-01

    Full Text Available Introduction: Obstructive sleep apnea syndrome (OSAS is a frequent breathing disorder occurring during sleep that is characterized by recurrent hypoxic episodes and sleep fragmentation. It remains unclear whether OSAS leads to structural brain changes, and if so, in which brain regions. Brain region-specific gray and white matter volume (GMV and WMV changes can be measured with voxel-based morphometry (VBM. The aims of this study were to use VBM to analyze GMV and WMV in untreated OSAS patients compared to healthy controls (HC; examine the impact of OSAS-related variables (nocturnal hypoxemia duration and sleep fragmentation index on GMV and WMV; and assess the effects of therapeutic versus sham continuous positive airway pressure (CPAP. We discuss our results in light of previous findings and provide a comprehensive literature review. Methods: Twenty-seven treatment-naïve male patients with moderate to severe OSAS and seven healthy age- and education-matched control subjects (HC were recruited. After a baseline fMRI scan, patients randomly received either active (therapeutic, n=14 or sham (subtherapeutic, n=13 nasal CPAP treatment for 2 months. Results: Significant negative correlations were observed between nocturnal hypoxemia duration and GMV in bilateral lateral temporal regions. No differences in GMV or WMV were found between OSAS patients and HC, and no differences between CPAP versus sham CPAP treatment effects in OSAS patients. Conclusion: It appears that considering VBM GMV changes there is little difference between OSAS patients and HC. The largest VBM study to date indicates structural changes in the lateral aspect of the temporal lobe, which also showed a significant negative correlation with nocturnal hypoxemia duration in our study. This finding suggests an association between the effect of nocturnal hypoxemia and decreased GMV in OSAS patients.

  10. Negative Pressure Pulmonary Edema Following use of Laryngeal Mask Airway (LMA)

    OpenAIRE

    2013-01-01

    Negative pressure pulmonary edema (NPPE) following upper airway obstruction is a non-cardiogenic pulmonary edema. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglotitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors.The Late diagnosis and treatment causes high morbidity and mortality. The protection of the airway and maintainance of arterial oxygenation will be life saving...

  11. 持续正压通气在重症毛细支气管炎中的应用%The clinical application of continuous positive airway pressure in severe bronchiolitis

    Institute of Scientific and Technical Information of China (English)

    史瑞鹤; 刘恩梅

    2015-01-01

    毛细支气管炎是小婴儿最常见的下呼吸道感染性疾病,目前尚无特异性治疗,主要以对症支持治疗为主,近年来其治疗方法的探索一直是临床热点。持续正压通气(CPAP)作为一种安全、有效、无创的治疗方法,能有效缓解毛细支气管炎患儿的症状,改善预后,其临床应用越来越受到重视。文章对持续正压通气在重症毛细支气管炎患儿中的临床应用进行综述。%Bronchiolitis is the most common lower respiratory tract disease in infants. There is no speciifc treatment for it and the treatment is mainly supportive. The management of bronchiolitis is the clinical hotspot recently. Continuous positive airway pressure (CPAP) has gained more attention in clinical application as it is a safe, effective, and noninvasive method and can effectively relieve symptoms of bronchiolitis and improve prognosis. This paper reviews the clinical application of CPAP in infants with severe bronchiolitis.

  12. Negative Pressure Pulmonary Edema After Extubation in Appendectomy: Case Report

    Directory of Open Access Journals (Sweden)

    Tarik Purtuloglu

    2016-01-01

    Full Text Available Negative pressure pulmonary edema (NPPE is a rare complication that can occur after acute upper airway obstruction or secondary to relax chronic upper airway obstruction and a life-threatening fatal condition. The first cause in the etiology of NPPE is developed laryngospasm after intubation or extubation, while the other causes are epiglottitis, croup, hiccups, foreign body aspiration, pharyngeal hematoma and oropharyngeal tumors. Supportive therapy is usually the only treatment. The fundamental principle of treatment is early diagnosis and to provide adequate oxygenation. Application of positive airway pressure is often provided with CPAP in most of patients, but sometimes re-intubation and mechanical ventilation may be required.

  13. Efeitos da pressão positiva contínua em vias aéreas sobre os sintomas nasofaríngeos em pacientes com a síndrome da apnéia obstrutiva do sono Effects of continuos positive airway pressure on nasal and pharyngeal symptoms in patients with obstructive sleep apnea

    Directory of Open Access Journals (Sweden)

    Adelaide Cristina de Figueiredo

    2004-12-01

    Full Text Available INTRODUÇÃO: Sintomas nasofaríngeos são comuns em pacientes com a síndrome da apnéia obstrutiva do sono (SAOS em tratamento com pressão positiva contínua em vias aéreas (CPAP. No entanto, sintomas nasofaríngeos são também comuns em pacientes com SAOS antes do início do tratamento. OBJETIVO: Determinar o impacto do tratamento com CPAP nasal sobre os sintomas nasofaríngeos em pacientes com SAOS. MÉTODO: Foram avaliados 35 pacientes (28 homens, com idade de 54 ±10 anos portadores de SAOS moderada a grave diagnosticada através de polissonografia. Os sintomas nasofaríngeos (espirros, coriza, prurido, obstrução, sangramento e ressecamento nasal e de garganta foram quantificados através de questionário aplicado antes e depois de pelo menos 3 meses de tratamento com CPAP nasal. RESULTADOS: O índice de apnéia + hipopnéia foi de 50±25 eventos por hora. Ao menos um sintoma nasofaríngeo estava presente em 26 pacientes (74% antes do tratamento. A obstrução nasal foi o sintoma mais comum, presente em 18 pacientes (51%. Dentre os pacientes inicialmente assintomáticos (n = 9, 78% apresentaram alguma reação nasofaríngea adversa com o tratamento. Em contraste, nos pacientes inicialmente sintomáticos, houve redução significativa da intensidade da obstrução, do ressecamento nasal e de garganta e do sangramento nasal após o tratamento. CONCLUSÃO: Sintomas nasofaríngeos são freqüentes em pacientes com SAOS. O uso de CPAP pode tanto desencadear sintomas nasofaríngeos em pacientes assintomáticos, como reduzir sua intensidade nos pacientes com sintomas prévios.BACKGROUND: Nasal and pharyngeal symptoms are common in patients with obstructive sleep apnoea (OSA treated with nasal continuous positive airway pressure (CPAP. However, these symptoms are common in OSA patients even before the treatment. OBJECTIVE: Determine the impact of nasal CPAP on nasal and pharyngeal symptoms in OSA patients. METHOD: Thirty-five adult patients

  14. Survey on the compliance of the continuous positive airway pressure in obstructive sleep apnea hypopnea syndrome%阻塞性睡眠呼吸暂停低通气综合征患者对持续气道正压治疗依从性及影响因素

    Institute of Scientific and Technical Information of China (English)

    杨琳; 罗华; 于兰芳; 郑绮雯; 王娘娣

    2011-01-01

    目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者对持续气道正压(CPAP)治疗依从性及其影响因素.方法 纳入多导睡眠图确诊的重度OSAHS 患者91 例,年龄(53 ±11 )岁,男/女(72 /19 ),体重指数(BMI)(27.8 ±3.6 ) kg /m2,呼吸暂停低通气指数(AHI)(50.9 ±8.2 )次/h,CPAP 水平(11.6 ±2.0 )cm H 2 O.比较应用与弃用CPAP 治疗的两组患者的各指标,如年龄、BMI 、AHI 、CPAP 水平、治疗前后的夜间血氧指标、学历、家庭人均月收入、系统合并症、嗜睡情况及应用面罩加湿器的情况,研究CPAP 治疗依从性的影响因素.结果 重度OSAHS 患者在6 个月内约47%放弃CPAP 治疗.两组患者的年龄、BMI 、AHI 、CPAP 水平、治疗前后的夜间平均血氧饱和度、夜间最低血氧饱和度均无统计学差异(P >0.05 );嗜睡、存在系统合并症、家庭人均月收入高于2000 元、高中以上学历的OSAHS 患者对CPAP 治疗依从性好.Logistic 回归分析显示,CPAP 治疗依从性的影响因素包括:嗜睡、家庭人均月收入及系统合并症,OR 值分别为12.9 (95%CI 2.209 ~75.338 )、3.134 (1.048 ~5.673 )和2.438 (1.031 ~1.190 )(P 均<0.05 ).结论 伴有嗜睡症状、高收入与出现系统合并症的OSAHS 患者对CPAP 治疗的依从性好.%Objective To investigate the compliance and its influence factors of applying continuous positive airway pressure ( CPAP) in obstructive sleep apnea hypopnea syndrome ( OSAHS) patients. Methods 91 severe OSAHS patients ( apnea hyponea index ,AHI ≥40 ) , whose mean age was (53 ± 11 ) year , 79% was men , body mass index was ( 27. 8 ± 3. 6 ) kg/m2 , AHI was ( 50. 9 ± 8. 2)/h,CPAP level was ( 11. 6 ±2. 0 ) cm H2 O , were divided into 2 groups according to the use or nonuse of CPAP . The possible influence factors of the use of CPAP ( such as age ,body mass index ,AHI,percentage arterial oxygen saturation,education background ,average household income ,complications

  15. The role of nasal CPAP in obstructive sleep apnoea syndrome due to mandibular hypoplasia.

    LENUS (Irish Health Repository)

    Miller, Stanley D W

    2012-02-01

    Melnick Needles syndrome (MNS), Treacher Collins syndrome (TCS) and Pierre Robin syndrome (PRS) are congenital abnormalities with characteristic facial appearances that include micrognathia. A 20-year-old girl with MNS, a 16-year-old boy with TCS and a 12-year-old girl with PRS attended the sleep apnoea clinic at our institution at different times. Diagnostic sleep studies were initially performed on all three patients to confirm the diagnosis of obstructive sleep apnoea syndrome (OSAS). They subsequently commenced nasal CPAP (nCPAP) treatment and their progress was followed. A limited sleep study on the patient with MNS demonstrated moderate\\/severe OSAS with an AHI of 33 events\\/h. Commencement of nCPAP resulted in symptomatic improvement. Overnight oximetry in the patient with TCS showed repeated desaturation to SpO2<90%. Subsequent treatment by nCPAP almost completely abolished the desaturation events. Overnight polysomnography in the patient with PRS demonstrated severe OSAS with an AHI of 49 events\\/h. After 3 years of nCPAP therapy, this patient requested discontinuation of treatment. Subsequent polysomnography without nCPAP revealed an AHI of <5 events\\/h. The use of nCPAP in the patients with MNS and TCS resulted in effective control of their sleep abnormalities. Mandibular growth and enlargement of the posterior airway space led to resolution of OSAS in the patient with PRS. There is a definite role for nCPAP therapy in patients with congenital micrognathia and OSAS. The use of nCPAP may obviate the need for more invasive corrective surgery for OSAS and is not necessarily a life-long requirement.

  16. Continuous positive airway pressure alters cranial blood flow and cerebrospinal fluid dynamics at the craniovertebral junction

    Directory of Open Access Journals (Sweden)

    Theresia I. Yiallourou

    2015-09-01

    Conclusion: Application of CPAP via a full-fitted mask at 15 cm H2O was found to have a significant effect on intracranial venous outflow and spinal CSF flow at the C2 vertebral level in healthy adult-age awake volunteers. CPAP can be used to non-invasively provoke changes in intracranial and CSF flow dynamics.

  17. Implementation of Boussignac continuous positive airway pressure in the coronary care unit : Experiences and attitudes

    NARCIS (Netherlands)

    Dieperink, Willem; Nijsten, Maarten W. N.; van de Stadt, Mark; van der Horst, Iwan C. C.; Aarts, Leon P. H. J.; Zijlstra, Felix; Jaarsma, Tiny

    2008-01-01

    OBJECTIVE: Boussignac continuous positive airway pressure (BCPAP) delivered by face mask is useful for patients with acute cardiogenic Pulmonary edema (ACPE). Although BCPAP is medically effective, we observed that not 611 suitable patients received it. In this descriptive, prospective, cohort study

  18. The Effect of Continuous Positive Airway Pressure on the Erectile Function of Patients with Obstructive Sleep Apnea Hypopnea Syndrome with Erectile Dysfunction and Research of the Related Mechanism%持续气道内正压通气治疗男性阻塞性睡眠呼吸暂停低通气综合征患者性功能障碍作用的研究

    Institute of Scientific and Technical Information of China (English)

    李国平; 王良兴; 许雯; 姜琴华; 蒋海波

    2011-01-01

    Objective To study the effect of continuous positive airway pressure in patient with obstructive sleep apnea hypopnea syndrome with erectile dysfunction and the related mechanism. Methods There were 48 patients diagnosed with OSAHS and ED by polysomnography and nocturnal penile tumescence. The 25 patients with treatment of 6 - months' CPAP were designated to CPAP group,and other non - CPAP 23 patients were designated to OSAHS group. Otherwise, twenty - eight normal adult male were assigned as healthy control group. Results The sex hormones levels of three groups had no significant change(P > 0. 05) . When the CPAP and OSAHS group compared with healthy control, the level of NO , NOS,LSaO2 and percentage of pemle blood volume change were significantly lower ( P < 0. 05) . All indexes were significantly higher in the CPAP group after therapy , but AHI was lower ( P < 0. 05) . Conclusion CPAP therapy can raise the level of NO and NOS, and significantly improve the sexual function of the patients with OSAHS.%目的 研究持续气道内正压通气(CPAP)对男性阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并勃起功能障碍(ED)患者的疗效及可能机制.方法 经多导睡眠监测仪(PSG)及同步夜间阴茎勃起(NPT)测定,诊断OSAHS合并ED患者48名,其中25名给予CPAP治疗作为CPAP组;未经CPAP治疗的23名患者作为OSAHS组,选取健康成年男性28名为健康对照组.结果 三组之间的性激素水平(PRL、TT、E2、FSH、LH)差异无统计学意义(P>0.05),但CPAP组、OSAHS组的NO、NOS、LSaO2及阴茎血容积变化率较健康对照组降低(P<0.05),且CPAP治疗后NO、NOS、LSaO2及阴茎血容积变化率不同程度升高,而AHI下降(P<0.05).结论 CPAP治疗可提高OSAHS患者血浆NO、NOS水平,从而改善OSAHS的性功能.

  19. The use of nasal dilator strips as a placebo for trials evaluating continuous positive airway pressure

    Directory of Open Access Journals (Sweden)

    Aline C.S. Amaro

    2012-01-01

    Full Text Available OBJECTIVES: The aim of the current study was to compare the objective and subjective effects of continuous positive airway pressure to the use of nasal dilator strips in patients with acromegaly and moderate to severe obstructive sleep apnea. METHODS: We studied 12 patients with acromegaly and moderate to severe obstructive sleep apnea (male/ females = 8/4, age = 52±8 ys, body mass index = 33.5±4.6 Kg/m², apnea-hypopnea index = 38±14 events/h who had been included in a randomized, crossover study to receive three months of treatment with continuous positive airway pressure and nasal dilator strips. All patients were evaluated at study entry and at the end of each treatment by polysomnography, and Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and treatment satisfaction questionnaires. ClinicalTrials.gov: NCT01265121 RESULTS: The apnea-hypopnea index values decreased significantly with continuous positive airway pressure treatment but did not change with the use of nasal dilator strips. All of the subjective symptoms improved with both treatments, but these improvements were significantly greater with continuous positive airway pressure than with the nasal dilator strips CONCLUSION: The use of nasal dilator strips had a much smaller effect on the severity of obstructive sleep apnea in patients with acromegaly and moderate to severe obstructive sleep apnea in comparison to the use of continuous positive airway pressure. Moreover, the improvement in several subjective parameters without any significant objective improvement in obstructive sleep apnea resulting from the use of nasal dilator strips is compatible with a placebo effect.

  20. Comparison of upper airway respiratory resistance measurements with the esophageal pressure/airflow relationship during sleep.

    Science.gov (United States)

    Morgenstern, C; Schwaibold, M; Randerath, W; Bolz, A; Jané, R

    2011-01-01

    Measurement of upper airway resistance is of interest in sleep disordered breathing to estimate upper airway patency. Resistance is calculated with the airflow and respiratory effort signals. However, there is no consensus on a standard for upper airway resistance measurement. This study proposes a new benchmarking method to objectively compare different upper airway resistance measurement methods by objectively differentiating between breaths with inspiratory flow limitation (high resistance) and non-limited breaths (low resistance). Resistance was measured at peak-Pes, at peak-flow, at the linear portion of a polynomial equation, as an area comparative and as average resistance for an inspiration. A total of 20 patients with systematic, gold-standard esophageal pressure and nasal airflow acquisition were analyzed and 109,955 breaths were automatically extracted and evaluated. Relative resistance values in relationship to a reference resistance value obtained during wakefulness were also analyzed. The peak-Pes measurement method obtained the highest separation index with significant (p < 0.001) differences to the other methods, followed by the area comparative and the peak-flow methods. As expected, average resistances were significantly (p < 0.001) lower for the non-IFL than for the IFL group. Hence, we recommend employing the peak-Pes for accurate upper airway resistance estimation.

  1. Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

    Directory of Open Access Journals (Sweden)

    Park Marcelo

    2001-01-01

    Full Text Available OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2, continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05. Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05. CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation.

  2. Prognostic Effects of Obstructive Sleep Apnea Treated with Continuous Positive Airway Pressure or Upper Airway Surgery on Coronary Heart Disease: A Systematic Review%持续气道正压通气或上呼吸道手术治疗对合并阻塞性睡眠呼吸暂停冠心病患者预后影响的系统评价

    Institute of Scientific and Technical Information of China (English)

    王少丽; 史大卓; 王承龙

    2012-01-01

    Objective To evaluate prognostic impact of treatment with Continuous Positive Airway Pressure (CPAP) or upper airway surgery on the patients with obstructive sleep apnea (OSA) and coronary heart disease (CHD). Methods Database search in The Cochrane Library, PubMed, OVID and CBM (from establishment dates to October 2009) were conducted. Cohort studies and randomized controlled trials of OSA with CPAP or upper airway surgery in CHD patients were identified. We assessed the quality of the included trials and extracted the relevant data. Statistical analysis was performed using RevMan 4.3.2 software. Results A total of 4 cohort studies involving 945 participants were included. The results of meta-analysis were as follows: a) there were no significant differences in the rate of late lumen loss and 10-year mortality between CHD patients with OSA treated by CPAP and those without OSA (RR=1.84, 95%CI 0.73 to 4.68, P=0.20; RR=0.80, 95%CI 0.24 to 2.64, P=0.71). b) CPAP or uvulopalatopharyngoplasty used in the treatment of OSA on CHD patients after PCI had a significant decrease in the rate of 5-year cardiac death when compared with those untreated OSA patients (RR=0.34, 95%CI 0.14 to 0.82, P=0.02). But there were no differences in the rate of 5-year all-cause mortality, major adverse cardiac events (MACE) between the two groups respectively (RR=0.66,95%CI 0.39 to 1.10, P=0.11; RR=0.97, 95%CI 0.81 to 1.15, P=0.69). c) CPAP or upper airway surgery in treating OSA significantly reduced the risk of MACE occurrence during the 86.5±39 months follow-up period (RR=0.22, 95%CI 0.07 to 0.72, P=0.01). Conclusion Current evidence indicates that treating OSA with CPAP or upper airway surgery in CHD patients might be associ-ated with a decrease in the risk of cardiac death. But more studies are necessary to evaluate prognostic impact of treatment with CPAP or upper airway surgery on the patients with OSA and CHD. However, due to the limited quantity and quality of the included studies

  3. Comparison of Airway Pressure Release Ventilation to Conventional Mechanical Ventilation in the Early Management of Smoke Inhalation Injury in Swine

    Science.gov (United States)

    2011-01-01

    acute respiratory distress syndrome developed ( PaO2 /FIO2 ratio ), plateau pressures were limited to ន cm H2O. Six uninjured pigs received...conventional mechanical ventilation for 48 hrs and served as time controls. Changes in PaO2 /FIO2 ratio, tidal volume, respiratory rate, mean airway pressure...plateau pressure, and hemody- namic variables were recorded. Survival was assessed using Kaplan- Meier analysis. PaO2 /FIO2 ratio was lower in airway

  4. Role of continuous positive airway pressure in patients with combined sleep apnea syndrome without congestive heart failure

    Directory of Open Access Journals (Sweden)

    Shereen Farghaly

    2016-07-01

    Conclusion: CPAP can be effective in combined obstructive and central apnea patients without heart failure with consideration of individual variability. A trial of CPAP titration should be done in those patients.

  5. Altered diaphragmatic contractile properties after high airway pressure controlled mechanical ventilation

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Acute respiratory failure is the most frequent indication for the application of mechanical ventilation. 1 As commonly used in clinical settings, lung protective strategies and recruitment manoeuvres are applications of higher than normal airway pressure to open the collapsed alveoli and prevent lung atelectasis caused by minimal vital ventilation. Under those conditions, we pay more attention to the lung injury and circulatory failure, and less attention to the diaphragmatic structure and function.

  6. The NOFLO trial: low-flow nasal prongs therapy in weaning nasal continuous positive airway pressure in preterm infants.

    LENUS (Irish Health Repository)

    O'Donnell, Sinéad M

    2013-07-01

    To determine if low-flow nasal prongs therapy with room air, compared with no treatment, facilitates weaning from nasal continuous positive airway pressure (NCPAP) in very low birth weight (VLBW, birth weight <1500 g) infants.

  7. Short-term effects of positive expiratory airway pressure in patients being weaned from mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Marcelo de Mello Rieder

    2009-05-01

    Full Text Available OBJECTIVE: To investigate the feasibility and the cardiorespiratory effects of using positive expiratory airway pressure, a physiotherapeutic tool, in comparison with a T-tube, to wean patients from mechanical ventilation. METHODS/DESIGN: A prospective, randomized, cross-over study. SETTING: Two intensive care units. PATIENTS AND INTERVENTIONS: We evaluated forty patients who met weaning criteria and had been mechanically-ventilated for more than 48 hours, mean age 59 years, including 23 males. All patients were submitted to the T-tube and Expiratory Positive Airway Pressure devices, at 7 cm H2O, during a 30-minute period. Cardiorespiratory variables including work of breathing, respiratory rate (rr, peripheral oxygen saturation (SpO2, heart rate (hr, systolic, diastolic and mean arterial pressures (SAP, DAP, MAP were measured in the first and thirtieth minutes. The condition was analyzed as an entire sample set (n=40 and was also divided into subconditions: chronic obstructive pulmonary disease (n=14 and non-chronic obstructive pulmonary disease (non- chronic obstructive pulmonary disease (n=26 categories. Comparisons were made using a t-test and Analysis of Variance. The level of significance was p < 0.05. RESULTS: Our data showed an increase in work of breathing in the first and thirtieth minutes in the EPAP condition (0.86+ 0.43 and 1.02+1.3 as compared with the T-tube condition (0.25+0.26 and 0.26+0.35 (p<0.05, verified by the flow-sensor monitor (values in J/L. No statistical differences were observed when comparing the Expiratory Positive Airway Pressure and T-tube conditions with regard to cardiorespiratory measurements. The same result was observed for both chronic obstructive pulmonary disease and non- chronic obstructive pulmonary disease subconditions. CONCLUSIONS: Our study demonstrated that, in weaning patients from mechanical ventilation, the use of a fixed level of Expiratory Positive Airway Pressure caused an increase in work of

  8. Effects of nasal-continuous positive airway pressure on patients with obstructive sleep apnea apnea-hypopnea syndrome combined with depression and anxiety emotions%经鼻持续正压通气治疗对合并抑郁焦虑情绪的阻塞性呼吸睡眠暂停综合征患者的影响

    Institute of Scientific and Technical Information of China (English)

    牛丹丹; 王亮

    2014-01-01

    Objective:To explore effects of nasal-continuous positive airway pressure ( CPAP ) on patients with obstructive sleep apnea apnea-hypopnea syndrome ( OSAHS) combined with depression and anxiety emotions. Methods:56 patients with moder-ate and severe OSAHS with mood disorders were randomly divided into CPAP treatment group and conventional treatment group. The patients were evaluated with HAD test three and six months after the treatment, and the two groups were compared. Results:For CPAP treatment group, the mood disorders were not improved three months after the treatment for the patients with OSAHS (P>0. 05);how-ever, they were significantly improved six months after the treatment (P0. 05). Conclusions:The state of mood could be improved by effective long-term CPAP therapy for OSAS patients with mood disorders.%目的::探讨经鼻持续正压通气( CPAP)治疗对合并情绪障碍的阻塞性呼吸睡眠暂停综合征( OSAHS)患者的影响。方法:选取中重度OSAHS合并情绪障碍患者56例,随机分为CPAP治疗组及常规治疗组,在治疗3月及6月后进行医院焦虑抑郁情绪测量表( HAD量表)评测,比较两组患者之间HAD评分情况。结果:使用CPAP治疗3月后OSAHS患者情绪障碍无明显改善(P>0.05),6月后有明显改善(P0.05)。结论:对临床上OSAHS合并情绪障碍的患者,经过较长时间CAPA治疗后,其情绪障碍可以得到有效改善。

  9. Use of Biphasic Continuous Positive Airway Pressure in Premature Infant with Cleft Lip–Cleft Palate

    Directory of Open Access Journals (Sweden)

    Lovya George

    2015-10-01

    Full Text Available Preterm infants (PIs often require respiratory support due to surfactant deficiency. Early weaning from mechanical ventilation to noninvasive respiratory support decreases ventilation-associated irreversible lung damage. This wean is particularly challenging in PIs with cleft lip and cleft palate due to anatomical difficulties encountered in maintaining an adequate seal for positive pressure ventilation. PI with a cleft lip and palate often fail noninvasive respiratory support and require continued intubation and mechanical ventilation. We are presenting the first case report of a PI with cleft lip and palate who was managed by biphasic nasal continuous positive airway pressure.

  10. Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

    Directory of Open Access Journals (Sweden)

    Marjory Fernanda Bussoni

    2014-01-01

    Full Text Available OBJECTIVE: The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O, while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854. RESULTS: The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′ after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015. There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020. CONCLUSIONS: Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.

  11. Early versus delayed initiation of nasal continuous positive airway pressure for treatment of respiratory distress syndrome in premature newborns: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Zohreh Badiee

    2013-01-01

    Conclusions: Early n CPAP is more effective than late n CPAP for the treatment of respiratory distress syndrome. In addition, the early use of n CPAP would reduce the need for some invasive procedures such as intubation and mechanical ventilation.

  12. Early treatment of idiopathic respiratory distress syndrome using binasal continuous positive airway pressure

    DEFF Research Database (Denmark)

    Kamper, J; Ringsted, C

    1990-01-01

    During a 3-year period (1979-81) 85 premature infants with idiopathic respiratory distress (IRDS) were treated early with an easily applicable light-weight CPAP-system with a binasal tube and a gas jet. We used conservative criteria for ventilator treatment. The treatment proved sufficient in 18...... the incidence of respiratory tract infections did not differ from that in a group of siblings; and the incidence of lower respiratory tract infections was low compared to previous studies. With the criteria used, early CPAP proved effective in the majority of infants with IRDS....

  13. Effect of Continuous Positive Airway Pressure in the Treatment of Obstructive Sleep Apnea Hypopnea Syn-drome Complicated with Coronary Heart Disease%持续气道正压通气在阻塞性睡眠呼吸暂停低通气综合征合并冠心病治疗中的作用观察

    Institute of Scientific and Technical Information of China (English)

    姜晶; 周秀梅

    2016-01-01

    Objective:To explore the application value of continuous positive airway pressure ( CPAP) in the treatment of obstruc-tive sleep apnea hypopnea syndrome (OSAHS ) complicated with coronary heart disease (CHD).Methods:Totally 50 patients with OSAHS complicated with CHD from June 2012 to June 2014 in our hospital were randomly divided into the control group and CPAP group with 25 ones in each .The patients in the control group were treated with the conventional drug therapy for coronary heart disease , while those in CPAP group were treated with CPAP additionally .After 6-month treatment, PSG index, clinical symptoms, arrhythmia and ischemia electrocardiogram changes of the patients in the two groups were compared .Results:After the 6-month treatment , AHI and oxygen desaturation index in CPAP group were significantly decreased when compared with those before the treatment , and the min-imum value of SaO2 and the average value of SaO 2 were higher than those before the treatment (P<0.01), and the above indices were better than those in the control group (P<0.01).The incidence rate of chest pain and chest tightness , arrhythmia, times of myocardi-al ischemia in a day and time of myocardial ischemia in a day were decreased after the treatment (P<0.01), and the decrease in CPAP group was more notable than that in the control group (P<0.01).Conclusion: CPAP combined with the conventional drug therapy for coronary heart disease can improve the oxygen concentration and reduce the incidence of arrhythmia and myocardial ischemia in the patients with OSAHS with CHD , which can be widely used in clinics .%目的:研究持续气道正压通气(CPAP)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并冠心病(CHD)治疗中的应用价值。方法:OSAHS合并CHD患者50例随机分为对照组和CPAP组两组,每组25例。对照组患者给予常规药物治疗, CPAP组患者在对照组基础上加以CPAP治疗。6个月后比较两

  14. Clinical comparison of early prophylactic application of nasal continuous positive airway pressure and pulmonary surfactant in the premature very low birth weight infants%早产极低出生体重儿早期预防性应用鼻塞式持续气道正压与肺表面活性物质的临床比较

    Institute of Scientific and Technical Information of China (English)

    高薇薇; 谭三智; 杨杰; 张永; 叶秀桢; 聂川; 王越; 王俊平

    2012-01-01

    目的:探讨在早产极低出生体重儿中生后早期使用鼻塞式持续气道正压(nCPAP)或应用肺表面活性剂(PS)以预防新生儿呼吸窘迫综合征(NRDS)的临床疗效比较.方法:采用前瞻性对照研究,对出生后早期使用nCPAP辅助通气或早期使用PS替代治疗的早产极低出生体重儿进行对照研究,观察其死亡率、支气管肺发育不良发生率、辅助通气时间及临床并发症.结果:共106例患儿人选,死亡率和支气管肺发育不良(BPD)发生率组间比较差异无统计学意义.机械辅助通气、总用氧时间组间比较差异无统计学意义;nCPAP组PS使用数少于对照组(Odds Ratio:0.37,90% CI 0.209~0.655);气漏发生率低(Odds Ratio:0.476,90% CI0.233~0.971),IVH发生率低(Odds Ratio:o.778,90%CI 0.319~1.898).其他临床并发症组间比较差异无统计学意义.结论:早期应用nCPAP是预防早产极低出生体重儿呼吸窘迫综合征另一良好选择.%Objective; To explore the clinical effects of early prophylactic application of nasal continuous positive airway pressure (nCPAP) and pulmonary surfactant (PS) in prevention of neonatal respiratory distress syndrome ( NROS) among the premature very low birth weight infants. Methods: The clinical effects of early prophylactic application of nCPAP and PS in the premature very low birth weight infants were compared, the death rates, the incidences of bronchopulmonary dysplasia, the duration times of assisted ventilation, and clinical complications in the two groups were observed. Results; A total of 106 infants were enrolled in the study. There was no significant difference in the death rate and the incidence of bronchopulmonary dysplasia between the two groups. There was no significant difference in the duration time of mechanical ventilation and total using oxygen time between the two groups; the number of infants using PS in nCPAP group was fewer than that in control group (Odds ratio; 0. 37, 90

  15. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway.

    Directory of Open Access Journals (Sweden)

    Samantha Torres Grams

    Full Text Available Maximal Inspiratory Pressure (MIP is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway.This study aimed to compare the MIP values assessed by standard method (MIPsta and by unidirectional expiratory valve method (MIPuni in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated.This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B at two moments (Tests 1 and 2 to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1] was used to determine intraobserver and interobserver reproducibility.The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O than the mean values for MIPsta (-102.5 ± 23.9 cmH2O (p<0.001. Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91, and high correlation for Test 2 (ICC[2,1] = 0.88. The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86 and evaluator B (ICC[2,1] = 0.77.MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway.

  16. Unidirectional Expiratory Valve Method to Assess Maximal Inspiratory Pressure in Individuals without Artificial Airway

    Science.gov (United States)

    Grams, Samantha Torres; Kimoto, Karen Yumi Mota; Azevedo, Elen Moda de Oliveira; Lança, Marina; de Albuquerque, André Luis Pereira; de Brito, Christina May Moran; Yamaguti, Wellington Pereira

    2015-01-01

    Introduction Maximal Inspiratory Pressure (MIP) is considered an effective method to estimate strength of inspiratory muscles, but still leads to false positive diagnosis. Although MIP assessment with unidirectional expiratory valve method has been used in patients undergoing mechanical ventilation, no previous studies investigated the application of this method in subjects without artificial airway. Objectives This study aimed to compare the MIP values assessed by standard method (MIPsta) and by unidirectional expiratory valve method (MIPuni) in subjects with spontaneous breathing without artificial airway. MIPuni reproducibility was also evaluated. Methods This was a crossover design study, and 31 subjects performed MIPsta and MIPuni in a random order. MIPsta measured MIP maintaining negative pressure for at least one second after forceful expiration. MIPuni evaluated MIP using a unidirectional expiratory valve attached to a face mask and was conducted by two evaluators (A and B) at two moments (Tests 1 and 2) to determine interobserver and intraobserver reproducibility of MIP values. Intraclass correlation coefficient (ICC[2,1]) was used to determine intraobserver and interobserver reproducibility. Results The mean values for MIPuni were 14.3% higher (-117.3 ± 24.8 cmH2O) than the mean values for MIPsta (-102.5 ± 23.9 cmH2O) (p<0.001). Interobserver reproducibility assessment showed very high correlation for Test 1 (ICC[2,1] = 0.91), and high correlation for Test 2 (ICC[2,1] = 0.88). The assessment of the intraobserver reproducibility showed high correlation for evaluator A (ICC[2,1] = 0.86) and evaluator B (ICC[2,1] = 0.77). Conclusions MIPuni presented higher values when compared with MIPsta and proved to be reproducible in subjects with spontaneous breathing without artificial airway. PMID:26360255

  17. Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica Respiratory physiotherapy associated with airway positive pressure in the postoperative bariatric surgery evolution

    Directory of Open Access Journals (Sweden)

    Fabiana Sobral Peixoto-Souza

    2012-09-01

    Full Text Available Analisar volume corrente (VC, volume minuto (VM e frequência respiratória (FR de obesas mórbidas no pós-operatório de cirurgia bariátrica (CB, após a fisioterapia respiratória convencional (FRC associada ou não à pressão positiva contínua nas vias aéreas (CPAP no pré-operatório. Foram estudadas 36 mulheres, com idade de 40,1±8,41 anos, que seriam submetidas à CB por laparotomia e que realizaram FRC (exercícios respiratórios diafragmáticos, de inspirações profundas, fracionadas e associados a movimentos de membros superiores, 1 série de 10 repetições de cada exercício por 30 dias antes da cirurgia. Após internação, 18 delas foram submetidas a 20 minutos de CPAP, 1 hora antes da indução anestésica e compuseram o grupo FRC+CPAP. As outras 18 não receberam o CPAP e compuseram o grupo FRC. Foram avaliados VM, VC e FR por meio do ventilômetro, no momento da internação e 24 horas após a realização da cirurgia. Constatou-se que as medidas de VC, VM e FR não apresentaram significância estatística quando comparados os resultados do pré e pós-operatório em ambos os grupos, bem como quando comparados os dois grupos entre si tanto no pré como no pós-operatório. Os resultados sugerem que a tanto a aplicação da FRC como a aplicação da FRC+CPAP no período pré-operatório contribui para a manutenção das variáveis respiratórias no pós-operatório. A aplicação do CPAP antes da indução anestésica não promoveu benefícios adicionais no pós-operatório de CB no que se refere aos volumes pulmonares.To assess the tidal volume (VT, minute volume (MV and respiratory rate (RR of morbidly obese women in postoperative bariatric surgery (BS, after the conventional respiratory physiotherapy (CRP with or without preoperatively continuous positive airway pressure (CPAP. Thirty-six women, aged 40.1±8.41 years, that would be submitted to BS by laparotomy were studied. All of them underwent preoperative outpatient

  18. Upper airway collapsibility evaluated by a negative expiratory pressure test in severe obstructive sleep apnea

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    Salvatore Romano

    2011-01-01

    Full Text Available OBJECTIVES: To investigate the usefulness of measuring upper airway collapsibility with a negative expiratory pressure application as a screening test for severe obstructive sleep apnea (OSA. INTRODUCTION: OSA is a risk factor for cardiovascular disease, and it may have serious consequences. Its recognition may have important implications during the perioperative period. Increased upper airway collapsibility is one of the main determinants of OSA, and its evaluation could be useful for identifying this condition. METHODS: Severe OSA and normal subjects (24 in each group were matched by body mass index and referred to our sleep laboratory. The subjects were enrolled in an overnight sleep study, and a diurnal negative expiratory pressure test was performed. Flow drop (DV and expiratory volume were measured in the first 0.2 s (V02 of the negative expiratory pressure test. RESULTS: DV (% and V02 (% values were statistically different between normal and OSA subjects. OSA patients showed a greater decrease in flow than normal subjects. In addition, severely OSA patients exhaled during the first 0.2 s of the negative expiratory pressure application was an average of only 11.2% of the inspired volume compared to 34.2% for the normal subjects. Analysis of the receiver operating characteristics showed that V02 (% and DV (% could accurately identify severe OSA in subjects with sensitivities of 95.8% and 91.7%, respectively, and specificities of 95.8% and 91.7%, respectively. CONCLUSIONS: V02 (% and DV (% are highly accurate parameters for detecting severe OSA. The pharyngeal collapsibility measurement, which uses negative expiratory pressure during wakefulness, is predictive of collapsibility during sleep.

  19. Treatment of upper airway resistance syndrome in adults: Where do we stand?☆

    Science.gov (United States)

    de Godoy, Luciana B.M.; Palombini, Luciana O.; Guilleminault, Christian; Poyares, Dalva; Tufik, Sergio; Togeiro, Sonia M.

    2015-01-01

    Objective: To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS) treatment. Methods: Keywords “Upper Airway Resistance Syndrome,” “Sleep-related Breathing Disorder treatment,” “Obstructive Sleep Apnea treatment” and “flow limitation and sleep” were used in main databases. Results: We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP) has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established. Conclusion: Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options. PMID:26483942

  20. Treatment of upper airway resistance syndrome in adults: Where do we stand?

    Directory of Open Access Journals (Sweden)

    Luciana B.M. de Godoy

    2015-01-01

    Full Text Available Objective: To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS treatment. Methods: Keywords “Upper Airway Resistance Syndrome,” “Sleep-related Breathing Disorder treatment,” “Obstructive Sleep Apnea treatment” and “flow limitation and sleep” were used in main databases. Results: We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established. Conclusion: Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options.

  1. Effects of Altered Intra-abdominal Pressure on the Upper Airway Collapsibility in a Porcine Model

    Institute of Scientific and Technical Information of China (English)

    Shu-Lin Ren; Yan-Ru Li; Ji-Xiang Wu; Jing-Ying Ye; Rachel Jen

    2015-01-01

    Background: Obstructive sleep apnea is strongly associated with obesity, particularly abdominal obesity common in centrally obese males.Previous studies have demonstrated that intra-abdominal pressure (IAP) is increased in morbid obesity, and tracheal traction forces may influence pharyngeal airway collapsibility.This study aimed to investigate that whether IAP plays a role in the mechanism of upper airway (UA) collapsibility via IAP-related caudal tracheal traction.Methods: An abdominal wall lifting (AWL) system and graded CO2 pneumoperitoneum pressure was applied to four supine, anesthetized Guizhou miniature pigs and its effects on tracheal displacement (TD) and airflow dynamics of UA were studied.Individual run data in 3 min obtained before and after AWL and obtained before and after graded pneumoperitoneum pressure were analyzed.Differences between baseline and AWL/graded pneumoperitoneum pressure data of each pig were examined using a Student's t-test or analysis of variance.Results: Application of AWL resulted in decreased IAP and significant caudal TD.The average displacement amplitude was 0.44 mm (P < 0.001).There were three subjects showed increased tidal volume (TV) (P < 0.0l) and peak inspiratory airflow (P < 0.01);however, the change of flow limitation inspiratory UA resistance (Rua) was not significant.Experimental increased IAP by pneumoperitoneum resulted in significant cranial TD.The average displacement amplitude was 1.07 mm (P < 0.001) when IAP was 25 cmH20 compared to baseline.There were three subjects showed reduced Rua while the TV increased (P < 0.01).There was one subject had decreased TV and elevated Rua (P < 0.001).Conclusions: Decreased IAP significantly increased caudal TD, and elevated IAP significantly increased cranial TD.However, the mechanism of UA collapsibility appears primarily mediated by changes in lung volume rather than tracheal traction effect.TV plays an independent role in the mechanism of UA collapsibility.

  2. CPAP at 10 cm H2O during cardiopulmonary bypass does not improve postoperative gas exchange CPAP de 10 cmH2O durante a circulação extracorpórea não melhora a troca gasosa pós-operatória

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    Luciana Castilho de Figueiredo

    2008-06-01

    Full Text Available OBJECTIVE: To compare postoperative (PO pulmonary gas exchange indexes in patients submitted to myocardial revascularization (MR with or without the application of continuous positive airway pressure (CPAP during cardiopulmonary bypass (CPB. METHODS: Thirty adult patients submitted to MR with CPB between March and September 2005 were randomly allocated to two groups: CPAP (n=15, patients that received CPAP at 10 cmH2O during CPB, and control (n=15, patients that didn't receive CPAP. PaO²/FiO2 and P(A-aO2 were analyzed at four moments: Pre (just before CPB, with FiO2=1.0 ; Post (30min post-CPB, with FiO2=1.0; immediate PO period (12h post-surgery, with FiO2=0.4 by using a Venturi® facial mask and first PO day (24h post-surgery, with FiO2=0.5 by a facial mask. RESULTS: PaO2/FiO2 and P(A-aO2 tend to get significantly worst as time elapsed during the postoperative period in both groups, but no differences were observed between them at any moment. When PaO2/FiO2 was subdivided into three categories, a greater prevalence of patients with values between 200 mmHg and 300mmHg were observed in CPAP group only at moment Post (30min post-CPB; p = 0.02. CONCLUSION: CPAP at 10cmH2O administered during CPB, although had lightly improved PaO2/FiO2 at 30 minutes post-CPB, had no significant sustained effect on postoperative pulmonary gas exchange. We concluded that in patients submitted to MR, application of 10 cmH2O CPAP does not improve postoperative pulmonary gas exchange.OBJETIVO: Comparar os índices de trocas gasosas no pós-operatório de pacientes submetidos a revascularização do miocárdio (RM que receberam ou não pressão positiva contínua nas vias aéreas (CPAP durante a circulação extracorpórea (CEC. MÉTODOS: Trinta pacientes adultos submetidos a RM com CEC no período de março a setembro de 2005 foram alocados aleatoriamente em dois grupos: CPAP (n=15, pacientes que utilizaram CPAP a 10 cmH2O durante a CEC, e controle (n=15, pacientes que

  3. Effect of continuous positive airway pressure treatment on serum angiotensin converting enzyme levels in patients with obesity-associated obstructive sleep apnea syndrome%持续气道正压通气对阻塞性睡眠呼吸暂停综合征患者血清血管紧张素转换酶水平的影响

    Institute of Scientific and Technical Information of China (English)

    沈文富; 李红苗; 王强; 王骏; 蒋冬兰; 严锡祥

    2012-01-01

    目的:探讨持续气道正压通气(continuous positive air-way pressure,CPAP)对阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)患者血清中血管紧张素转换酶(angiotensin converting enzyme,ACE)水平的影响.方法:根据睡眠期多导睡眠监测中的呼吸暂停低通气指数(apnea hypopnea index,AHI) 检查结果,选择43例符合OSAS诊断标准的患者作为研究对象(OSAS组),测定OSAS组实施CPAP治疗1个月前后ACE水平,与AHI正常者(正常组)比较,并分析OSAS组中ACE与睡眠呼吸紊乱指数的相关性.结果:OSAS组治疗前ACE浓度(23.35±15.62) U/L显著低于正常组(38.95±21.83) U/L (P0.05),相关性分析显示OSAS组中ACE浓度与AHI无明显相关性(r=-0.018,P>0.05).结论:OSAS患者血清中ACE水平与睡眠呼吸紊乱指数无明显相关性,与正常人相比,OSAS患者血清ACE显著降低,CPAP治疗不能影响ACE水平变化.%Objective: To investigate the influence of continuous positive airway pressure( CPAP )treatment on the serum angiotensin converting enzyme levels in patients with obstructive sleep apnea syndrome ( OSAS ). Methods: Based on apnea hypopnea index( AHI ) measured by polysomnography, 43 patients were diagnosed as OSAS( OSAS group ) and enrolled in this study. The serum ACE levels of OSAS group were measured and compared with the subjects without OSAS( normal groups ). In patients with OSAS, the relationship between levels of ACE and AHI were analyzed. Results: Compared with normal group[ ( 38. 95 ±21.83 ) U/L], serum ACE levels in OSAS group[ ( 23.35 ±15.62 ) U/L,P 0. 05 ). No relationship was observed in OSAS group between the ACE levels and AHI levels. Conclusion: The serum ACE levels in OSAS group was significantly higher than in normal group. The CPAP treatment cannot change the ACE level in OSAS patients. The serum ACE levels were not correlated with the AHI levels in OSAS patients.

  4. 持续气道正压通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者疗效的系统评价%Effect of CPAP Treatment on Life Quality in Patients with Obstructive Sleep Apnea-hypopnea Syndrome Results of a Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    叶红; 李涛平; 冯媛; 申海燕; 刘爱华

    2009-01-01

    Objective To assess the effect of continuous positive airway pressure treatment (CPAP) on subjective and objective sleepiness in patients with obstructive sleep apnea-hypopnea syndrom (OSAHS). Methods We conducted a thorough literature search to identify all published randomized controlled trials of CPAP in patients with OSAHS. We use computer to search Pubmed (1990-2008.5), CNKI (1994-2008.5), google (1995-2008.5), Springer Link (1997-2008)、 and many meeting articals. We chose the literatures that divided patients randomly into two groups as CPAP group and subtheraputic CPAP or drug group. Meta-analysis were performed to access the effect and bias. Results A total of 15 trials involving 1 052 patients were included. A Meta-analysis showed that (1) The total effect was that compared with the control group, CPAP treatment group significantly depressed the degree of sleepiness in ESS [WMD= – 2.61, 95%CI (– 3.92, – 1.29)] and in MWT/ MSLT [WMD= 1.42, 95%CI (– 0.01, 2.85)]. (2) Results of subgroups on ESS were that: 1. CPAP vs CT: there was a significant effect on CPAP therapy [WMD= – 3.15, 95%CI (– 4.84, – 1.47)]. 2. CPAP vs sham CPAP: there was no significant difference between the two groups. 3. CPAP vs drugs: CPAP was more efficient than drugs. CPAP may be more efficient in improving patients’ life quality. Conclusion CPAP is a valuable treatment for OSAHS no matter in subjective or objective sleepiness .But more attention should be paid to the lone-time treatment of CPAP.%目的 系统评价持续气道正压通气治疗(CPAP)对不同程度的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrom,OSAHS)患者的疗效.方法 计算机检索PubMed(1990~2008.5)、中国期刊全文数据库(1994~2008.5)、学术搜索引擎(1995~2008.4)、Springer Link(1997~2008),查找公开发表的评价CPAP对OSAHS患者生活质量影响的随机对照试验(RCT)和相关会议文献及未发表的文章,试验组采

  5. Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation

    NARCIS (Netherlands)

    Borckink, Ilse; Essouri, Sandrine; Laurent, Marie; Albers, Marcel J. I. J.; Burgerhof, Johannes G. M.; Tissieres, Pierre; Kneyber, Martin C. J.

    2014-01-01

    AIM: Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first-line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanic

  6. Safety and Effectiveness of Bubble Continuous Positive Airway Pressure in Neonates With Respiratory Distress and Its Failure Factors

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    Ajay Sethi

    2015-09-01

    Conclusion: Bubble Continuous Positive Airway Pressure is safe, efficacious and easy to use in preterm and term neonates with mild to moderate respiratory distress. The major failure factors in our study were sepsis, recurrent apnea, and shock. The survival rate in our study was 60%. [Natl J Med Res 2015; 5(3.000: 202-206

  7. Lung pressures and gas transport during high-frequency airway and chest wall oscillation.

    Science.gov (United States)

    Khoo, M C; Ye, T H; Tran, N H

    1989-09-01

    The major goal of this study was to compare gas exchange, tidal volume (VT), and dynamic lung pressures resulting from high-frequency airway oscillation (HFAO) with the corresponding effects in high-frequency chest wall oscillation (HFCWO). Eight anesthetized paralyzed dogs were maintained eucapnic with HFAO and HFCWO at frequencies ranging from 1 to 16 Hz in the former and 0.5 to 8 Hz in the latter. Tracheal (delta Ptr) and esophageal (delta Pes) pressure swings, VT, and arterial blood gases were measured in addition to respiratory impedance and static pressure-volume curves. Mean positive pressure (25-30 cmH2O) in the chest cuff associated with HFCWO generation decreased lung volume by approximately 200 ml and increased pulmonary impedance significantly. Aside from this decrease in functional residual capacity (FRC), no change in lung volume occurred as a result of dynamic factors during the course of HFCWO application. With HFAO, a small degree of hyperinflation occurred only at 16 Hz. Arterial PO2 decreased by 5 Torr on average during HFCWO. VT decreased with increasing frequency in both cases, but VT during HFCWO was smaller over the range of frequencies compared with HFAO. delta Pes and delta Ptr between 1 and 8 Hz were lower than the corresponding pressure swings obtained with conventional mechanical ventilation (CMV) applied at 0.25 Hz. delta Pes was minimized at 1 Hz during HFCWO; however, delta Ptr decreased continuously with decreasing frequency and, below 2 Hz, became progressively smaller than the corresponding values obtained with HFAO and CMV.

  8. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

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    Macario Camacho

    2015-01-01

    Full Text Available Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies, apnea-hypopnea index (seventeen studies, and neck circumference (eleven studies were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted.

  9. Mathematical Equations to Predict Positive Airway Pressures for Obstructive Sleep Apnea: A Systematic Review

    Science.gov (United States)

    Camacho, Macario; Riaz, Muhammad; Tahoori, Armin; Certal, Victor; Kushida, Clete A.

    2015-01-01

    Objective. To systematically review the international literature for mathematical equations used to predict effective pressures for positive airway pressure (PAP) devices. Methods. Google Scholar, PubMed, Scopus, Embase, Web of Science, CINAHL, and The Cochrane Library were searched through June 27, 2015. The PRISMA statement was followed. There was no language limitation. Results. 709 articles were screened, fifty were downloaded, and twenty-six studies presented equations that met the inclusion and exclusion criteria. In total, there were 4,436 patients in the development phases and 3,489 patients in the validation phases. Studies performed multiple linear regressions analyses as part of the equation(s) development and included the following variables: physical characteristics, polysomnography data, behavioral characteristics, and miscellaneous characteristics, which were all predictive to a variable extent. Of the published variables, body mass index (BMI) and mean oxygen saturation are the most heavily weighted, while BMI (eighteen studies), apnea-hypopnea index (seventeen studies), and neck circumference (eleven studies) were the variables most frequently used in the mathematical equations. Ten studies were from Asian countries and sixteen were from non-Asian countries. Conclusion. This systematic review identified twenty-six unique studies reporting mathematical equations which are summarized. Overall, BMI and mean oxygen saturation are the most heavily weighted. PMID:26294977

  10. 持续气道正压通气对合并阻塞性睡眠呼吸暂停低通气综合征的2型糖尿病患者糖代谢及糖皮质激素的影响%Effect of continuous positive airway pressure therapy on glucose metabolism and glucocorticoid in patients with obstructive sleep apnea-hypopnea syndrome and type 2 diabetes

    Institute of Scientific and Technical Information of China (English)

    郭立新; 赵心; 潘琦; 李慧; 王晓霞; 蒋蕾; 孙明晓; 王洪冰; 雷玉晶

    2010-01-01

    Objective To investigate the effects of continuous positive airway pressure (CPAP) treatment on glucose metabolism and glucocorticoid in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS) and type 2 diabetes mellitus(T2DM). Methods To use at least 30 days of CPAP treatment on 36 cases of patients with T2DM and newly diagnosed OSAHS hospitalized during July 2008 and December 2009 in the Department of Endocrinology, Beijing Hospital. To take CPAP treatment for the patients without contraindication. Insulin sensitivity and glucose metabolism were tested and compared to the data previously obtained. Paired-t-test were used for statistical analysis. Results After the application of CPAP treatment,the glycohemoglobin ( (7.1±1.0)% ) and fasting blood glucose( (6.5 ± 1.1 ) mmol/L)were lower than that been previous obtained ( HbA1c (9.1 ± 2. 2) %, FBG ( 10.0±3.0) mmol/L; t = 6.517,P 0.05 ).Conclusion CPAP can cause an overall improvement in insulin sensitivity in type 2 diabetes patients with OSAHS, CPAP is also an effective treatment in addition to lifestyle intervention and drug treatment.%目的 探讨持续气道正压通气(CPAP)对合并有阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的2型糖尿病(T2DM)患者糖代谢及糖皮质激素的影响.方法 选取2008年7月至2009年12月于卫生部北京医院内分泌科确诊合并有OSAHS的T2DM患者36例.对无禁忌者应用至少30 d的CPAP治疗.在治疗前后检测受试患者血糖、胰岛素敏感性指标及糖皮质激素水平.采用配对t检验对受试者前后指标进行分析.结果 应用CPAP治疗后受试者空腹血糖[(6.5±1.1)mmol/L]及糖化血红蛋白水平(7.1%±1.0%)较治疗前[(10.0±3.0)mmol/L,(9.1±2.2)%]显著降低(t=6.517,P0.05).结论 CPAP可以全面改善合并有OSAHS的2型糖尿病患者的血糖控制及胰岛素抵抗,是除生活方式干预及药物治疗外的一种行之有效的治疗手段.

  11. Titrated flow versus fixed flow Bubble Nasal CPAP for respiratory distress in preterm neonates.

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    Srinivas eMurki

    2015-10-01

    Full Text Available Background: The clinical effects of a pre-fixed flow of air-oxygen versus a flow titrated according to visible bubbling are not well understood.Objective: To compare the effects of a fixed flow (5 L/min and titrated flow ( flow just enough to ensure bubbling at different set pressures on delivered intra-prong pressure, gas exchange and clinical parameters in preterm infants on bubble CPAP for respiratory distress.Methods: Preterm infants less than 35 weeks gestation on bubble CPAP and less than 96 h of age, were enrolled in this cross over study. They were subjected to 30 minute periods of titrated flow and fixed flow. At the end of both epochs, gas flow rate, set pressure, FiO2, SpO2, Silverman retraction score, respiratory rate , abdominal girth, and blood gases were recorded. The delivered intra-prong pressure was measured by an electronic manometer. Results: Sixty nine recordings were made in 54 infants. For each of the set CPAP pressures (4, 5 and 6 cm H2O, the mean delivered pressure with a fixed flow of 5 L/min was higher than that delivered by the titrated flow. During the fixed flow epoch, the delivered pressure was closer to and higher than the set pressure resulting in higher PaO2 and lower PaCO2 as compared to titrated flow epoch. In the titrated flow period, the delivered pressure was consistently lower than the set pressure. Conclusion: In preterm infants on bubble CPAP with set pressures of 4 to 6 cm H2O, a fixed flow of 5 L/min is more effective than a flow titrated to ensure adequate visible bubbling. It achieves higher delivered pressures, better oxygenation and ventilation.

  12. Noninvasive Positive Airway Pressure Treatment in Children Less Than 12 Months of Age

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    Adetayo Adeleye

    2016-01-01

    Full Text Available Study Objectives. We identified the associated conditions of patients less than 12 months of age who were referred for polysomnogram (PSG studies. We collated PSG findings and physician interpretation. We determined the correlation between the recommended treatment by the PSG interpreting physician and actual prescribed treatment by the referring or subjects’ physician. We determined adherence with noninvasive positive airway pressure (PAP treatment. Methods. This was a retrospective cohort study. Participants included children less than 12 months of age referred for PSG studies between 2007 and 2012. Results. 92 patients under the age of 12 months were included in the study analysis. Mean (standard deviation, SD age in days at time of the PSG study was 208.5 (101.2. 35 (38% patients had a diagnosis of Trisomy 21. Seven (8% patients had no prior diagnosis. Median (Q1, Q3 apnea hypopnea index (AHI was 22.5 (11.3–37.0. Agreement between the PSG interpreting physician’s recommendation and actual prescribed treatment by the referring or subjects’ physician was 85.9% [95% CI 77.1–91.6]. Mean (SD percentage days with PAP therapy usage more than 4 hours was 25.2% (32. Conclusions. In our experience, despite consistent physician messaging to families, adherence with noninvasive PAP treatment is low.

  13. Positive airway pressure improves nocturnal beat-to-beat blood pressure surges in obesity hypoventilation syndrome with obstructive sleep apnea.

    Science.gov (United States)

    Carter, Jason R; Fonkoue, Ida T; Grimaldi, Daniela; Emami, Leila; Gozal, David; Sullivan, Colin E; Mokhlesi, Babak

    2016-04-01

    Positive airway pressure (PAP) treatment has been shown to have a modest effect on ambulatory blood pressure (BP) in patients with obstructive sleep apnea (OSA). However, there is a paucity of data on the effect of PAP therapy on rapid, yet significant, BP swings during sleep, particularly in obesity hypoventilation syndrome (OHS). The present study hypothesizes that PAP therapy will improve nocturnal BP on the first treatment night (titration PAP) in OHS patients with underlying OSA, and that these improvements will become more significant with 6 wk of PAP therapy. Seventeen adults (7 men, 10 women; age 50.4 ± 10.7 years, BMI 49.3 ± 2.4 kg/m(2)) with OHS and clinically diagnosed OSA participated in three overnight laboratory visits that included polysomnography and beat-to-beat BP monitoring via finger plethysmography. Six weeks of PAP therapy, but not titration PAP, lowered mean nocturnal BP. In contrast, when nocturnal beat-to-beat BPs were aggregated into bins consisting of at least three consecutive cardiac cycles with a >10 mmHg BP surge (i.e., Δ10-20, Δ20-30, Δ30-40, and Δ>40 mmHg), titration, and 6-wk PAP reduced the number of BP surges per hour (time × bin, P < 0.05). PAP adherence over the 6-wk period was significantly correlated to reductions in nocturnal systolic (r = 0.713, P = 0.001) and diastolic (r = 0.497, P = 0.043) BP surges. Despite these PAP-induced improvements in nocturnal beat-to-beat BP surges, 6 wk of PAP therapy did not alter daytime BP. In conclusion, PAP treatment reduces nocturnal beat-to-beat BP surges in OHS patients with underlying OSA, and this improvement in nocturnal BP regulation was greater in patients with higher PAP adherence.

  14. Asymmetric spindle pole formation in CPAP-depleted mitotic cells.

    Science.gov (United States)

    Lee, Miseon; Chang, Jaerak; Chang, Sunghoe; Lee, Kyung S; Rhee, Kunsoo

    2014-02-21

    CPAP is an essential component for centriole formation. Here, we report that CPAP is also critical for symmetric spindle pole formation during mitosis. We observed that pericentriolar material between the mitotic spindle poles were asymmetrically distributed in CPAP-depleted cells even with intact numbers of centrioles. The length of procentrioles was slightly reduced by CPAP depletion, but the length of mother centrioles was not affected. Surprisingly, the young mother centrioles of the CPAP-depleted cells are not fully matured, as evidenced by the absence of distal and subdistal appendage proteins. We propose that the selective absence of centriolar appendages at the young mother centrioles may be responsible for asymmetric spindle pole formation in CPAP-depleted cells. Our results suggest that the neural stem cells with CPAP mutations might form asymmetric spindle poles, which results in premature initiation of differentiation.

  15. 提高呼吸道正压通气治疗OSAS依从性的几点策略%How to improve the CPAP adherence in OSAS treatment

    Institute of Scientific and Technical Information of China (English)

    钱炜; 赵琳; 马永明

    2015-01-01

    Objective The present study introduced strategies to improve the continuous positive airway pressure (CPAP) adherence in obstructive sleep apnea syndrome (OSAS). Methods In 84 OSAS patients with CPAP treatment (male: 74, mean aged:43.3 years old; female: 10, mean aged 51.3 years old), the following strategies were emphasized in addition to the treatment routines:1) Assessing and treating to the nasal airway dysfunctions with medication or surgically, 2) A team of physician and technician follow-up patient within two weeks of the initiation of CPAP treatment, and 3) The economic status, the recognizing capacity to the disorder and the family support were discussed with the patient to build up a better social supporting circumstance. Results The overall adherence rate was 70.4% at week two follow-up and increased to 90.4% after medical or surgical inference. Conclusion Pay attentions to the nasal airway dysfunction, early detect, and correction to the problems in CPAP treatment might play important roles to improve the CPAP adherence.%目的:本文介绍提高呼吸道连续正压通气(CPAP)治疗阻塞性睡眠呼吸暂停综合征(OSAS)依从性的几点策略。方法对84例接受CPAP治疗患者(男74例,平均年龄43.3岁;女10例,平均年龄51.3岁)采取以下策略以提高CPAP治疗依从性:1)评估和改善患者鼻腔通气功能障碍;2)在患者使用CPAP 2周内,由医生和技术员共同对CPAP使用情况进行评估和干预指正;3)就经济能力、对疾病认知能力和家属支持能力等与患者及家属充分沟通,建立有效的社会支持模式。结果患者2周内依从性(CPAP超过4h/24h)为70.4%(59/84),经指导干预后依从性上升为90.4%(76/84)。结论评估和改善鼻腔通气功能障碍和早期指正CPAP治疗中的问题对提高CPAP依从性有重要意义。

  16. Reliability and Validity of Self-rating Adverse Reaction Scale of Continuous Positive Airway Pressure among Patients with Obstructive Sleep Apnea Hypopnea Syndrome%阻塞性睡眠呼吸暂停低通气综合征患者持续正压通气治疗副作用自评量表的信度与效度研究

    Institute of Scientific and Technical Information of China (English)

    贾雯碧; 杨希; 曾继红; 余林

    2013-01-01

    目的:评价阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)患者持续正压通气(continuous positive airway pressure, CPAP)治疗副作用自评量表的信度与效度。方法根据相关文献和临床工作自制CPAP治疗副作用自评量表,采用内部一致性分析和重测信度法检测量表的信度;采用专家评议,选用副反应量表(Treatment Emergent Symptom Scale, TESS)、汉密尔顿焦虑量表(Hamilton Anxiety Scale, HAMA)、健康调查简表(the MOS 36-item Short-form Health Survey, SF-36)作为效标并结合因子分析法测量量表效度。结果量表内部一致性信度Cronbach’sα系数为0.825,重测信度为0.687;内容效度指数为0.870,量表与TESS、HAMA、SF-36显著相关(P0.4。结论 CPAP治疗副作用自评量表具有较好的信度与效度,可应用于OSAHS患者CPAP治疗副作用以及其对依从性影响的评估。%Objective To evaluate the reliability and validity of self-rating adverse reaction of continuous positive airway pressure (CPAP) scale among patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A self-rating adverse reaction of CPAP scale was developed based on literatures and clinical practice. The reliability of the scale was evaluated by internal consistency and test-retest reliability. Through expert review, taking Treatment Emergent Symptom Scale (TESS), Hamilton Anxiety Scale (HAMA) and the MOS 36-item Short-form Health Survey (SF-36) as criterion, the validity of the scale was evaluated with factor analysis. Results Cronbach’sαcoefficient was 0.825, ICC 0.687 and CVI 0.870. The scale was significantly related with TESS, HAMA and SF-36 (P<0.01) with the accumulative variance contribution rate of 77.271% and the load of every item on corresponding factor was higher than 0.4. Conclusion The self-rating adverse reaction of CPAP scale among OSAHS patients is with good reliability and

  17. Effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia

    Institute of Scientific and Technical Information of China (English)

    Ni-Na Huang; Yu-Dan Zhang

    2016-01-01

    Objective:To analyze the effect of adjuvant nasal continuous positive airway pressure therapy on immune response and organ injury in children with severe pneumonia.Methods:A total of 90 children with severe pneumonia were randomly divided into observation group and control group (n=45), control group received conventional therapy, observation group accepted regular + adjuvant nasal continuous positive airway pressure therapy, and then differences in immune globulin, Th1/Th2 indexes, blood coagulation indexes, echocardiography parameters and so on were compared between two groups of children.Results:IgG2, IgG3, IgA and IgM content in peripheral blood of observation group were higher than those of control group; Th1/Th2 indexes IL-4 and IFN-γ content in serum as well as IL-4/IFN-γ level were lower than those of control group; blood coagulation indexes PT, TT, APTT and D-D levels were lower than those of control group while FIB and PLT levels were higher than those of control group; echocardiography parameters PVAT and AVAT levels were higher than those of control group while PFVMA level was lower than that of control group.Conclusions: Adjuvant nasal continuous positive airway pressure therapy helps to enhance the immune response and optimize blood coagulation function and cardiac function in children with severe pneumonia.

  18. A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation

    Institute of Scientific and Technical Information of China (English)

    JIANG Hai; MIAO Hai-sheng; JIN San-qing; CHEN Li-hong; TIAN Jing-ling

    2011-01-01

    Background Difficult airway remains not only a challenge to the anesthesiologists,but also a life-threatening event to the patients.Awake intubation is the principal choice to deal with difficult airway,and a key point for awake intubation is airway topical anesthesia.Yet,so far there is no ideal topical anesthesia approach for awake intubation.This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.Methods Thirty adult patients referred for elective surgery under general anesthesia,aged 18-60 years and Mallampati class Ⅰ or Ⅱ,were recruited for the study.Before topical anesthesia,the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg),propofol (2 mg.kg1·h-1) andremifentanil (0.05 μg.kg-1·min-1).Ten minutes after sedation,topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min.After topical anesthesia,tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist,and a score of less than 10 was considered to be satisfactory.Attempts to intubate the patient were recorded,and the complications such as local anesthetic toxicity,mucosa injury,and respiration depression were also recorded.The mean arterial blood pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation.Patients were asked 24 hours after the operation whether they could recall the events during intubation.Results All patients were intubated at the first attempt,the average intubation condition score was 7.0±1.1,from 6 to 10,satisfied intubation condition.MAP and HR increased

  19. Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Elinaldo da Conceição dos Santos

    2015-04-01

    Discussion: Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.

  20. Physiological Correlation of Airway Pressure and Transpulmonary Pressure Stress Index on Respiratory Mechanics in Acute Respiratory Failure

    Institute of Scientific and Technical Information of China (English)

    Chun Pan; Lu Chen; Yun-Hang Zhang; Wei Liu; Rosario Urbino; V Marco Ranieri; Hai-Bo Qiu

    2016-01-01

    Background:Stress index at post-recruitment maneuvers could be a method of positive end-expiratory pressure (PEEP) titration in acute respiratory distress syndrome (ARDS) patients.However,airway pressure (Paw) stress index may not reflect lung mechanics in the patients with high chest wall elastance.This study was to evaluate the Paw stress index on lung mechanics and the correlation between Paw stress index and transpulmonary pressure (PL) stress index in acute respiratory failure (ARF) patients.Methods:Twenty-four ARF patients with mechanical ventilation (MV) were consecutively recruited from July 2011 to April 2013 in Zhongda Hospital,Nanjing,China and Ospedale S.Giovanni Battista-Molinette Hospital,Turin,Italy.All patients underwent MV with volume control (tidal volume 6 ml/kg) for 20 min.PEEP was set according to the ARDSnet study protocol.The patients were divided into two groups according to the chest wall elastance/respiratory system elastance ratio.The high elastance group (H group,n =14) had a ratio ≥30%,and the low elastance group (L group,n =10) had a ratio <30%.Respiratory elastance,gas-exchange,Paw stress index,and PL stress index were measured.Student's t-test,regression analysis,and Bland-Altman analysis were used for statistical analysis.Results:Pneumonia was the major cause of respiratory failure (71.0%).Compared with the L group,PEEP was lower in the H group (5.7 ± 1.7 cmH2O vs.9.0 ± 2.3 cm2O,P < 0.01).Compared with the H group,lung elastance was higher (20.0 ± 7.8 cmH2O/L vs.11.6 ± 3.6 cmH2O/L,P < 0.01),and stress was higher in the L group (7.0 ± 1.9 vs.4.9 ± 1.9,P =0.02).A linear relationship was observed between the Paw stress index and the PL stress index in H group (R2 =0.56,P < 0.01) and L group (R2 =0.85,P < 0.01).Conclusion:In the ARF patients with MV,Paw stress index can substitute for PL to guide ventilator settings.

  1. Non-invasive positive pressure ventilation for acute asthma in children

    DEFF Research Database (Denmark)

    Korang, Steven Kwasi; Feinberg, Joshua; Wetterslev, Jørn

    2016-01-01

    BACKGROUND: Asthma is one of the most common reasons for hospital admission among children and constitutes a significant economic burden. Use of non-invasive positive pressure ventilation (NPPV) in the care of children with acute asthma has increased even though evidence supporting the intervention......: To assess the benefits and harms of NPPV as an add-on therapy to usual care (e.g. bronchodilators and corticosteroids) in children with acute asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR). The Register contains trial reports identified through...... both studies as having high risk of bias; both trials assessed effects of bilateral positive airway pressure (BiPAP). Neither trial used continuous positive airway pressure (CPAP). Controls received standard care. Investigators reported no deaths and no serious adverse events (Grades of Recommendation...

  2. Effects of the Treatment with Continuous Positive Airway Pressure for One Night on the Sleep Architecture of the Patients with Obstructive Sleep Apnea Syndrome%一夜持续正压呼吸道通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构的影响

    Institute of Scientific and Technical Information of China (English)

    张立芳; 李博; 刘煜; 宿长军

    2013-01-01

    Objective To investigate the effects of the treatment with continuous positive airway pres-sure( CPAP ) for one night on sleep architecture of the patients with obstructive sleep apnea syndrome ( OSAS ). Methods 113 patients with slight, moderate or serious OSAS diagnosed by polysomnogram ( PSG )were treated by CPAP for at least 7 hours during one night. In the mean time, PSG was used to monitor the changes of sleep of the patients and some parameters related to the severity of the disease. Results After treatment with CPAP for one night, the ratio of the patients' sleep durations at stage 1 and stage 2 to total sleep time( TST ) decreased significantly ( P<0.05),4.5% and 10. 1% respectively. And the ratio of the deep sleep time( stage 3 and stage 4 )to total sleep time increased by 6. 5%( P < 0. 05 ). The ratio of the time of rapid eye movement( REM ) sleep to TST increased by 8 % ( P < 0. 05 ). Apnea hyponea index( AHI) decreased by 59. 6% ( P < 0. 05 ). Minimum SaO2 and average SaO2 increased by 18.0% and 5% respectively (P <0. 05 ). Conclusion CPAP treatment for one night can significantly improve the sleep architecture of OSAS patients , increasing the duration of deep sleep , decreasing AHI and increasing SaO2.%目的 了解一夜持续正压呼吸道通气(CPAP)治疗对阻塞性睡眠呼吸暂停低通气综合征(OSAS)患者睡眠结构的影响.方法 经多导睡眠图(PSG)确诊的OSAS患者113例,经CPAP治疗一夜(≥7 h),同时行PSG监测,观察患者治疗前后睡眠结构以及病情严重程度的参数变化.结果 经一夜CPAP治疗后,1、2期睡眠占睡眠总时间的比率显著降低,分别为4.5%、10.1%(P<0.05);3、4期睡眠(深睡眠)占睡眠总时间比率增加6.5%(P<0.05),快速眼动睡眠比率增加8.0%(P<0.05).呼吸紊乱指数(AHI)下降59.6%(P<0.05);最低血氧饱和度、平均血氧饱和度分别增加18.0%、5.0%(P<0.05).结论 一夜CPAP治疗能显著改善睡眠结构,增加患者的深睡眠,降低AHI,增高血氧饱和度.

  3. Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Riaz, Muhammad; Certal, Victor; Nigam, Gaurav; Abdullatif, Jose; Zaghi, Soroush; Kushida, Clete A.; Camacho, Macario

    2015-01-01

    Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP) devices or Provent as treatment for obstructive sleep apnea (OSA). Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients) were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD) for apnea-hypopnea index (AHI) in 345 patients decreased from 27.32 ± 22.24 to 12.78 ± 16.89 events/hr (relative reduction = 53.2%). Random effects modeling mean difference (MD) was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI) in 247 patients decreased from 21.2 ± 19.3 to 12.4 ± 14.1 events/hr (relative reduction = 41.5%, p value < 0.00001). Lowest oxygen saturation (LSAT) M ± SD improved in 146 patients from 83.2 ± 6.8% to 86.2 ± 11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS) M ± SD improved (359 patients) from 9.9 ± 5.3 to 7.4 ± 5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent) reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding) that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent). PMID:26798519

  4. Accuracy of Positive Airway Pressure Device—Measured Apneas and Hypopneas: Role in Treatment Followup

    Directory of Open Access Journals (Sweden)

    Carl Stepnowsky

    2013-01-01

    Full Text Available Improved data transmission technologies have facilitated data collected from positive airway pressure (PAP devices in the home environment. Although clinicians’ treatment decisions increasingly rely on autoscoring of respiratory events by the PAP device, few studies have specifically examined the accuracy of autoscored respiratory events in the home environment in ongoing PAP use. “PAP efficacy” studies were conducted in which participants wore PAP simultaneously with an Embletta sleep system (Embla, Inc., Broomfield, CO, which was directly connected to the ResMed AutoSet S8 (ResMed, Inc., San Diego, CA via a specialized cable. Mean PAP-scored Apnea-Hypopnea Index (AHI was 14.2 ± 11.8 (median: 11.7; range: 3.9–46.3 and mean manual-scored AHI was 9.4 ± 10.2 (median: 7.7; range: 1.2–39.3. Ratios between the mean indices were calculated. PAP-scored HI was 2.0 times higher than the manual-scored HI. PAP-scored AHI was 1.5 times higher than the manual-scored AHI, and PAP-scored AI was 1.04 of manual-scored AI. In this sample, PAP-scored HI was on average double the manual-scored HI. Given the importance of PAP efficacy data in tracking treatment progress, it is important to recognize the possible bias of PAP algorithms in overreporting hypopneas. The most likely cause of this discrepancy is the use of desaturations in manual hypopnea scoring.

  5. Nasal Expiratory Positive Airway Pressure Devices (Provent for OSA: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Muhammad Riaz

    2015-01-01

    Full Text Available Objective. To quantify the effectiveness of nasal expiratory positive airway pressure (nasal EPAP devices or Provent as treatment for obstructive sleep apnea (OSA. Methods. PubMed and six other databases were searched through November 15, 2015, without language limitations. Results. Eighteen studies (920 patients were included. Pre- and post-nasal EPAP means ± standard deviations (M ± SD for apnea-hypopnea index (AHI in 345 patients decreased from 27.32±22.24 to 12.78±16.89 events/hr (relative reduction = 53.2%. Random effects modeling mean difference (MD was −14.78 events/hr [95% CI −19.12, −10.45], p value < 0.00001. Oxygen desaturation index (ODI in 247 patients decreased from 21.2±19.3 to 12.4±14.1 events/hr (relative reduction = 41.5%, p value < 0.00001. Lowest oxygen saturation (LSAT M ± SD improved in 146 patients from 83.2±6.8% to 86.2±11.1%, MD 3 oxygen saturation points [95% CI 0.57, 5.63]. Epworth Sleepiness Scale (ESS M ± SD improved (359 patients from 9.9±5.3 to 7.4±5.0, MD −2.5 [95% CI −3.2, −1.8], p value < 0.0001. Conclusion. Nasal EPAP (Provent reduced AHI by 53.2%, ODI by 41.5% and improved LSAT by 3 oxygen saturation points. Generally, there were no clear characteristics (demographic factors, medical history, and/or physical exam finding that predicted favorable response to these devices. However, limited evidence suggests that high nasal resistance could be associated with treatment failure. Additional studies are needed to identify demographic and polysomnographic characteristics that would predict therapeutic success with nasal EPAP (Provent.

  6. Centrobin-centrosomal protein 4.1-associated protein (CPAP) interaction promotes CPAP localization to the centrioles during centriole duplication.

    Science.gov (United States)

    Gudi, Radhika; Zou, Chaozhong; Dhar, Jayeeta; Gao, Qingshen; Vasu, Chenthamarakshan

    2014-05-30

    Centriole duplication is the process by which two new daughter centrioles are generated from the proximal end of preexisting mother centrioles. Accurate centriole duplication is important for many cellular and physiological events, including cell division and ciliogenesis. Centrosomal protein 4.1-associated protein (CPAP), centrosomal protein of 152 kDa (CEP152), and centrobin are known to be essential for centriole duplication. However, the precise mechanism by which they contribute to centriole duplication is not known. In this study, we show that centrobin interacts with CEP152 and CPAP, and the centrobin-CPAP interaction is critical for centriole duplication. Although depletion of centrobin from cells did not have an effect on the centriolar levels of CEP152, it caused the disappearance of CPAP from both the preexisting and newly formed centrioles. Moreover, exogenous expression of the CPAP-binding fragment of centrobin also caused the disappearance of CPAP from both the preexisting and newly synthesized centrioles, possibly in a dominant negative manner, thereby inhibiting centriole duplication and the PLK4 overexpression-mediated centrosome amplification. Interestingly, exogenous overexpression of CPAP in the centrobin-depleted cells did not restore CPAP localization to the centrioles. However, restoration of centrobin expression in the centrobin-depleted cells led to the reappearance of centriolar CPAP. Hence, we conclude that centrobin-CPAP interaction is critical for the recruitment of CPAP to procentrioles to promote the elongation of daughter centrioles and for the persistence of CPAP on preexisting mother centrioles. Our study indicates that regulation of CPAP levels on the centrioles by centrobin is critical for preserving the normal size, shape, and number of centrioles in the cell.

  7. Efficacy of continuous positive airway pressure therapy upon resistant hypertension in patients with obstructive sleep apnea hypopnea syndrome%持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征合并难治性高血压疗效分析

    Institute of Scientific and Technical Information of China (English)

    张希龙; 黎燕群

    2009-01-01

    目的 探讨持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)合并难治性高血压(RH)的疗效及其可能机制.方法 选择13例合并RH的中重度OSAHS患者,分别于CPAP治疗前及治疗3个月末测量睡前(22:00)、夜间(2:00)和清晨(6:00)的血压,并检测晨起(6:00)卧位血浆醛同酮(ALD)浓度和血浆肾素活性(PRA).ALD、PRA检测采用放射免疫分析法.结果 与CPAP治疗前相比,治疗第3个月末患者睡前、夜间和清晨血压(mm Hg,1 mm Hg=0.133 kPa)均显著下降(睡前135.5±2.8/84.2±4.6比152.2 4±19.2/98.9 4±15.6,夜间133.1 4±2.4/81.5 4±4.6比156.6 ±19.4/102.8±16.6,清晨151.5 ±3.0/81.2 4±3.2比172.1 ±23.7/98.1±6.5,均P<0.01);晨起卧位ALD浓度(pmoo/L)明显降低(411±54比542 ±43,P<0.01);但PRA(μg·L-1·h-1)无明显变化(0.27±0.14比0.204±0.12,P=0.221).结论 CPAP治疗可显著改善OSAHS合并RH患者的血压并降低血浆ALD浓度.OSAHS患者的RH可能与血浆ALD浓度增高有关.%Objective To investigate the efficacy and possible mechanism of continuous positive airway pressure (CPAP) therapy upon blood pressure in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and resistant hypertension (RH). Methods Thirteen OSAHS patients with RH were recruited. Before and after 3-month CPAP therapy, their blood pressures at 10:00 PM, 2:00 AM and 6:00 AM were measured and their morning plasma concentrations of aldosterone (ALD) and plasma renin activity (PRA) tested at supine position with radioimmunoassay. Results Compared with blood pressure parameters at pre-CPAP therapy, there was a significant decrease in blood pressure before sleep at the end of 3-month CPAP therapy [(135.5±2.8)/(84.2±4.6) vs (152.2 ±19.2)/(98.9 ± 15.6) mm Hg, P<0.01], at night during sleep [(133. 1± 2.4)/(81.5 ± 4.6) vs (156.6 ± 19.4)/(102.8 ± 16.6)mm Hg, P<0.01] and in the early morning [(151.5±3.0)/(81.2 ±3.2) vs (172.1±23.7)/(98.1 ±6.5) mm Hg, P <0

  8. 持续正压通气对顽固性高血压合并阻塞性睡眠呼吸暂停患者血浆醛固酮水平的影响%Influence of Continuous Positive Airway Pressure on Plasma Aldosterone Concentration in Patients With Resistant Hypertension Combined With Obstructive Sleep Apnea

    Institute of Scientific and Technical Information of China (English)

    任冬冬; 杨敏华; 李艳艳; 崔应麟

    2016-01-01

    中,单独药物治疗与 CPAP 和药物治疗患者治疗前夜间 SBP、24 h SBP、AHI,治疗后日间 SBP、日间 DBP、夜间 SBP、夜间 DBP、24 h DBP、AHI、PAC 水平比较,差异均有统计学意义(P ﹤0.05);单独药物治疗患者治疗后 AHI 与治疗前比较,差异有统计学意义(P ﹤0.05);CPAP 和药物治疗患者治疗后日间 SBP、日间 DBP、夜间 SBP、夜间 DBP、24 h DBP、AHI、Epworth 嗜睡评分及 PAC 水平与治疗前比较,差异有统计学意义(P ﹤0.05)。以治疗前 PAC 为因变量,年龄、BMI、血氧饱和度﹤90%时间占总睡眠时间的百分比(CT90%)、治疗前24 h SBP、治疗前24 h DBP、治疗前 AHI 为自变量,进行多元线性回归分析,结果显示,回归方程为 y =0.198× CT90%+0.058(P =0.023,R2=0.026)。以治疗后 PAC 为因变量,年龄、BMI、CT90%、治疗前24 h SBP、治疗前24 h DBP、治疗前 AHI 为自变量,进行多元线性回归分析,结果显示,回归方程为 y =0.168×24 h DBP +0.113(P=0.015,R2=0.094)。结论 PAC 可能参与了 OSA 和顽固性高血压的发生过程,CPAP 能有效改善顽固性高血压合并OSA 患者的 PAC 水平。%Objective To investigate the influence of continuous positive airway pressure( CPAP)on the plasma aldosterone concentration(PAC)in patients with resistant hypertension and obstructive sleep apnea(OSA). Methods From July 2012 to October 2013,we enrolled 513 patients with resistant hypertension and OSA who were admitted into Henan Province Hospital of TCM and accorded with inclusion criteria. 17 patients who didn’t received 24 h ABPM and 16 patients with AHI less than 15 times per hour were excluded,and other 480 patients were divided into CPAP group(n = 240)and control group(n= 240)by random number table method. CPAP group and control group respectively received CPAP plus medication and medication alone for 3 months. We recorded patients’ general data,24 h ABPM indexes

  9. Aplicação da pressão positiva contínua nas vias aéreas em pacientes em pós-operatório de cirurgia bariátrica Applying continuous positive airways pressure in patients after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Eli Maria Pazzianotto-Forti

    2012-03-01

    Full Text Available O objetivo deste trabalho foi avaliar o efeito da aplicação da pressão positiva contínua nas vias aéreas (CPAP, na frequência respiratória (FR, no volume corrente (VC e no volume minuto (VM, em pacientes em pós-operatório de cirurgia bariátrica. Foram estudadas dez pacientes com média de idade 29,8±8 anos, classificadas como obesas mórbidas [índice de massa corpórea (IMC de 47,5±7,2 kg/m²] que receberam CPAP de 8 a 10 cmH2O, por 30 minutos, uma vez ao dia, durante dois dias consecutivos, no pós-operatório de cirurgia bariátrica. Antes e após a aplicação da CPAP, foram aferidos a FR e o VM por meio do ventilômetro e, de forma indireta, foi calculado o VC. Para verificar a normalidade dos dados foi aplicado o teste de Shapiro-Wilk, e, após, as medidas foram comparadas com o uso do Teste t de Student e de Man-Whitney. As análises foram processadas com o uso do SPSS 7,5 considerando o nível de 5% de significância. Houve um aumento significativo para as seguintes variáveis estudadas no primeiro e no segundo dia de aplicação: FR=20±6 resp/min versus 26±7 resp/min (p=0,009 e FR=22±7 resp/min versus 26±8 resp/min (p=0,007; VM=9,57±2,75 L versus 12,39±4,18 L (p=0,041 e VM=9,71±2,52 L versus 11,18±2,96 L (p=0,037. Os valores do VC=360±157,59 mL versus 440±69,18 mL (p=0,21 e 401±90,46 mL versus 416±78,04 mL (p=0,18 não apresentaram diferença significativa na comparação pré- e pós-aplicação, nos dois dias de terapia. Assim, foi possível concluir que a CPAP pode ser aplicada como recurso auxiliar da fisioterapia respiratória no tratamento de pacientes em período pós-operatório de cirurgia bariátrica, para a manutenção do VC, porém atenção deve ser tomada durante a aplicação, pois pode haver aumento da FR.The objective was to evaluate the effect of continuous positive airway pressure (CPAP in the respiratory rate (RR, tidal volume (TV and minute volume (MV in patients after bariatric surgery. Ten

  10. Continuous Positive Airway Pressure Therapy for Obstructive Sleep Apnea: Maximizing Adherence Including Using Novel Information Technology-based Systems.

    Science.gov (United States)

    Hevener, Bretton; Hevener, William

    2016-09-01

    Sleep apnea is a form of sleep-disordered breathing that is associated with an increase in disease comorbidities, mortality risks, health care costs, and traffic accidents. Sleep apnea is most commonly treated with positive airway pressure (PAP). PAP can be difficult for patients to tolerate. This leads to initial and long-term noncompliance. Most insurance companies require compliance with PAP treatment to cover ongoing reimbursements for the device and related disposable supplies. Therefore, there are both clinical and financial incentives to a sleep apneic patient's compliance with PAP therapy.

  11. Efficacy of the New Perilaryngeal Airway (CobraPLA™) Versus the Laryngeal Mask Airway (LMA™) to Improve Oropharyngeal Leak Pressure in Obese and Overweight Patients

    NARCIS (Netherlands)

    Yaghoobi, Siamak; Abootorabi, Seyed Mohamadreza; Kayalha, Hamid; Van Zundert, Tom C; Pakpour, Amir H

    2015-01-01

    BACKGROUND: This study aimed to evaluate the applicability of Cobra perilaryngeal airway (Cobra PLA™) for obese patients under general anesthesia and also to compare the results with those of classic laryngeal mask airway (LMA™). MATERIALS AND METHODS: Seventy-three overweight and obese patients wer

  12. A pilot study of quantitative assessment of mandible advancement using pressure-flow relationship during midazolam sedation.

    Science.gov (United States)

    Ayuse, T; Hoshino, Y; Inazawa, T; Oi, K; Schneider, H; Schwartz, A R

    2006-11-01

    It has been proposed that a titration of the mandibular positioner would be a promising method for predicting the outcome of nasal continuous positive airway pressure (CPAP) therapy. This study was carried out to test the hypothesis that mandible advancement could be evaluated by analysis of inspiratory flow limitation using a titration procedure. To explore its effect, we examined upper airway pressure-flow relationships using a titrated mandible positioner during midazolam sedation. Non-flow limited inspiration occurred when the mandible was advanced 7.1 +/- 1.2 mm from centric occlusion position. In the centric occlusion position (0 mm advancement), Pcrit was -1.9 +/- 2.9 cmH2O and Rua was 23.3 +/- 4.5 cmH2O L(-1) s(-1). In the eMAP position, Pcrit was -7.3 +/- 1.9 cmH2O and Rua was 27.8 +/- 3.3 cmH2O L(-1) s(-1). Essentially no CPAP was required to overcome flow limitation in eMAP position, whereas 3.7 +/- 2.2 cmH2O CPAP was required in centric occlusion position. We conclude that assessing inspiratory flow limitation using a titrated mandible positioner was effective for estimating individual-matched mandible positions.

  13. Investigation of Ischemic Stroke Patients with Mild or Moderate Obstructive Sleep Apnea-hypopnea Syndrome Treated by Nasal Continuous Positive Airway Pressure%nCPAP治疗伴轻中度OSAHS缺血性卒中患者的随访研究

    Institute of Scientific and Technical Information of China (English)

    唐晓梅; 于逢春; 孟晓梅; 陈新平; 刘伟; 冯浩; 朱健

    2013-01-01

    月无明显变化(nCPAP组14.3%、14.3%、14.3%、14.3%)(非nCPAP组18.8%、18.8%、18.8%、18.8%),差异无显著性(P值均>0.05)。在第6、12、18、24个月BMI nCPAP组(22.8±1.4、23.1±1.4、22.7±1.4、22.6±1.4)与非nCPAP组(23.3±1.4、23.7±1.6、23.5±1.6、23.0±1.3)差异无显著性(P值均>0.05)。  结论 nCPAP治疗可降低合并轻中度OSAHS缺血性卒中患者的AHI,降低患者ESS评分及改善焦虑状态。%Objective To observe the clinical results of ischemic stroke patients with mild and moderate obstructive sleep apnea-hypopnea syndrome treated by nasal continuous positive airway pressure (nCPAP). Methods Sixty-two cases were selected from March 2008 to March 2010 who suffered acute ischemic stroke. After 90 days, thirty patients with mild or moderate obstructive sleep apnea-hypopnea syndrome were enrolled into the study by using polysomnography. Then they were divided into two groups by whether using nCPAP or not:one group (14 cases) accepted treatment with nCPAP, while the other group (16 cases) rejected it. The recurrence rate of stroke, apnea hypopnea index (AHI), blood pressure, body mass index (BMI), Epworth Sleepiness Score (ESS), Hospital Anxiety and Depression Scale (HAD) at the 6th, 12th, 18th, 24th month were measured. Results There were no significant differences between two groups in age, sex, diabetes mellitus,hypertension disease, AHI, systolic pressure, diastolic pressure, BMI, modiifed Rankin Scale score, ESS, HAD (P value>0.05). There are no recurrent ischemic strokes through two years of observation. The nCPAP group performs better than non-nCPAP group in reducing AHI (nCPAP group AHI:3.9±0.6, 3.8±0.5, 3.9±0.5, 3.8±0.5, non-CPAP group AHI:20.8±4.1, 21.7±4.5, 22.6±4.2, 26.8±6.1, t value 16.2, 15.9, 17.8, 15.0, P value0.05). Conclusion It proves that treatment with nCPAP can reduce AHI, decrease ESS scores, and improve the level of anxiety.

  14. CPAP对小儿重症肺炎的疗效及安全性观察%Observation on Clinical Effects and Safety of CPAP on Children with Severe Pneumonia

    Institute of Scientific and Technical Information of China (English)

    耿立建

    2013-01-01

    Objective: To observe the clinical effects and safety of applying CPAP( nasal continuous positive airway pressure ventilation ) to treat children with severe pneumonia. Method: 100 children with severe pneumonia treated in our hospital from October 2009 to October 2011 were selected and divided into 2 groups, the observation group and the control group, each group for 50 cases. The control group were given conventional treatment, and the observation group were given CPAP treatment on basis of conventional treatment. Comparing and analyzing the breathing, heart rate and lung function. Result: The total effective rate of the observation group was 94% , and the control group was 60%. The observation group was better evidently than the control group. The difference had statistical significance (P〈0. 01 ). Conclusion: The clinical effect of CPAP to treat children with severe pneumonia is safe and reliable.%目的:探讨应用CPAP(鼻塞式持续气道正压通气)治疗小儿重症肺炎的疗效与安全性观察.方法:选取我院2009年10月至2011年10月期间收治的重症肺炎患儿100例,随机分为观察组和对照组各50例,对照组给予常规治疗,观察组在常规治疗的基础上给予鼻塞式CPAP治疗.对两组的呼吸、心率、肺部等情况进行对比分析.结果:观察组总有效率为94%,对照组总有效率为60%,观察组明显优于对照组,统计学比较存在显著性差异( P<0.01).结论:CPAP治疗小儿重症肺炎效果显著且安全可靠.

  15. Interaction between otorhinolaryngology and orthodontics: correlation between the nasopharyngeal airway and the craniofacial complex

    Science.gov (United States)

    Stellzig-Eisenhauer, Angelika; Meyer-Marcotty, Philipp

    2011-01-01

    In terms of pathophysiology, an anatomically narrow airway is a predisposing factor for obstruction of the upper respiratory tract. The correlation between the nasopharyngeal airway and the craniofacial structures is discussed in this context. Thus a mutual interaction between the pharynx and the mandibular position was demonstrated, whereby the transverse dimension of the nasopharynx was significantly larger in patients with prognathism than in patients with retrognathism. The influence of chronic obstruction of the nasal airway on craniofacial development was also discussed. The form-and-function interaction, which ought to explain the causal relationship between nasal obstruction and craniofacial growth, appears to be of a multifactorial rather than a one-dimensional, linear nature. It is not disputed, however, that expanding the maxilla improves not only nasal volume and nasal flow, but also the subjective sensation of patients, although it is not possible to make a prognostic statement about the extent of this improvement because of the differing reactions of individuals. Orthodontic appliances for advancing the mandible can also be successfully used in the treatment of mild obstructive sleep apnea syndrome. This treatment method should be considered particularly for patients who are unwilling to undergo or cannot tolerate CPAP (continuous positive airway pressure) treatment. PMID:22073108

  16. Clinical and Hemodynamic Effects of CPAP-Therapy in Patients with Cardiogenic Pulmonary Edema

    Directory of Open Access Journals (Sweden)

    M. V. Gorbunova

    2007-01-01

    Full Text Available Objective: to evaluate the clinical and hemodynamic effects of CPAP-therapy in the treatment of alveolar cardiogenic pulmonary edema (CPE in patients with acute myocardial infarction (AMI.Subjects and methods. The open-labeled prospective study included 22 patients (19 males; mean age, 59.2±5.8 years with CPE that had complicated the course of AMI. Despite the drug and oxygen therapies of CPE for 30 minutes, progressive respiratory and left ventricular failures were an indication for the initiation of CPAP-therapy (7.3±1.2 cm H2O that was performed, by employing REM-Star apparatuses (Respironics, USA and Ultra Mirage facial masks (ResMed, Australia. Oxygen, 2 l/min (FiO2 = 40%, was delivered through the mask circuit. Central hemodynamic parameters were measured before and 60 and 180 minutes after the initiation of CPAP-therapy, by using a Swan-Ganz thermodilution cathether (HANDS OFF, model AH-05000-H, ARROW, USA. Arterial and mixed venous blood gas composition was rapidly determined on an automatic gas analyzer (Rapidlab 348, Bayer, USA.Results. Cyanosis and acrocyanosis disappeared and the number of congestive moist rales reduced in the lung in 19 (86.4% patients during 30-min CPAP-therapy. The patients’ oxygen status changed: the value of PaO2 significantly increased (82.5±2.5 versus 57.4±4.2 mm Hg at the baseline;p<0.05; SaO2 reached the normal values 60 minutes following CPAP-therapy. There was an increase in the cardiac index (3.1±0.2 versus 2.3±0.1 l/min/m2 at the baseline; p<0.05, a decrease in pulmonary wedge pressure (14.4±21 versus 23.6±2.1 mm Hg at the baseline; p<0.05, and synchronism of right and left cardiac performance.Conclusion. CPAP-therapy optimizes treatment of patients with CPE-complicated AMI, results in the normalization of the arterial blood gas composition, significantly diminishes hydrostatic pulmonary capillary pressure, and promotes the synchronism of the right and left hearts. 

  17. Unilateral pulmonary oedema due to lung re-expansion following pleurocentesis for spontaneous pneumothorax. The role of non-invasive continuous positive airway pressure ventilation.

    Science.gov (United States)

    Papakonstantinou, Dimitrios K; Gatzioufas, Zisis I; Tzegas, Georgios I; Stergiopoulos, Panagiotis I; Tsokantaridis, Christos G; Chalikias, Georgios K; Tziakas, Dimitrios N

    2007-01-18

    Re-expansion pulmonary oedema represents a rare complication of treatment of spontaneous pneumothorax with only a few cases documented in the current literature. We present the case of a 47-year-old male who presented a right-sided spontaneous pneumothorax and developed respiratory failure after chest tube drainage. The diagnosis of re-expansion pulmonary oedema was made and he was successfully treated with non-invasive continuous positive airway pressure ventilation. Since pathogenesis of re-expansion unilateral pulmonary oedema differs significantly from that of cardiogenic pulmonary oedema, the role of non-invasive continuous positive airway pressure ventilation is discussed as an additional therapeutic option.

  18. 电话随访对阻塞性睡眠呼吸暂停综合征患者使用正压通气依从性的影响%Influence of follow-up by telephone on rehabilitation compliance of obstructive sleep apnea syndrome patients treated with continuous positive airway pressure

    Institute of Scientific and Technical Information of China (English)

    孙龙凤; 孔德磊; 王爱平

    2012-01-01

    Objective Research the follow-up effect for the compliance of obstructive sleep apnea syndrome(OSAHS) patients treated with nasal continuous positive airway pressure (CPAP) by telephone. Methods Divide sixty OSAHS patients treated with CPAP into observation groups and control group. Both groups have 30 patients. The patients in control group were carried on routing guidance treatment and enjoined regular subsequent visit. The patients in observation group were carried on the above-mentioned treatment and also receive regular follow-up by telephone. Through the follow-up by telephone we provided guidance for present and will-present problems. Then we compared the EPWorth sleepiness scale (ESS) and status of using breathing machine before and after half of year. Results The apnea hyponea index (AHI) and average air leakage of patients in observation group were lower than those in control group. The average total days,average actual using days and percentage of treatment time higher than 4 hours in using days in the observation group were higher than the control group. Conclusions The follow-up by telephone can improve the compliance of the OSAHS patients with treatment of CPAP and reduce the medical burden.%目的 探讨电话随访对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者使用经鼻持续正压通气(CPAP)治疗依从性的干预效果.方法 将60例使用CPAP治疗的OSAHS患者分为观察组和对照组各30例,观察组在常规治疗指导、嘱其定期复诊的基础上,定期电话随访,对患者在治疗期间出现的和可能出现的问题进行指导.对照组行常规治疗指导,嘱其定期复诊;两组接受CPAP治疗前和治疗后6个月进行嗜睡评分及呼吸机使用情况比较.结果 观察组的呼吸紊乱指数(AHI)、平均漏气量低于对照组,观察组的使用天数及使用天数的平均使用时间、使用天数治疗时间>4h、最低氧饱和度(LSAT)均高于对照组.结论 电话随访能有

  19. [Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].

    Science.gov (United States)

    Fedorova, E A; Vyzhigina, M A; Gal'perin, Iu S; Zhukova, S G; Titov, V A; Godin, A V

    2004-01-01

    The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external

  20. Measurement of Pressure between Upper Airway Tract and Laryngoscope Blade during Orotracheal Intubation with Film of Microcapsules

    Directory of Open Access Journals (Sweden)

    Shigehiro Hashimoto

    2014-04-01

    Full Text Available The measurement system for the pressure between the blade of a laryngoscope and the upper airway tract during orotracheal intubation has been investigated with a film of microcapsules. Two types of the laryngoscope were used in the study: Wis-Foregger and Mac-Intosh. The film is attached on the surface of the blade of the laryngoscope. The measurement was applied to 20 cases of the orotracheal intubation. In the pressed part of the film, the microcapsules burst and release chemicals, which react with chemicals out of microcapsules and show a red color. The color density was photoelectrically measured, and converted to the pressure value in three regions on the blade; the epiglottis, the tongue, and the upper incisor. The results show that the pressures are 1.2±0.6 MPa on the epiglottis, 0.8±0.4 MPa on the tongue, and (11±3×10 MPa on the upper incisor, and that the pressures on the epiglottis are 2.0±0.3 MPa in bled cases, and 0.8±0.4 MPa in non-bled cases.

  1. Gene families of cuticular proteins analogous to peritrophins (CPAPs in Tribolium castaneum have diverse functions.

    Directory of Open Access Journals (Sweden)

    Sinu Jasrapuria

    Full Text Available The functional characterization of an entire class of 17 genes from the red flour beetle, Tribolium castaneum, which encode two families of Cuticular Proteins Analogous to Peritrophins (CPAPs has been carried out. CPAP genes in T. castaneum are expressed exclusively in cuticle-forming tissues and have been classified into two families, CPAP1 and CPAP3, based on whether the proteins contain either one (CPAP1, or three copies (CPAP3 of the chitin-binding domain, ChtBD2, with its six characteristically spaced cysteine residues. Individual members of the TcCPAP1 and TcCPAP3 gene families have distinct developmental patterns of expression. Many of these proteins serve essential and non-redundant functions in maintaining the structural integrity of the cuticle in different parts of the insect anatomy. Three genes of the TcCPAP1 family and five genes of the TcCPAP3 family are essential for insect development, molting, cuticle integrity, proper locomotion or fecundity. RNA interference (RNAi targeting TcCPAP1-C, TcCPAP1-H, TcCPAP1-J or TcCPAP3-C transcripts resulted in death at the pharate adult stage of development. RNAi for TcCPAP3-A1, TcCPAP3-B, TcCPAP3-D1 or TcCPAP3-D2 genes resulted in different developmental defects, including adult/embryonic mortality, abnormal elytra or hindwings, or an abnormal 'stiff-jointed' gait. These results provide experimental support for specialization in the functions of CPAP proteins in T. castaneum and a biological rationale for the conservation of CPAP orthologs in other orders of insects. This is the first comprehensive functional analysis of an entire class of cuticular proteins with one or more ChtBD2 domains in any insect species.

  2. Dynamic Characteristics of Mechanical Ventilation System of Double Lungs with Bi-Level Positive Airway Pressure Model

    Directory of Open Access Journals (Sweden)

    Dongkai Shen

    2016-01-01

    Full Text Available In recent studies on the dynamic characteristics of ventilation system, it was considered that human had only one lung, and the coupling effect of double lungs on the air flow can not be illustrated, which has been in regard to be vital to life support of patients. In this article, to illustrate coupling effect of double lungs on flow dynamics of mechanical ventilation system, a mathematical model of a mechanical ventilation system, which consists of double lungs and a bi-level positive airway pressure (BIPAP controlled ventilator, was proposed. To verify the mathematical model, a prototype of BIPAP system with a double-lung simulators and a BIPAP ventilator was set up for experimental study. Lastly, the study on the influences of key parameters of BIPAP system on dynamic characteristics was carried out. The study can be referred to in the development of research on BIPAP ventilation treatment and real respiratory diagnostics.

  3. The Efficacy of a Protocolized Nursing Care on Nasal Skin Breakdown in Preterm Neonates Receiving Nasal Continuous Positive Airway Pressure

    Directory of Open Access Journals (Sweden)

    Mahnaz Jabraeili

    2017-01-01

    Full Text Available Background: Nasal continuous positive airway pressure (NCPAP is an effective method of ventilation in newborns with respiratory distress syndrome (RDS. Using an appropriate nasal skin care protocol is identical to prevention or reduction of nasal skin breakdown in those who receive NCPAP. This study aimed to investigate the effectiveness of an evidence-based clinical care protocol on nasal skin integrity in preterm newborns who receive NCPAP.Materials and Methods: A Randomized Controlled Trial was used to conduct the study. A cohort of 110 preterm newborns with a gestational age (GA of 25 to 36 weeks, receiving nasal continuous positive airway pressure (NCPAP for RDS in the neonatal intensive care unit of a university teaching hospital were selected to perform the study. They were randomly assigned to a protocolized nasal skin care (group A or to a group receiving the routine care (group B. Nasal skin integrity of the preterm neonates, were measured on a daily basis for 10 days using the Neonatal Skin Condition Scale (NSCS 24 hours after placement of NCPAPs in both groups.Results: Each intervention and control group included 55 neonates. 65.50% of neonates in the control group and 47.30% of neonates in the intervention group were male. Repeated measures analysis showed thatNSCS scores were significantly lower in intervention group receiving nasal skin care in accordance with the protocol than the control group receiving the routine nasal skin care (P=0.000. Conclusion: In this study, the protocolized care reduced nasal skin breakdown in the preterm newborns receiving NCPAP. Therefore, it can be used as an effective method in nasal skin care in neonates who are treated by NCPAP.

  4. Effect of Positive Airway Pressure on Cardiovascular Outcomes in Coronary Artery Disease Patients with Non-Sleepy Obstructive Sleep Apnea : The RICCADSA Randomized Controlled Trial

    NARCIS (Netherlands)

    Peker, Yüksel; Glantz, Helena; Eulenburg, Christine; Wegscheider, Karl; Herlitz, Johan; Thunström, Erik

    2016-01-01

    RATIONALE: Obstructive sleep apnea is common in patients with coronary artery disease, many of whom do not report daytime sleepiness. First-line treatment for symptomatic obstructive sleep apnea is continuous positive airway pressure, but its value in patients without daytime sleepiness is uncertain

  5. CPAP, effective respiratory support in patients with AIDS-related Pneumocystis carinii pneumonia.

    Science.gov (United States)

    Prevedoros, H P; Lee, R P; Marriot, D

    1991-11-01

    Human Immunodeficiency Virus (HIV) related Pneumocystis carinii pneumonia (PCP) associated with severe respiratory failure is an increasingly common problem in major centres and is associated with a high mortality in previous and recent studies. Early in the epidemic, alternatives to invasive intensive care treatment were utilized in our institution and found to be successful. When respiratory failure developed, mask CPAP was used instead of intubation and ventilation. A retrospective review of 175 cases of HIV infected patients with confirmed first presentation PCP was undertaken. Treatment with our protocol resulted in an overall hospital mortality of 9%. Those patients who did not require supplemental oxygen or respiratory support had no in-hospital mortality. The group who required supplemental oxygen had a mortality of 10%. If respiratory failure supervened (severe respiratory distress, PaO2 less than 50 mmHg, SaO2 less than 90% on mask oxygen), CPAP was introduced. The mortality in this group was 22%. Only two patients were admitted to the intensive care unit for respiratory support after failure of CPAP. Both patients were intubated and received intermittent positive pressure ventilation (IPPV). Both patients died.

  6. The SomnuSeal Oral Mask Is Reasonably Tolerated by Otherwise CPAP Noncompliant Patients with OSA

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    N. Katz

    2013-01-01

    Full Text Available Compliance with CPAP is the major limiting factor in treating patients with OSA. The novel SomnuSeal mask is an oral self-adaptable mask located between the teeth and the lips ensuring that there are no air leaks or skin abrasions. Fifty patients with AHI>20, who failed previous CPAP trials, were asked to sleep with the mask for one month. In all patients, the mask was connected to an AutoPAP machine with a heated humidifier. Efficacy, convenience, and compliance (average usage for 4 or more hours per night were monitored. Fifty patients (41 m and 9 f, mean age 57±12 years, BMI 33.6±4.9 kg/m2, and AHI 47±23/h participated. Eleven were classified as compliant (average mask usage of 26 nights, 4.7 hours per night, five were only partially compliant (average usage of 13 nights, 2.9 hours per night, and 34 could not comply with it. In all patients who slept with it, the efficacy (assessed by residual AHI derived from the CPAP device was good with an AHI of less than 8/hour. Interestingly, the required optimal pressure decreased from an average of 9.3 cmH2O to 4.6 cmH2O. The SomnuSeal oral interface is effective and may result in converting noncompliant untreated patients with OSA into well-treated ones.

  7. Inductance plethysmography: an alternative signal to servocontrol the airway pressure during proportional assist ventilation in small animals.

    Science.gov (United States)

    Schulze, A; Suguihara, C; Gerhardt, T; Schaller, P; Claure, N; Everett, R; Devia, C; Hehre, D; Bancalari, E

    2001-02-01

    During proportional assist ventilation (PAV), the ventilator pressure is servocontrolled throughout each spontaneous inspiration such that it instantaneously increases in proportion to the airflow (resistive unloading mode), or inspired volume (elastic unloading mode), or both (combined unloading mode). The PAV pressure changes are generated in a closed-loop feedback circuitry commonly using a pneumotachographic signal. In neonates, however, a pneumotachograph increases dead space ventilation, and its signal may include a substantial endotracheal tube leak component. We hypothesized that respiratory inductive plethysmography (RIP) can replace pneumotachography to drive the ventilator during PAV without untoward effects on ventilation or respiratory gas exchange. Ten piglets and five rabbits were supported for 10-min (normal lungs) or 20-min (meconium injured lungs) periods by each of the three PAV modes. In each mode, three test periods were applied in random order with the ventilator driven by the pneumotachograph signal, or the RIP abdominal band signal, or the RIP sum signal of rib cage and abdomen. Interchanging the three input signals did not affect the regularity of spontaneous breathing, and gas exchange was achieved with similar peak and mean airway pressures (ANOVA). However, the RIP sum signal worked adequately only when the relative gains of rib cage and abdominal band signal were calibrated. We conclude that an RIP abdominal band signal can be used to generate PAV, avoiding increased dead space and endotracheal tube leak problems.

  8. Centriolar CPAP/SAS-4 Imparts Slow Processive Microtubule Growth.

    Science.gov (United States)

    Sharma, Ashwani; Aher, Amol; Dynes, Nicola J; Frey, Daniel; Katrukha, Eugene A; Jaussi, Rolf; Grigoriev, Ilya; Croisier, Marie; Kammerer, Richard A; Akhmanova, Anna; Gönczy, Pierre; Steinmetz, Michel O

    2016-05-23

    Centrioles are fundamental and evolutionarily conserved microtubule-based organelles whose assembly is characterized by microtubule growth rates that are orders of magnitude slower than those of cytoplasmic microtubules. Several centriolar proteins can interact with tubulin or microtubules, but how they ensure the exceptionally slow growth of centriolar microtubules has remained mysterious. Here, we bring together crystallographic, biophysical, and reconstitution assays to demonstrate that the human centriolar protein CPAP (SAS-4 in worms and flies) binds and "caps" microtubule plus ends by associating with a site of β-tubulin engaged in longitudinal tubulin-tubulin interactions. Strikingly, we uncover that CPAP activity dampens microtubule growth and stabilizes microtubules by inhibiting catastrophes and promoting rescues. We further establish that the capping function of CPAP is important to limit growth of centriolar microtubules in cells. Our results suggest that CPAP acts as a molecular lid that ensures slow assembly of centriolar microtubules and, thereby, contributes to organelle length control.

  9. Analysis of long-term compliance to continuous positive airway pressure in patients with obstructive sleep apnea%阻塞性睡眠呼吸暂停患者持续气道正压通气治疗的长期依从性

    Institute of Scientific and Technical Information of China (English)

    王倩; 欧琼; 田相亭; 陈勇池; 聂志强; 高兴林

    2016-01-01

    目的 分析阻塞性睡眠呼吸暂停(OSA)患者持续气道正压通气(CPAP)治疗的长期依从性.方法 采用前瞻性研究方法对2009年5月至2013年12月在广东省人民医院睡眠呼吸障碍诊治中心诊断并接受CPAP治疗的OSA患者进行长期随访,探讨其治疗的长期依从性.OSA的诊断、压力滴定和CPAP治疗均采用中心外睡眠诊疗模式,以治疗后第1、3、6、12个月及之后的每年定期1次与专科医师面对面形式完成随访,内容包括患者主观症状、CPAP治疗的依从性、对患者定期教育及不良反应的处理,并分为依从性好与差两组进行统计学分析.结果 随访截至2015年12月,共入选77例患者,73例完成随访,随访时间2~6年,平均(3.93±1.29)年,总体CPAP治疗依从性为54.8% (40/73),平均用机时间(4.02±1.87)h/晚.长期依从性趋势为治疗初始3个月升高,随后下降,至第2年随访点后又升高.依从性好组治疗的依从性初始3个月呈上升趋势,随后下降,第1年随访点后稳定至第3年,再次下降,至第4年随访点后再次升高.依从性差组自治疗开始即呈下降趋势,到第2年有一小段上升,后呈直线下降.多因素分析显示长期依从性与第1周自动压力滴定时间(P <0.001)、气流监测时间(P<0.01)及压力滴定次数(P<0.05)相关;与年龄、白天嗜睡、氧减指数、焦虑、抑郁等均无显著相关(均P>0.05).结论 OSA患者CPAP治疗的长期依从性呈曲线式改变,依从性的升高与定期随访有关.患者初期的诊治配合度可预测长期依从性.%Objective To explore the continuous positive airway pressure (CPAP) therapy compliance in patients with obstructive sleep apnea (OSA).Methods This prospective study recruited a group of subjects from May 2009 to December 2013 who were diagnosed and had accepted CPAP treatment in Sleep Center of Guangdong General Hospital,and the patients were followed-up regularly for long-term and assessed the

  10. A comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube using anesthesia with propofol and remifentanil in cataract surgery

    Directory of Open Access Journals (Sweden)

    Mohsen Ziyaeifard

    2012-01-01

    Full Text Available Background: The aim of this study was to evaluate intraocular pressure (IOP and hemodynamic responses following insertion of laryngeal mask airway (LMA or endotracheal tube (ETT after anesthesia induction with propofol and remifentanil in cataract surgery. Materials and Methods: In a randomized controlled study, 50 adults scheduled for elective cataract extraction procedure under general anesthesia were allocated to LMA insertion (n = 25 or ETT (n = 25 groups. IOP, systolic blood pressure (SBP, diastolic blood pressure (DBP, and heart rate (HR were measured after insertion of the airway device every minute up to 5 min. Results: There were no significant differences between LMA and ETT groups in SBP, DBP, HR, and IOP immediately after airway instrumentation up to 5 min, except in 4th min in DBP, 2nd min in HR, and 5th min in IOP (7.9 ± 2.3 mmHg in LMA and 9.4 ± 2.5 mmHg in ETT group; P = 0.030. There was good surgeon satisfaction for providing acceptable surgical field in both groups (88% in LMA and 80% in ETT group; P = 0.702. Conclusion: Propofol combined with remifentanil provides good and excellent conditions for insertion of LMA or ETT with minimal hemodynamic disturbances in cataract surgery. Considering LMA insertion is less traumatic than ETT, using LMA may be better than ETT for airway securing in these patients.

  11. CPAP Treats Muscle Cramps in Patients with Obstructive Sleep Apnea

    OpenAIRE

    Westwood, Andrew J.; Spector, Andrew R.; Auerbach, Sanford H.

    2014-01-01

    We describe a case series of 4 patients with varying degrees of obstructive sleep apnea who incidentally had a history of nocturnal leg cramps. None of the patients had periodic limb movements during the study and denied symptoms consistent with restless legs syndrome. In 3 of the 4 patients, nocturnal leg cramps resolved with CPAP treatment for OSA, while the fourth patient noted near-resolution of cramping after starting CPAP. In patients presenting with muscle cramps, obstructive sleep apn...

  12. 双水平呼吸道正压通气治疗重叠综合征的临床效果观察%Clinical observation of Bi-level positive airway pressure ventilation therapy treating overlap syndrome

    Institute of Scientific and Technical Information of China (English)

    刘晓丽; 刘芳勋; 张华; 刘芳; 牛志红; 黄秀清; 蒋延文

    2016-01-01

    Objective To discuss the therapeutic effect of Bi-Level positive airway pressure (Bi-PAP) ventilation therapy treating overlap syndrome.Methods Fifty patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea hypopnea syndrome(OSAHS) from August 2013 to December 2014 in Beijing Shijitan Hospital,Capital Medical University were collected;according to the random number table method,all patients were divided into observation group and control group(25 cases in each group).The observation group was treated by Bi-PAP for 72 h and the control group was treated by continuous positive airway pressure (CPAP) for 72 h.pH value,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),serum C reactive protein (CRP) and tumor necrosis factor-α (TNF-α) levels before and after treatment in two groups were compared.After treatment,the apnea hypopnea index (AHI),the longest apnea duration,forced expiratory volume in one second (FEV1) and forced vital capacity(FVC) in two groups were compared.Results The pH value,PaO2,PaCO2,SaO2 had no statistical difference in two groups before treatment(P >0.05).After treatment,the pH value,PaO2 and SaO2 were significantly higher in observation group than those in control group;PaCO2 was significantly lower[(7.41 ±0.05) vs (7.31 ±0.04),(90 ±5)mmHg vs (76 ± 7) mmHg,(98.3 ± 1.2) % vs (95.7 ± 1.6) %,(45 ± 6) mmHg vs (57 ± 8) mmHg,P < 0.05].Serum CRP and TNF-α levels did not show significant difference before treatment in 2 groups(P >0.05);after treatment,those in the observation group were significantly lower than those of the control group[(4.9 ± 1.2) mg/L vs (7.6 ±1.1) mg/L,(44 ± 8) ng/L vs (53 ± 6) ng/L,P < 0.05].Mter treatment,the AHI and the longest apnea duration in observation group were significantly lower than those of the control group[(7.2 ±2.9) vs (15.6 ±3.2),(10 ±4)s vs (16 ±5)s,P <0.05].After treatment

  13. Phosphorylation of CPAP by Aurora-A Maintains Spindle Pole Integrity during Mitosis

    Directory of Open Access Journals (Sweden)

    En-Ju Chou

    2016-03-01

    Full Text Available CPAP is required for centriole elongation during S/G2 phase, but the role of CPAP in mitosis is incompletely understood. Here, we show that CPAP maintains spindle pole integrity through its phosphorylation by Aurora-A during mitosis. Depletion of CPAP induced a prolonged delay in mitosis, pericentriolar material (PCM dispersion, and multiple mitotic abnormalities. Further studies demonstrated that CPAP directly interacts with and is phosphorylated by Aurora-A at serine 467 during mitosis. Interestingly, the dispersal of the PCM was effectively rescued by ectopic expression of wild-type CPAP or a phospho-mimic CPAP-S467D mutant, but not a non-phosphorylated CPAP-S467A mutant. Finally, we found that CPAP-S467D has a low affinity for microtubule binding but a high affinity for PCM proteins. Together, our results support a model wherein CPAP is required for proper mitotic progression, and phosphorylation of CPAP by Aurora-A is essential for maintaining spindle pole integrity.

  14. Phosphorylation of CPAP by Aurora-A Maintains Spindle Pole Integrity during Mitosis.

    Science.gov (United States)

    Chou, En-Ju; Hung, Liang-Yi; Tang, Chieh-Ju C; Hsu, Wen-Bin; Wu, Hsin-Yi; Liao, Pao-Chi; Tang, Tang K

    2016-03-29

    CPAP is required for centriole elongation during S/G2 phase, but the role of CPAP in mitosis is incompletely understood. Here, we show that CPAP maintains spindle pole integrity through its phosphorylation by Aurora-A during mitosis. Depletion of CPAP induced a prolonged delay in mitosis, pericentriolar material (PCM) dispersion, and multiple mitotic abnormalities. Further studies demonstrated that CPAP directly interacts with and is phosphorylated by Aurora-A at serine 467 during mitosis. Interestingly, the dispersal of the PCM was effectively rescued by ectopic expression of wild-type CPAP or a phospho-mimic CPAP-S467D mutant, but not a non-phosphorylated CPAP-S467A mutant. Finally, we found that CPAP-S467D has a low affinity for microtubule binding but a high affinity for PCM proteins. Together, our results support a model wherein CPAP is required for proper mitotic progression, and phosphorylation of CPAP by Aurora-A is essential for maintaining spindle pole integrity.

  15. Assessment of the effect of bariatric surgery on severe obstructive sleep apnea patients not tolerating CPAP therapy

    Directory of Open Access Journals (Sweden)

    H. Shaarawy

    2016-07-01

    Full Text Available Obstructive sleep apnea (OSA is increasingly prevalent worldwide and is associated with morbidity and mortality, the main line of treatment is CPAP but the compliance is doubtful, as obesity is highly linked to OSA weight loss can help in treatment. The aim of the present study: was to assess the effect of bariatric surgery on severe obstructive sleep apnea patients not tolerating CPAP therapy. Patients and methods: the study was done on 22 patients documented to have morbid obesity (BMI > 40 and severe OSA with Apnea Hypopnea Index (AHI >30/h and not tolerating CPAP therapy, patients were offered sleeve gastrectomy then were followed up for 12 months before another polysomnography was done to assess the presence of OSA and need for CPAP. Results: 22 patients completed the study. The mean age of the patients was 37.2 ± 17.3 years, 13 males and 9 females. After sleeve gastrectomy and follow up for 12 months the body weight decreased from 135.6 ± 17.8 to 101.3 ± 7.6 kg m (p = 0.001, BMI dropped from 48.2 ± 7.3 to 35.9 ± 4.8 kg m/m2 (p = 0.001, mean AHI decreased from 55.8 ± 8.3 to 12.8 ± 11.3 attacks/hour of sleep (p = 0.001 and CPAP pressure needed to control OSA was decreased from 13.2 ± 2.3 to 8.2 ± 3.9 cm H2O (p = 0.001. Conclusion: sleeve gastrectomy can be an alternate option of treatment for severe OSA patients who are not tolerating CPAP and surgery may cure the disease or at least improve compliance to CPAP by decreasing the needed pressure to control OSA.

  16. Effectiveness of Oral Appliance versus Continuous Positive Airway Pressure in Treating Patients with Mild to Moderate Obstructive Sleep Apnea-Hypopnea Syndrome: A Meta-Analysis%口腔矫正器和持续正压气道通气治疗轻中度OSAHS疗效比较的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王念; 涂学平; 胡克; 肖锦秀; 郭毅

    2013-01-01

    目的 系统评价口腔矫正器和持续正压气道通气比较治疗轻中度睡眠呼吸暂停低通气综合征(OSAHS)的疗效.方法 计算机检索PubMed、EMbase、The Cochrane Library、CBM、VIP、WanFang Data及CNKI,查找公开发表及未发表的有关口腔矫正器(OA)和持续正压气道通气(CPAP)比较治疗OSAHS疗效的随机对照试验(RCT),检索时限均为建库至2012年11月30日,并查找相关会议论文文献,文种和发表时间不限.由2位评价者根据纳入与排除标准独立筛选文献,提取资料并评价质量后,采用RevMan 5.1软件进行Meta分析,并采用GRADEpr0 3.6软件评价证据质量.结果 最终纳入7个RCT.Meta分析结果显示:①CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著,其差异具有统计学意义[WMD=9.13,95%CI(8.77,9.50),P<0.000 01];②OA和CPAP在改善轻中度OSAHS患者主观白天嗜睡方面,差异无统计学意义[WMD=0.00,95%CI(-0.12,0.12),P=0.97].结论 与OA相比,CPAP在改善轻中度OSAHS患者睡眠呼吸暂停低通气指数的作用更显著,但在改善患者主观白天嗜睡方面无显著差异.受纳入研究质量与数量所限,上述结论尚需开展更多高质量RCT加以验证.%Objective To evaluate the effectiveness of oral appliance (OA) vs. continuous positive airway pressure (CPAP) in treating patients with mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods The following databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang data and CNKI were searched from inception to November 30, 2012 to collect the randomized controlled trials (RCTs) on OA vs. CPAP in treating OSAHS. The relevant conference proceedings were also retrieved without limitation of type and publication time. In accordance with the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated quality. And then meta-analysis was performed using Rev

  17. Thoracic Block Technique Associated with Positive End-Expiratory Pressure in Reversing Atelectasis

    Directory of Open Access Journals (Sweden)

    Luciana Carnevalli Pereira

    2015-01-01

    Full Text Available A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA, which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient.

  18. Impact of obstructive sleep apnea on blood pressure in patients with hypertension

    Directory of Open Access Journals (Sweden)

    Gurubhagavatula I

    2011-12-01

    Full Text Available Barry Fields1, Indira Gurubhagavatula1–31Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, 2Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, 3Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USAAbstract: Hypertension is the most significant risk factor for death worldwide. Approximately 30%–40% of affected individuals have coexisting obstructive sleep apnea (OSA, a disorder resulting from the upper airway’s inability to remain patent during sleep. A causal relationship between OSA and hypertension has been demonstrated. Blunting or elimination of normal blood pressure (BP dipping during sleep is commonly seen in OSA patients, with corresponding increases in daytime BP. This dipping is clinically salient, because it is associated with the end-organ damage seen with chronic hypertension, such as cardiovascular, renal, and cerebrovascular disease. African-Americans are at greatest risk for non-dipping and end-organ damage. Rapidly fluctuating changes in sympathetic tone, intrathoracic pressure, oxyhemoglobin saturation, and carbon dioxide levels are all thought to play a role in acute and chronic BP elevation. Individuals with preexisting hypertension are most susceptible to OSA’s BP-raising effects. First-line therapy for OSA includes continuous positive airway pressure (CPAP delivered via a mask interface. Patients who show the greatest BP declines while using CPAP are more likely to be those who have at least moderate OSA, adhere to therapy, have preexisting hypertension, and whose blood vessels retain reversibility in disease-related remodeling. Given the heavy burden OSA-related hypertension places on the healthcare system, prevention, early detection, and prompt intervention should be the goals for all affected individuals.Keywords: obstructive sleep apnea (OSA, hypertension, nocturnal dipping, continuous positive airway pressure (CPAP

  19. CPAP Continuous Positive Airway Pressure Auxiliary Nursing Experience in Treating Pediatric Severe Pneumonia%CPAP持续正压通气治疗小儿重症肺炎的护理体会

    Institute of Scientific and Technical Information of China (English)

    王焕芳

    2011-01-01

    目的:探讨鼻塞式持续正压通气CPAP治疗小儿重症肺炎有效呼吸道管理的重要性.方法:将90例CPAP治疗重症肺炎患儿随机分为两组,利用不同护理措施观察对患儿通气情况的影响.结果:干预组患儿在纠正缺氧、改善呼吸、恢复心率、缩短病程等方面明显优于对照组.结论:鼻塞式CPAP治疗小儿重症肺炎采取有效地呼吸道管理疗效显著.

  20. Cystic fibrosis airway secretions exhibit mucin hyperconcentration and increased osmotic pressure

    Science.gov (United States)

    Henderson, Ashley G.; Ehre, Camille; Button, Brian; Abdullah, Lubna H.; Cai, Li-Heng; Leigh, Margaret W.; DeMaria, Genevieve C.; Matsui, Hiro; Donaldson, Scott H.; Davis, C. William; Sheehan, John K.; Boucher, Richard C.; Kesimer, Mehmet

    2014-01-01

    The pathogenesis of mucoinfective lung disease in cystic fibrosis (CF) patients likely involves poor mucus clearance. A recent model of mucus clearance predicts that mucus flow depends on the relative mucin concentration of the mucus layer compared with that of the periciliary layer; however, mucin concentrations have been difficult to measure in CF secretions. Here, we have shown that the concentration of mucin in CF sputum is low when measured by immunologically based techniques, and mass spectrometric analyses of CF mucins revealed mucin cleavage at antibody recognition sites. Using physical size exclusion chromatography/differential refractometry (SEC/dRI) techniques, we determined that mucin concentrations in CF secretions were higher than those in normal secretions. Measurements of partial osmotic pressures revealed that the partial osmotic pressure of CF sputum and the retained mucus in excised CF lungs were substantially greater than the partial osmotic pressure of normal secretions. Our data reveal that mucin concentration cannot be accurately measured immunologically in proteolytically active CF secretions; mucins are hyperconcentrated in CF secretions; and CF secretion osmotic pressures predict mucus layer–dependent osmotic compression of the periciliary liquid layer in CF lungs. Consequently, mucin hypersecretion likely produces mucus stasis, which contributes to key infectious and inflammatory components of CF lung disease. PMID:24892808

  1. Effects of Continuous Positive Airway Pressure on Cognitive Deficits in Middle-aged Patients with Obstructive Sleep Apnea Syndrome: A Meta-analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Yue-Ying Pan

    2015-01-01

    Conclusions: Cognition partially improved in patients with OSAS after CPAP treatment. The only domain with significant improvement was vigilance. Rigorous randomized controlled trials need to be performed to obtain clear results.

  2. Influence of continuous positive airway pressure on N-terminal pro-B-type natriuretic peptide in non-obese patients with obstructive sleep apnea%持续正压通气对阻塞性睡眠呼吸暂停非肥胖者的氨基末端B型利钠肽原水平的影响

    Institute of Scientific and Technical Information of China (English)

    邱志辉; 陆冬晓

    2016-01-01

    目的:探讨持续正压通气(CPAP)对阻塞性睡眠呼吸暂停(OSA)非肥胖者的血清氨基末端B型利钠肽原(NT‐proB‐NP)水平的影响。方法选择41例重度OSA合并有冠心病(CAD)的患者,根据患者体质量指数(BMI)分为肥胖组(BMI>28 kg/m2)和非肥胖组(BMI≤28 kg/m2),所有患者均接受24周的CPAP治疗。采用电化学发光法测定NT‐proBNP水平,比较治疗前后NT‐proBNP水平的变化。结果非肥胖组患者治疗后的NT‐proBNP平均水平出现明显下降,从治疗前(141.8±156.5) pg/mL下降到(106.7±167.2)pg/mL ,治疗前后比较差异有统计学意义(P<0.05);肥胖组患者治疗后的NT‐proBNP平均水平出现升高的趋势,从治疗前(32.2±24.5)pg/mL 升高到(86.3±174.4)pg/mL ,治疗前后比较差异无统计学意义(P>0.05)。结论 CPAP能有效降低重度OSA合并CAD非肥胖者的NT‐proBNP水平。%Objective To explore the effects of continuous positive airway pressure (CPAP) on N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in the non‐obese patients with obstructive sleep apnea (OSA) .Methods A total of 41 cases of severe OSA complicating coronary artery disease(CAD) were divided into two groups based on their body mass index (BMI):obese group (BMI>28 kg/m2 ) and non‐obese group (BMI≤28 kg/m2 ) .All the patients were treated by CPAP for 24 weeks .Serum NT‐proBNP lev‐el was detected by adopting the electrochemiluminescence method ,the changes of the serum levels of NT‐proBNP were compared between before and after treatment .Results The NT‐proBNP level after treatment in the non‐obese group was significantly de‐creased ,which was decreased from (141 .8 ± 156 .5)pg/mL before treatment to (106 .7 ± 167 .2)pg/mL ,the difference was statisti‐cally significant (P0 .05) .Conclusion CPAP can effectively decrease the NT‐proBNP level in non

  3. Hypoxemia during bilevel positive airway pressure treatment in patients with obstructive sleep apnea syndrome and chronic respiratory insufficiency.

    Science.gov (United States)

    Brzecka, Anna; Piesiak, Pawel; Kosacka, Monika; Jankowska, Renata

    2013-01-01

    In patients with obstructive sleep apnea (OSA) syndrome and chronic respiratory insufficiency one of the options of treatment is bilevel positive airway pressure (BPAP) during sleep. The aim of the study was to find out what are the factors influencing the early results of BPAP treatment in such OSA patients. The study was carried out in 55 adult obese patients (mean body mass index 45 ± 7 kg/m(2)), severe OSA syndrome (mean apnea/hypopnea index 62 ± 19), and chronic respiratory insufficiency (mean PaCO(2) 54 ± 5.7 torr) who underwent polysomnography during BPAP treatment. In 31 patients (56%) the mean SaO(2) during sleep was <88% despite the optimal BPAP and oxygen titration: 83 ± 4% during NREM and 81 ± 7% during REM sleep vs. 91 ± 2% and 90 ± 3%, respectively, in the remaining 24 patients (p < 0.001). The patients with advanced hypoxemia during sleep and BPAP treatment had lower forced vital capacity (2.2 ± 0.9 vs. 2.7 ± 0.8 l, p < 0.05), lower diurnal PaO(2) (49 ± 8 vs. 54 ± 7 torr), higher diurnal PaCO(2) (57 ± 5 vs. 52 ± 5 torr, p < 0.01), and higher PaCO(2) during sleep (75 ± 13 vs. 59.5 ± 7.5 torr). In conclusion, in obese patients with severe OSA syndrome and chronic alveolar hypoventilation there is a risk of sleep hypoxemia during BPAP treatment, despite optimal pressure titration.

  4. 利用PSG评估CPAP和Auto-CPAP对不同程度OSAHS的治疗%Evaluation of Continuous Positive Airway Pressure and Auto-continuous Positive Airway Pressure on Treatment of Obstructive Sleep Apnea-hypopnea Syndrme by Polysomography

    Institute of Scientific and Technical Information of China (English)

    岳英明; 孟琨; 邱小建

    2009-01-01

    目的 探讨持续气道正压通气(CPAP)与自动调节持续气道正压通气呼吸机(Auto-CPAP)在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者时的选择性应用.方法 60例轻中度(AHI≤40)OSAHS患者和60例重度(AHI>40)OSAHS患者分别接受CPAP和Auto-CPAP治疗,观察治疗前和治疗时PSG参数变化.结果 轻中度OSAHS患者应用CPAP治疗较应用Auto-CPAP治疗睡眠结构明显改善(P<0.05);重度OSAHS患者应用Auto-CPAP治疗较应用CPAP治疗的睡眠结构明显改善(P<0.05).包括睡眠潜伏期(SL)、睡眠效率(SE)、觉醒次数(WASO)、浅睡眠(Ⅰ期+Ⅱ期)、深睡眠(Ⅲ期+Ⅳ期)及REM期睡眠各占总睡眠时间(TST)的比例、呼吸暂停低通气指数(AHI)、夜间平均血氧饱和度(M SaO2)、夜间最低血氧饱和度(L SaO2)的变化.结论 轻中度OSAHS患者选择应用CPAP治疗的效果优于应用Auto-CPAP治疗的效果.重度OSAHS患者选择应用Auto-CPAP治疗的效果优于应用CPAP治疗的效果.

  5. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    airway and the function of the lungs (decreased residual capacity and aggravated ventilation perfusion mismatch) worse than in lean patients. Proper planning and preparation of airway management is essential, including elevation of the patient's upper body, head and neck. Preoxygenation is mandatory...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...... pressure, noninvasive ventilation and physiotherapy....

  6. Nasal CPAP and surfactant for treatment of respiratory distress syndrome and prevention of bronchopulmonary dysplasia

    DEFF Research Database (Denmark)

    Verder, Henrik; Bohlin, Kajsa; Kamper, Jens

    2009-01-01

    The Scandinavian approach is an effective combined treatment for respiratory distress syndrome (RDS) and prevention of bronchopulmonary dysplasia (BPD). It is composed of many individual parts. Of significant importance is the early treatment with nasal continuous positive airway pressure (n...

  7. Liberação de pressão de vias aéreas em pacientes pediátricos submetidos à cirurgia cardíaca Airway pressure release ventilation in post operative cardiac surgery in pediatric patients

    Directory of Open Access Journals (Sweden)

    W. B. de Carvalho

    2000-06-01

    positive end expiratory pressure (IMV+PEEP, APRV and continuous positive airway pressure (CPAP in children during cardiac surgery post operative with pulmonary hypertension and mild or moderate pulmonary lesion. METHODS: Ten patients were studied with respiratory monitoring (Bear Neonatal Volume Monitor-1Ò in MV with a continuos flow, time cycled and pressure limited ventilator. The cardiocirculatory variables analyzed were central venous pressure (CVP, oxygen extraction ratio, cardiac rate, systolic arterial pressure, and arterial- mixed venous CO2 difference. Friedman's test (non-parametric was used to compare the variables in three modalities of ventilation and the Wilcoxon test was used for the variables obtained in two of the modalities. RESULTS: The mean airway pressure (MAP showed a significant increasing during APRV compared to IMV+PEEP (p=0,012. The positive inspiratory pressure (PIP, the minute volume and the ratio of oxygen arterial pressure to oxygen inspired fraction (PaO2/FiO2 didn't show statistical difference. During APRV there was a significant decrease in respiratory rate (p= 0,004 and an increase in tidal volume (p=0,045 when compared to CPAP and IMV+PEEP. In the cardiocirculatory system only CVP showed a significant increased (p=0,019 during APRV. CONCLUSION: Due to the methodology utilized MAP was higher with APRV resulting in an increased tidal volume without respiratory or cardiocirculatory adverse effects when the three modes were compared. Our results suggest that APRV is a simple and safe method of ventilation.

  8. Elective nasal continuous positive airway pressure to support respiration after prolonged ventilation in infants after congenital cardiac surgery

    Science.gov (United States)

    Gandhi, Hemang; Mishra, Amit; Thosani, Rajesh; Acharya, Himanshu; Shah, Ritesh; Surti, Jigar; Sarvaia, Alpesh

    2017-01-01

    Background: We sought to compare the effectiveness of oxygen (O2) treatment administered by an O2 mask and nasal continuous positive airway pressure (NCPAP) in infants after congenital cardiac surgery. Methods: In this retrospective observational study, 54 infants undergoing corrective cardiac surgery were enrolled. According to the anesthesiologist's preference, the patients ventilated for more than 48 h were either put on NCPAP or O2 mask immediately after extubation. From pre-extubation to 24 h after treatment, arterial blood gas and hemodynamic data were measured. Results: After 24 h of NCPAP institution, the patients showed a significant improvement in oxygenation compared to O2 mask group. Respiratory rate (per minute) decreased from 31.67 ± 4.55 to 24.31 ± 3.69 (P < 0.0001), PO2 (mmHg) increased from 112.12 ± 22.83 to 185.74 ± 14.81 (P < 0.0001), and PCO2 (mmHg) decreased from 42.88 ± 5.01 to 37.00 ± 7.22 (P < 0.0076) in patients on NCPAP. In this group, mean pediatric cardiac surgical Intensive Care Unit (PCSICU) stay was 4.72 ± 1.60 days, with only 2 (11.11%) patients requiring re-intubation. Conclusion: NCPAP can be used safely and effectively in infants undergoing congenital cardiac surgery to improve oxygenation/ventilation. It also reduces the work of breathing, PCSICU stay, and may reduce the likelihood of re-intubation. PMID:28163425

  9. The effects of continuous positive airway pressure short-term treatment on 8-hydroxydeoxyguanosine and tumor necro-sis factor-α levels in the serum of the middle- and advanced-aged patients with obstructive sleep apnea/hypopnea syn-drome%短期CPAP干预对中老年OSAHS患者血清8-OHdG、TNF-α的影响

    Institute of Scientific and Technical Information of China (English)

    章婷; 汪俊; 杨晶; 罗荧荃

    2016-01-01

    Objective To investigate whether continuous positive airway pressure (CPAP) could have an impact on levels of 8-OHdG and TNF-α in the serum of middle- and advanced-aged OSAHS patients. Methods Twenty-three patients with moderate to severe OSAHS(AHI≥15 events/h) and twenty-five patients(AHI<15 events/h) who were matched for sex,age,body mass index (BMI),and diseases as the control group were recruited. The OSAHS patients received the 3d CPAP treatment,and 8-OHdG,and TNF-αlevels were measured. After CPAP treatment,serum 8-OHdG and TNF-αlevels were reassessed. Results The Apnea-Hy-popnea Index (AHI),8-OHdG,TNF-αwere significantly higher and the minimum arterial oxygen saturation (SaO2) and mean SaO2 significantly lower in OSAHS patients than in the control group. After the 3d CPAP treatment,8-OHdG,TNF-α,and AHI signifi-cantly decreased in,while the minimum SaO2 and mean SaO2 significantly increased in the OSAHS patients. There were significant positive correlations between AHI and 8-OHdG,and TNF-αand significant negative correlations between the minimum SaO2 and mean SaO2 and 8-OHdG,and TNF-αin all subjects (P<0.05). There were significant positive correlations between the minimum SaO2 and mean SaO2 and between 8-OHdG and TNF-α. Conclusion There might be oxidative stress and inflammatory responses in middle- and advanced-aged OSAHS patients. CPAP treatment has a positive effect on oxidative stress and inflammatory re-sponses.%目的:观察血清8-OHdG、TNF-α在中老年OSAHS患者中的水平变化,比较短期CPAP干预对上述指标的影响。方法随机选择确诊的23例中、重度OSAHS患者(AHI≥15次/h)作为试验组和25例(AHI<15次/h)对照者。比较两组8-O-HdG、TNF-α水平及其关系,试验组随机给予连续3d CPAP干预,观察8-OHdG、TNF-α的变化。结果试验组AHI、8-O-HdG、TNF-α均高于对照组(P<0.05),夜间最低SaO2、平均SaO2低于对照组(P<0.05)。试验组经呼吸机治疗3d

  10. nCPAP治疗对合并中重度OSAHS的2型糖尿病患者胰岛素抵抗及瘦素水平的影响%Effects of nCPAP treatment on insulin resistance and serum leptin in patients with type 2 diabetes and moderate and severe obstructive sleep apnea -hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    鲁颖; 田卢峰; 韩锐; 梁常兴; 安月

    2011-01-01

    Objective:To investigate the effects of nasal continuous positive airway pressure (nCPAP) treatment for long time on insulin resistance and serum leptin in patients with moderate and severe obstructive sleep apnea - hypopnea syndrome (OS-AHS)and type 2 diabetes. Methods: To use 6 months of nCPAP treatment on 50 patients,who can receive the treatment without contraindication,with type 2 diabetes and newly diagnosed OSAHS. The level of FGB, glycohemoglobin( HbAlc), insulin and serum leptin were measured and compared to the data previously obtained. Results: After the application of nCPAP treatment, the patients' concentration of FGB [ (7.5 ± 1.8) mmol/L], HbAlc [(7.0±1.4)%] and Ieptin[ (9.6 ±5.2) ng/ml] were lower than those previous obtained [ FGB (9.7 ±2. 2) mmol/L, HbAlc (8. 6 ±2. 0)% , leptin ( 14. 9 ±8. 8) ng/ml, 1=9.348, P< 0.001: t = 10.598, P<0.001: t=6.086, P<0.001]. And the homeostasis model assessment (HOMA) index of insulin resist-ance(2.4±l. 1) was significantly lower compared with that obtained before the nCPAP treatment (< =3.140, P<0.001). Conclusion : For the patients with moderate and severe OSAHS and type 2 diabetes, nCPAP treatment can improve the control of the level of FGB, HbAlc, leptin and promote the insulin sensitivity.%目的:探讨长期nCPAP治疗对合并中重度OSAHS的2型DM患者胰岛素抵抗及血清瘦素(leptin)水平的影响.方法:选取多导睡眠监测(PSG)确诊的中重度OSAHS伴2型DM患者且对nCPAP治疗依从性好者50例进行6个月的nCPAP,治疗前后检测其FGB、HbA1c、胰岛素敏感性指标及血清leptin水平,采用配对t检验进行比较、评价.结果:(1)nCPAP治疗后受试者FGB [(7.5±1.8) mmol/L]、HbA1c[ (7.0±1.4)%]和leptin水平[(9.6±5.2) ng/ml]较治疗前FGB[ (9.7±2.2) mmol/L]、HbA1c[(8.6±2.0)%]和leptin[( 14.9±8.8)ng/ml]显著降低(t=9.348,P<0.001;t=10.598,P<0.001;t=6.086,P<0.001);(2)治疗后胰岛素抵抗(IR)的稳态模式评估指数(HOMA - IR) (2.4±1

  11. Pre- and in-therapy predictive score models of adult OSAS patients with poor adherence pattern on nCPAP therapy

    Directory of Open Access Journals (Sweden)

    Wang Y

    2015-05-01

    Full Text Available Yeying Wang,1,2 Alan F Geater,3 Yanling Chai,1 Jiahong Luo,2 Xiaoqun Niu,1 Bing Hai,1 Jingting Qin,1 Yongxia Li1 1Department of Respiratory Medicine, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China; 2Department of Epidemiology and Biostatistics, School of Public Health, Kunming Medical University, Kunming, Yunnan Province, People’s Republic of China; 3Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand Objectives: To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. Methods: Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS, Fatigue Severity Scale (FSS, Zung’s Self-Rating Depression Scale (SDS, and The Pittsburgh Sleep Quality Index (PSQI at baseline and at the end of 3rd-week therapy were collected. Twelve weeks’ adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. Results: Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night, moderate (n=19, 5.3±0.6 hours per night, or good (n=43, 6.8±0.3 hours per night. Cumulative logit regression models (good → moderate → poor revealed independent baseline

  12. Determination of Mother Centriole Maturation in CPAP-Depleted Cells Using the Ninein Antibody

    OpenAIRE

    Miseon Lee; Kunsoo Rhee

    2015-01-01

    Background Mutations in centrosomal protein genes have been identified in a number of genetic diseases in brain development, including microcephaly. Centrosomal P4.1-associated protein (CPAP) is one of the causal genes implicated in primary microcephaly. We previously proposed that CPAP is essential for mother centriole maturation during mitosis. Methods We immunostained CPAP-depleted cells using the ninein antibody, which selectively detects subdistal appendages in mature mother centrioles. ...

  13. Plasma cytokine levels fall in preterm newborn infants on nasal CPAP with early respiratory distress.

    Directory of Open Access Journals (Sweden)

    Clarissa Gutierrez Carvalho

    Full Text Available Early nCPAP seems to prevent ventilator-induced lung injury in humans, although the pathophysiological mechanisms underlying this beneficial effect have not been clarified yet.To evaluate plasma levels IL-1β, IL-6, IL-8, IL-10, and TNF-α immediately before the start of nCPAP and 2 hours later in preterm infants.Prospective cohort including preterm infants with 28 to 35 weeks gestational age with moderate respiratory distress requiring nCPAP. Extreme preemies, newborns with malformations, congenital infections, sepsis, surfactant treatment, and receiving ventilatory support in the delivery room were excluded. Blood samples were collected right before and 2 hours after the start of nCPAP.23 preterm infants (birth weight 1851±403 grams; GA 32.3±1.7 weeks were treated with nCPAP. IL-1β, IL-10, TNF-α levels were similar, IL-8 levels were reduced in 18/23 preterm infants and a significant decrease in IL-6 levels was observed after 2 hours of nCPAP. All newborns whose mothers received antenatal steroids had lower cytokine levels at the onset of nCPAP than those whose mothers didn't receive it; this effect was not sustained after 2 hours of nCPAP.Early use nCPAP is not associated with rising of plasma pro-inflammatory cytokines and it seems to be a less harmful respiratory strategy for preterm with moderate respiratory distress.

  14. Sustained inflation and incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation in a large porcine model of acute respiratory distress syndrome

    Directory of Open Access Journals (Sweden)

    Wunder Christian

    2006-06-01

    Full Text Available Abstract Background To compare the effect of a sustained inflation followed by an incremental mean airway pressure trial during conventional and high-frequency oscillatory ventilation on oxygenation and hemodynamics in a large porcine model of early acute respiratory distress syndrome. Methods Severe lung injury (Ali was induced in 18 healthy pigs (55.3 ± 3.9 kg, mean ± SD by repeated saline lung lavage until PaO2 decreased to less than 60 mmHg. After a stabilisation period of 60 minutes, the animals were randomly assigned to two groups: Group 1 (Pressure controlled ventilation; PCV: FIO2 = 1.0, PEEP = 5 cmH2O, VT = 6 ml/kg, respiratory rate = 30/min, I:E = 1:1; group 2 (High-frequency oscillatory ventilation; HFOV: FIO2 = 1.0, Bias flow = 30 l/min, Amplitude = 60 cmH2O, Frequency = 6 Hz, I:E = 1:1. A sustained inflation (SI; 50 cmH2O for 60s followed by an incremental mean airway pressure (mPaw trial (steps of 3 cmH2O every 15 minutes were performed in both groups until PaO2 no longer increased. This was regarded as full lung inflation. The mPaw was decreased by 3 cmH2O and the animals reached the end of the study protocol. Gas exchange and hemodynamic data were collected at each step. Results The SI led to a significant improvement of the PaO2/FiO2-Index (HFOV: 200 ± 100 vs. PCV: 58 ± 15 and TAli: 57 ± 12; p 2-reduction (HFOV: 42 ± 5 vs. PCV: 62 ± 13 and TAli: 55 ± 9; p Ali: 6.1 ± 1 vs. T75: 3.4 ± 0.4; PCV: TAli: 6.7 ± 2.4 vs. T75: 4 ± 0.5; p Conclusion A sustained inflation followed by an incremental mean airway pressure trial in HFOV improved oxygenation at a lower mPaw than during conventional lung protective ventilation. HFOV but not PCV resulted in normocapnia, suggesting that during HFOV there are alternatives to tidal ventilation to achieve CO2-elimination in an "open lung" approach.

  15. Adherencia al tratamiento con presión positiva continua nasal en pacientes con síndrome de apnea/hipoapnea del sueño Compliance with continuous positive airway pressure therapy in patients with sleep apnea/hypopnea syndrome

    Directory of Open Access Journals (Sweden)

    Claudio W. Gallego

    2004-10-01

    /day and >5day/week. Of 46 patients (male 34; age 62±9years; BMI 33±7kg/m²; AHI 38±18/h; time of therapy 2.1±1.7years; CPAP 9±1.4 cmH2O, 34 had a clock counter and 24 (71% were C+. Initial symptoms included: somnolence (65%, snoring (39%, bed-partner witnessed apneas (28%. Comparing C+ y C- we didn't find significant difference in age, BMI, CPAP pressure, length of therapy, AHI and pre-treatment Epworth classification. Referred vs. measured time of use in C+ and C- were 6.6±1 vs. 6.1±1h/d (p=0.02 y 5.6±1 vs. 2.4±1h/d (p1year of use, we observed a lower percentage of fine elements (87 to 44%, 74 to 44%, 83 to 44%, 91 to 78%, respectively. Most common defects included stiffness of SI, cracks in SI, M-C and AT, loose conexions. The study confirms the importance of objective monitoring in patients with CPAP. Side effects and equipment condition require special attention because this could affect an effective treatment.

  16. 睡眠呼吸障碍的气道正压通气治疗策略%Positive airway pressure ventilation for obstructive sleep apnea

    Institute of Scientific and Technical Information of China (English)

    韩芳

    2011-01-01

    @@ 1 北景介绍 1981年,澳大利亚Sullivan等首次报告应用持续气道正压通气(CPAP)治疗睡眠呼吸暂停低通气(SAHS)取得满意疗效.1985年由于鼻罩技术的改进,经鼻CPAP治疗得到广泛应用,目前已成为治疗成人SAHS患者的主要手段.1991年可分别调节吸气正压(IPAP)及呼气正压(EPAP)的双水平气道正压呼吸机(BiPAP)应用于临床.1993年,能够随患者上气道阻力变化而增减压力的智能型CPAP(Auto-CPAP)问世,舒适度好,目前其技术已较成熟.由于CPAP价格便宜,仍为大部分患者的首选治疗.国内在上世纪90年代初开始应用CPAP治疗SAHS,并研制了国产的CPAP呼吸机,取得了良好的效果[1-2].

  17. Relationship between aldosterone and the metabolic syndrome in patients with obstructive sleep apnea hypopnea syndrome: effect of continuous positive airway pressure treatment.

    Directory of Open Access Journals (Sweden)

    Antonia Barceló

    Full Text Available BACKGROUND: Metabolic syndrome (MS occurs frequently in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS. We hypothesized that aldosterone levels are elevated in OSAHS and associated with the presence of MS. METHODS: We studied 66 patients with OSAHS (33 with MS and 33 without MS and 35 controls. The occurrence of the MS was analyzed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III clinical criteria. Measurements of plasma renin activity (PRA, aldosterone, aldosterone:PRA ratio, creatinine, glucose, triglycerides, cholesterol and HDL cholesterol were obtained at baseline and after CPAP treatment. RESULTS: Aldosterone levels were associated with the severity of OSAHS and higher than controls (p = 0.046. Significant differences in aldosterone levels were detected between OSAHS patients with and without MS (p = 0.041. A significant reduction was observed in the aldosterone levels in patients under CPAP treatment (p = 0.012. CONCLUSION: This study shows that aldosterone levels are elevated in OSAHS in comparison to controls, and that CPAP therapy reduces aldosterone levels. It also shows that aldosterone levels are associated with the presence of metabolic syndrome, suggesting that aldosterone excess might predispose or aggravate the metabolic and cardiovascular complications of OSAHS. TRIAL REGISTRATION: The study is not a randomized controlled trial and was not registered.

  18. Effect of Positive Airway Pressure Therapy on Body Mass Index in Obese Patients With Obstructive Sleep Apnea Syndrome: A Prospective Study.

    Science.gov (United States)

    Rishi, Muhammad Adeel; Copur, Ahmet Sinan; Nadeem, Rashid; Fulambarker, Ashok

    2016-01-01

    Because obesity is a common cause of obstructive sleep apnea syndrome (OSAS), weight loss can be an effective treatment. OSAS also may cause weight gain in some patients. Effective treatment of sleep apnea may facilitate weight loss in obese patients. We hypothesize that positive airway pressure (PAP) therapy is associated with weight loss in obese patients with OSAS. This was a single-center observational prospective cohort study. Forty-five patients were diagnosed with OSAS after polysomnographic analysis in sleep laboratory and underwent continuous positive airway pressure titration. Patients were followed for 3 months in terms of change in body mass index (BMI) and compliance with PAP therapy. Of the 45 patients recruited, 3 patients were eliminated because of miss recruitment. Nine patients had incomplete data, and the rest (n = 33) were included for analysis. The mean age was 54.9 ± 16.9 years (mean ± SD), 93.9% were male, and 90.9% were whites. Mean apnea-hypopnea index was 36.3 ± 28.17 events per hour. Mean BMI before treatment was 34.7 ± 3.9 kg/m. Fifteen patients (45.5%) were compliant with therapy of OSAS with PAP. There was no difference in age, gender, neck circumference, BMI, and apnea-hypopnea index of patients compliant to therapy when compared with those who were not. There was a significant decrease in BMI in patients compliant with PAP therapy compared with noncompliant patients (-1.2 ± 0.7 vs. 0.3 ± 0.9 kg/m, P ≤ 0.001). PAP therapy may cause significant loss of weight within 3 months in obese patients with OSAS. Further study is needed to elucidate the physiological basis of this change.

  19. Clinical Study of Therapy for Neonatal Respiratory Distress Syndrome with Pulmonary Surfactant and CPAP%肺表面活性物质联合鼻塞持续正压通气治疗新生儿呼吸窘迫综合征临床观察

    Institute of Scientific and Technical Information of China (English)

    秦素芳; 蔡家平; 严璃

    2012-01-01

    Objective: To study the clinical effect of pulmonary surfactant (Curosurf) and CPAP on neonatal respiratory distress syndrome. Methods: Randomly 36 cases of newborn infants admitted into Yueyang Women and Children's Hospital from January 2009 to June 2011 with a confirmed diagnosis of neonatal respiratory distress syndrome were analyzed, who were treated with pulmonary surfactant and continuous positive airway pressure ( CACP) , and then the clinical syndrome and blood gas analysis of these infants, the readings of the ventilator as well as the complications were studied. Results: The clinical syndrome of newborn infants were improved evidently or disappeared, and PO2, PCO2 and pH were improved significantly (P<0. 01). Conclusions: The combination of pulmonary surfactant and CPAP could significantly improve the neonatal respiratory distress syndrome within the primary treatment.%目的:探讨应用肺表面活性物质(固尔苏)联合鼻塞持续正压通气(CPAP)治疗新生儿呼吸窘迫综合征的临床疗效.方法:随机选取2009年1月~2011年6月我科新生儿病房入院确诊为新生儿呼吸窘迫综合征的患儿36例,使用肺表面活性物质联合CPAP治疗,观察治疗前后患儿临床症状及血气分析、呼吸机参数的变化及并发症情况.结果:用药后临床症状明显减轻,PO2 、PCO2 、pH、FiO2、PEEP均较用药前明显改善,差异有统计学意义(P<0.01).结论:肺表面活性物质联合CPAP治疗新生儿呼吸窘迫综合征疗效显著,便于开展.

  20. Effect of CPAP on Endothelial Function in Subjects With Obstructive Sleep Apnea: A Meta-Analysis.

    Science.gov (United States)

    Xu, Huajun; Wang, Yuyu; Guan, Jian; Yi, Hongliang; Yin, Shankai

    2015-05-01

    Obstructive sleep apnea (OSA) is related to endothelial dysfunction. CPAP is the first-line treatment for OSA. We conducted a meta-analysis to evaluate the effect of CPAP on endothelial function in subjects with OSA. The PubMed, Embase, and Cochrane Library databases were searched. The overall effects were measured by the weighted mean difference with a 95% CI. Subgroup and meta-regression analyses were used to explore the sources of between-study heterogeneity. Eleven studies were eligible for the meta-analysis. A random-effects model revealed that CPAP significantly improved endothelial function as assessed by flow-mediated dilation (weighted mean difference of 2.92, 95% CI 2.21-3.63, P CPAP compliance and duration, and sleep-related variables had no effect on reduction in arterial stiffness after CPAP. Sensitivity analyses indicated that the protective effect of CPAP on endothelial function was robust. CPAP significantly improved flow-mediated dilation in subjects with OSA. Long-term randomized controlled trials with larger sample sizes are needed to confirm the positive effect of CPAP on endothelial function in subjects with OSA.

  1. Urinary proteomic profiling in severe obesity and obstructive sleep apnoea with CPAP treatment

    Directory of Open Access Journals (Sweden)

    Ian W Seetho

    2015-04-01

    Conclusions: The urinary proteome is compared in OSA with CPAP and without OSA in severe obesity. The effects of CPAP on OSA may lead to changes in the urinary peptides but further research work is needed to investigate the potential role for urinary proteomics in characterising urinary peptide profiles in OSA.

  2. Changes in Plasma Angiotensin II and Circadian Rhythm of Blood Pressure in Hypertensive Patients with Sleep Apnea Syndrome Before and After Treatment

    Institute of Scientific and Technical Information of China (English)

    Hai-ling Wang; Qing-zeng Liu; Yu Wang; Ying Zhang; Yun-dai Chen; Xin-chun Wang; Zhi-xuan Liu; Guo-li Jing; Hai-feng Tong; Yuan Tian

    2011-01-01

    Objective To explore the changes in plasma angiotensin Ⅱ (Ang Ⅱ) and circadian rhythm of blood pressure among hypertensive patients with sleep apnea syndrome (SAS) before and after continuous positive airway pressure (CPAP) or surgical treatment. Methods A total of 180 essential hypertension patients were enrolled in our study. The determination of plasma Ang Ⅱ concentration, ambulatory blood pressure (ABP), and polysomnography (PSG) monitoring were performed before and 3 months after CPAP or surgical treatment.Results Patients were dassified into three groups by their apnea-hypopnea index (AHI): essential hypertension group (EH group, n=72; AHI<5), essential hypertension with mild SAS group (EH+mild SAS group, n=60, 5≤AHI<20), and essential hypertension with moderate and severe SAS group (EH+moderate-severe SAS group, n=48, AHI≥20). The concentrations of plasma Ang Ⅱ in the above three groups were 13.42±3.27, 16.17±3.82, and 18.73±4.05 ng/mL respectively before treatment, and AngⅡ concentration in EH patients combined with SAS was significantly higher than that in EH group (all P<O.05).After treatment the values in the latter two groups significantly decreased to 14.67±2.56 and 15.03±3.41 ng/mL respectively (P<0.05). The incidence of non-dipper blood pressure curve in EH patients was 31.9%,and those in hypertensive patients with mild SAS and moderate-severe SAS were 51.7% and 58.3%, respectively before treatment. The incidence of non-dipper blood pressure curve in the EH patients with mild SAS was significantly higher than that of patients with EH alone (P<0.05). After CPAP treatment or surgery, the incidence of non-dipper blood pressure curve in the two SAS groups was significantly decreased to 38.3% and 39.6%, respectively (P<0.05).Condusions Ang Ⅱ might phy a role in blood pressure variability in patients with obstructive SAS. CPAP or surgical treatment can improve blood pressure disorder and decrease plasma Ang

  3. [A case of respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation].

    Science.gov (United States)

    Shimoyama, Yuichiro; Majima, Nozomi; Kadono, Noriko; Ito, Masayuki; Agui, Tomoyuki; Umegaki, Osamu; Minami, Toshiaki

    2011-04-01

    We experienced a patient with respiratory insufficiency after resection of the aortic aneurysm and replacement with a synthetic conduit which recovered by airway pressure release ventilation (APRV) dramatically. A 44-year-old man diagnosed as aortic aneurysm of the descending thoracic aorta was admitted to our hospital and an operation was scheduled. The operation lasted for 19 hours and the time of general anesthesia was 23 hours. The immediate post-operative chest x-ray showed atelectasis of the right upper lobe, elevated right diaphragm and poor aeration of the lungs. A volume-limited mechanical ventilation was used for this patient postoperatively in ICU. But accumulation of carbon dioxide and poor oxygenation were observed. We started APRV by Bennet 840 (Tyco Healthcare, Tokyo). Specifically, we used Bilevel mode (PEEP 20/3 cmH20/3, inspiratory time 3.2 seconds, respiratory rate 15 times per minute, pressure support 20 cm H2O, FI(O2) 1.0). Promptly accumulation of carbon dioxide was improved and atelectasis of the right upper lobe vanished. Additionally, oxygenation was improved. He was weaned from a ventilator on postoperative day 5. We have demonstrated that APRV is an important tool that should be used to improve severe respiratory insufficiency.

  4. Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.

    NARCIS (Netherlands)

    Visser, W.A.; Gielen, M.J.M.; Giele, J.L.P.

    2006-01-01

    Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the

  5. Effect of Auto-CPAP Method on Obstructive Sleep Apneahypopnea Syndrome and Its Pressure Level%智能型持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的疗效及压力变化

    Institute of Scientific and Technical Information of China (English)

    杨巍巍; 韩芳

    2009-01-01

    目的 评价智能型持续气道正压通气(Auto-CPAP)治疗中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效及治疗压力的变化.方法对60例诊断为中重度OSAHS的患者,分别行Auto-CPAP及持续气道正压通气(CPAP)治疗,比较两种治疗方法改善最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)、血氧饱和度<90%的时间占总睡眠时间的百分数(SIT90%)、每小时血氧饱和度减少4%(DI4)以上的次数及平均治疗压力水平的变化.结果治疗前、CPAP治疗时、Auto-CPAP治疗时,患者LSaO2、MSaO2、SIT90%和DI4间差别均有统计学意义(P<0.05).而CPAP治疗时和Auto-CPAP治疗时患者LSaO2、MSaO2、DI4和SIT90%间差别无统计学意义(P>0.05).Auto-CPAP治疗第1天和治疗第7天时不同压力持续时间占总睡眠时间的比例比较,差别均有统计学意义(P<0.05).结论 Auto-CPAP治疗OSAHS与传统CPAP治疗效果相同,且Auto-CPAP治疗第1天时,15 cm H2O压力水平所占时间比例最高,而在治疗第7天时4 cm H2O压力水平所占时间比例最高.

  6. 持续正压通气可改善2型糖尿病伴阻塞性睡眠呼吸暂停低通气综合征患者炎症及胰岛素抵抗%Improvement on inflammation and insulin resistance after continuous positive airway pressure in patients with type 2 diabetes mellitus and obstructive sleep apnea hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    李晨光; 陈莉明; 倪长霖; 常宝成; 李竹; 杨敏; 汤云昭; 姜振环; 朱艳娟

    2014-01-01

    Objective To observe the effects of continuous positive airway pressure(CPAP) treatment on inflammation and insulin resistance in patients with type 2 diabetes mellitus(T2DM) and obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods Seventy-four patients (51 males and 23 females,with an age range of 45-66 years old) diagnosed as T2DM and OSAHS syndrome from January 2012 to January 2014 were randomly and equally divided into the treatment group(n=37) and the control group(n=37).Patients in the treatment group were treated with CPAP for 14 days.The fasting blood glucose (FBG),fructosamine (FMN),fasting insulin (FINS),white blood cell (WBC)count,high sensitive C reactive protein (hs-CRP),hypoxia inducible factor-1α (HIF-1α) and soluble vascular cell adhesion molecule-1(sVCAM-1) was detected before and after treatment.The homeostasis model assessment (HOMA) insulin resistance (HOMA-IR) index,the mean pulse oxygen saturation (MSpO2),the lowest pulse oxygen saturation (LSpO2) and apnea hypopnea index (AHI) were monitored by polysomnography (PSG) before and after treatment.T test,x2 test and Spearman correlation analysis were used to evaluate the data.Results Compared to the control group,the level of FBG,FMN,FINS,MSpO2,LSpO2,AHI was improved in the treatment group by a certain degree after treatment (t =-123.761-120.676,all P<0.05).The level of hs-CRP,HIF-1α,sVCAM-1 and HOMA-IR was significantly reduced from (7.3±0.3)mg/L,(275±53) ng/L,(717±73) ng/L and 3.7±0.2 before treatment to (2.4±0.4) mg/L,(21 1±6) ng/L,(589±57) ng/L and 2.1±0.7 after treatment,respectively (t=-53.046,-19.827,-12.827,-28.342,respectively,all P<0.05).The improvements showed by Pearson analysis in HOMA-IR after treatment were positively correlated with HIF-1α and sVCAM-1 improvements r=0.87,0.86,both P<0.05).Conclusion CPAP may improves the inflammation status,sleep quality,insulin resistance in patients with T2DM and OSAHS.%目的 观察持续正压通气(CPAP)对2

  7. Adolescents with obstructive sleep apnea adhere poorly to positive airway pressure (PAP, but PAP users show improved attention and school performance.

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    Dean W Beebe

    Full Text Available BACKGROUND: Obstructive Sleep Apnea (OSA is associated with medical and neurobehavioral morbidity across the lifespan. Positive airway pressure (PAP treatment has demonstrated efficacy in treating OSA and has been shown to improve daytime functioning in adults, but treatment adherence can be problematic. There are nearly no published studies examining functional outcomes such as academic functioning in adolescents treated with PAP. This study was conducted as an initial step towards determining whether PAP treatment improves daytime functioning among adolescents with OSA. METHODS: Self-reported academic grades, self- and parent-reported academic quality of life, and objectively-measured attention were assessed before and after PAP was clinically initiated in a sample of 13 obese adolescents with OSA, as well as 15 untreated obese Controls without OSA. Based on adherence data, the treated group was divided into PAP Users (n = 6 and Non-Adherent participants (n = 7. RESULTS: Though demographically similar, the three groups significantly differed in how their academic performance and attention scores changed from baseline to follow-up. Non-Adherent participants showed worsening functioning over time, while PAP Users showed stable or improved functioning, similar to controls. CONCLUSION: Although many adolescents prescribed PAP for OSA are non-adherent to the treatment, those who adhere to treatment can display improved attention and academic functioning.

  8. Efficacy of split night CPAP titration in moderate and severe obstructive sleep apnea syndrome patients

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    Shereen Farghaly

    2016-01-01

    Conclusion: Split night sleep study is more commonly associated with unsuccessful CPAP titration than full night titration but successful titration could be obtained during split night titration in patients with severe AHI >36.5 event/h.

  9. Control study of pulmonary surfactant combined with CPAP and BIPAP ventilation modes respectively in treatment of neonatal NRDS

    Institute of Scientific and Technical Information of China (English)

    Yao Liu

    2016-01-01

    Objective:To analyze the differences in effect of pulmonary surfactant combined with CPAP and BIPAP ventilation modes respectively in treatment of neonatal NRDS.Methods:A total of 50 cases of children with neonatal respiratory distress syndrome (NRDS) born and receiving treatment in our hospital from August 2012 to January 2015 were selected as research subjects and randomly divided into observation group and control group, each with 25 cases. Control group received pulmonary surfactant combined with CPAP ventilation mode treatment, observation group received pulmonary surfactant combined with BIPAP ventilation mode treatment, and then differences in blood gas indicators and mechanical ventilation parameters, pulmonary artery pressure, endothelin and nitric oxide levels, blood coagulation and anticoagulation indicators and protein expression levels of CD24, TNF-α, IL-6 and IL-17A of two groups after treatment were compared.Results:PaO2, PH value and oxygenation index of observation group after treatment were higher than those of control group, and PaCO2, positive end-expiratory pressure, peak inspiratory pressure and inspired oxygen concentration were lower than those of control group; pulmonary artery pressure and EF-1 level of observation group after treatment were lower than those of control group, and NO level was higher than that of control group; PC, TPS and AT-Ⅲ levels of observation group after treatment were higher than those of control group, and D-D and vWF levels were lower than those of control group; protein expression of CD24 and IL-6 of observation group after treatment were lower than those of control group, and protein expression of TNF-α and IL-17A were higher than those of control group.Conclusion:Pulmonary surfactant combined with BIPAP ventilation mode treatment of children with NRDS can effectively optimize ventilation function and realize homeostasis, and it has active clinical significance.

  10. Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators.

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    Murray Hinder

    Full Text Available Non-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or 'rainout' from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.To assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.Seven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH2O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.Several ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H2O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from 'specific' (tube occluded to 'ambiguous' (Safety valve open. Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH2O compared to the measured values of 13cmH2O.This study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.

  11. Therapeutic efficacy of nasal continuous positive airway pressure on patients with obstructive sleep apnea hypopnea syndrome complicated with hypertention and chronic heart failure%经鼻持续气道正压通气治疗高血压慢性心力衰竭伴重度阻塞性睡眠呼吸暂停低通气综合征患者的疗效分析

    Institute of Scientific and Technical Information of China (English)

    刘长河; 许青宗; 华娜; 迟相林

    2013-01-01

    目的:探讨经鼻持续气道正压通气(nCPAP)治疗高血压慢性心力衰竭(CHF)伴重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的临床疗效。方法入选高血压慢性心力衰竭伴重度OSAHS患者43例。随机分两组:接受nCPAP及常规药物治疗者23例为治疗组,只接受常规药物治疗者20例为对照组。治疗3个月。比较两组治疗前后心功能分级、血压、睡眠呼吸暂停低通气指数(AHI)、最长低通气时间、夜间平均血氧饱和度(SaO2)、左心室舒张末期内径(LVDd)、左心室射血分数(LVEF)及脑钠肽(BNP)的变化。结果治疗组的治疗总有效率明显高于对照组(P<0.05)。两组治疗后血压均显著下降(P<0.01),但治疗组血压下降更显著(P<0.05)。治疗组治疗后AHI、最长低通气时间、LVDd、BNP显著降低(P<0.05);夜间SaO2、LVEF显著提高(P<0.01)。对照组治疗后AHI、最长低通气时间、夜间平均SaO2、LVDd、LVEF无显著变化(P>0.05),BNP亦显著下降(P<0.05)。血压下降程度与BNP下降程度呈正相关趋势。结论对于高血压慢性心力衰竭伴重度OSAHS患者,nCPAP能有效改善心力衰竭症状,降低血压,改善睡眠呼吸暂停和低通气,纠正低氧血症,改善心功能。%Objective To investigate the clinical efficiency of nasal continuous positive airway pressure (nCPAP) therapy on patients with obstructive sleep apnea hypopnea syndrome complicated with hypertention and CHF. Methods Forty-three cases with OSAHS complicated with hypertention and CHF were randomly divided into treatment group (n=23) and control group (n=20). nCPAP and routine drug treatment were administered in the treatment group, while only routine drug treatment was given in the control group. Cardiac functional grading, blood pressure, apnea hypopnea index(AHI), maximum hypopnea time, mean night arterial oxygen saturation

  12. 无创正压通气在早产儿呼吸窘迫综合征治疗中的价值分析%Value Analysis of Noninvasive Positive Pressure Ventilation in the Treatment of Preterm Infants with Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    李梅君; 张红

    2014-01-01

    目的:分析鼻塞式持续正压通气(CPAP)在治疗早产儿呼吸窘迫综合征(NRDS)中的临床疗效,探讨持续呼吸道正压通气在早产儿呼吸窘迫综合征治疗中的价值。方法:在综合治疗基础上,对大理州妇幼保健院新生儿科2012年10月至2013年10月84例胎龄为32~36周的早产RDS患儿给予CPAP治疗,观察患儿在应用CPAP前及CPAP治疗6 h后的疗效。结果:实施CPAP通气6 h后,患儿青紫消失,吸气性呼吸困难减轻,呼吸频率降至(58.2±4.7)次/min,心率降至(142.8±9.4)次/min,吸入氧浓度为(42.0±7.3)%,而经皮血氧饱和度维持在(94.8±4.5)%,动脉血氧分压升至(8.7±0.7)kPa,动脉血二氧化碳分压降至(5.3±0.6)kPa,差异具有统计学意义。应用CPAP期间除2例病情加重改用有创机械通气外未发生其他明显并发症。结论:使用CPAP对早产儿RDS有较好疗效,且治疗时间越早,痊愈率、成功率越高,无明显副作用。值得基层医院推广使用。%Objective:To analyze clinical efficacy of nasal continuous positive airway pressure ventilation(CPAP)in the treatment of preterm infants with respiratory distress syndrome(NRDS)and explore the value of CPAP for NRDS preterm infants. Methods:Based on combined therapy, CPAP was adopted for 84 cases with RDS from Oct. 2012 to Oct. 2013 at the neonatal department of the Maternal and Child Health Care Hospital of Dali Prefecture with the neonatal gestation age between 32 and 36 weeks. The efficacy was observed before the adoption of CPAP and six hours after the adoption of CPAP. Results: Six hours after the adoption of CPAP, cyanosis disappeared, inspiratory dyspnea was alleviated, the respiratory rate dropped to (58.2 ± 4.7)/min, the heart rate dropped to (142.8 ± 9.4)/min, fraction of inspired oxygen was(42.0 ± 7.3)%, percutaneous oxygen saturation remained(94.8 ± 4.5)%, the arterial partial pressure of oxygen fell

  13. Estimation of airway obstruction using oximeter plethysmograph waveform data

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    Desmond Renee' A

    2005-06-01

    Full Text Available Abstract Background Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. Methods Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. Results There were significant relationships between maximal change in area under the curve (P Conclusion The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases.

  14. The Effects of Massage with Coconut and Sunflower Oils on Oxygen Saturation of Premature Infants with Respiratory Distress Syndrome Treated With Nasal Continuous Positive Airway Pressure

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    Sousan Valizadeh

    2012-11-01

    Full Text Available Introduction: Nowadays particular emphasis is placed on the developmental aspects of premature infants care. Massage therapy is one of the best-known methods of caring. Due to the minimal touch policy in neonatal intensive care units (NICUs, massaging is not usually performed on premature infants. However, there is not sufficient evidence to support the claim that newborn infants with complex medical conditions should not be massaged. This study aimed to determine the effects of massage with coconut and sunflower oils on oxygen saturation of infants with respiratory distress syndrome (RDS treated with nasal continuous positive airway pressure (NCPAP. Methods: This was a randomized controlled trial on 90 newborns who were admitted to Alzahra Hospital (Tabriz, Iran. The infants were divided into control and massage therapy groups (massage with coconut and sunflower oils. Data was collected using a hospital documentation form. A 15-minute daily massage was performed for 3 days. Respiratory rate (RR, fraction of inspired oxygen (FiO2 and oxygen saturation were measured 5 minutes before the massage, 3 times during the massage, and 5 minutes after the massage. The collected data was analyzed using a mixed model. Results: In comparison to coconut oil and control groups, mean oxygen saturation of sunflower oil group was improved. In addition, the coconut massage group showed lower oxygen saturation than the control group but was all values were within the normal range. Although massage decreased oxygen saturation, there was no need to increase FiO2. Conclusion: Massage therapy can provide developmental care for infants treated with NCPAP.

  15. Postoperative pharyngolaryngeal adverse events with laryngeal mask airway (LMA Supreme) in laparoscopic surgical procedures with cuff pressure limiting 25 cmH₂O: prospective, blind, and randomised study.

    Science.gov (United States)

    Kang, Joo-Eun; Oh, Chung-Sik; Choi, Jae Won; Son, Il Soon; Kim, Seong-Hyop

    2014-01-01

    To reduce the incidence of postoperative pharyngolaryngeal adverse events, laryngeal mask airway (LMA) manufacturers recommend maximum cuff pressures not exceeding 60 cmH₂O. We performed a prospective randomised study, comparing efficacy and adverse events among patients undergoing laparoscopic surgical procedures who were allocated randomly into low (limiting 25 cmH₂O, L group) and high (at 60 cmH₂O, H group) LMA cuff pressure groups with LMA Supreme. Postoperative pharyngolaryngeal adverse events were evaluated at discharge from postanaesthetic care unit (PACU) (postoperative day 1, POD 1) and 24 hours after discharge from PACU (postoperative day 2, POD 2). All patients were well tolerated with LMA without ventilation failure. Before pneumoperitoneum, cuff volume and pressure and oropharyngeal leak pressure (OLP) showed significant differences. Postoperative sore throat at POD 2 (3 versus 12 patients) and postoperative dysphagia at POD 1 and POD 2 (0 versus 4 patients at POD 1; 0 versus 4 patients at POD 2) were significantly lower in L group, compared with H group. In conclusion, LMA with cuff pressure limiting 25 cmH₂O allowed both efficacy of airway management and lower incidence of postoperative adverse events in laparoscopic surgical procedures. This clinical trial is registered with KCT0000334.

  16. Edema pulmonar assimétrico por pressão negativa pós-obstrução de via aérea superior: relato de caso Edema pulmonar asimétrico por presión negativa pós-obstrucción aguda de vía aérea superior: relato de caso Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report

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    Aldo José Peixoto

    2002-06-01

    ventilatorio con PEEP o CPAP, no necesitando de cualquier otra terapia. El pronóstico es bueno, con mejoría en la mayoría de los casos en las primeras 24 horas.BACKGROUND AND OBJECTIVES: Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, though infrequently diagnosed and reported. This report aimed at presenting a case of upper airway obstruction negative pressure pulmonary edema following acute upper airway obstruction characterized by pulmonary edema asymmetry, being more prominent in the right lung. CASE REPORT: A 4-year-old boy, 17 kg, phisical status ASA I submitted to combined tonsillectomy, adenoidectomy and turbinate cauterization under general anesthesia with sevoflurane/nitrous oxide/O2. Surgery duration was 90 minutes without complications. During anesthetic recovery and spontaneously breathing, patient reacted to tracheal tube, which was removed. Following, ventilatory efforts resulted in chest wall retraction without apparent air movement, being impossible to ventilate him with facial mask. Symptoms evolved to severe hypoxemia (50% SpO2 requiring reintubation. At this point, it was observed that the lung was stiffer and there were bilateral rales characterizing pulmonary edema. A chest X-ray showed diffuse bilateral infiltrates, right upper lobe atelectasis and marked pulmonary edema asymmetry (right greater than left. Patient was mechanically ventilated with PEEP for 20 hours when he was extubated. There was a progressive pulmonary edema improvement and patient was discharged 48 hours later. CONCLUSIONS: Negative pressure pulmonary edema (NPPE is a rare event with high morbidity risk. It is often not diagnosed and requires from the anesthesiologist an updated knowledge and adequate management. It is usually bilateral, rarely unilateral, and exceptionally asymmetric as in this case. Most cases are treated by mechanical ventilation with PEEP or CPAP without any other therapy. The prognosis is favorable, with most

  17. CPAP promotes timely cilium disassembly to maintain neural progenitor pool.

    Science.gov (United States)

    Gabriel, Elke; Wason, Arpit; Ramani, Anand; Gooi, Li Ming; Keller, Patrick; Pozniakovsky, Andrei; Poser, Ina; Noack, Florian; Telugu, Narasimha Swamy; Calegari, Federico; Šarić, Tomo; Hescheler, Jürgen; Hyman, Anthony A; Gottardo, Marco; Callaini, Giuliano; Alkuraya, Fowzan Sami; Gopalakrishnan, Jay

    2016-04-15

    A mutation in the centrosomal-P4.1-associated protein (CPAP) causes Seckel syndrome with microcephaly, which is suggested to arise from a decline in neural progenitor cells (NPCs) during development. However, mechanisms ofNPCs maintenance remain unclear. Here, we report an unexpected role for the cilium inNPCs maintenance and identifyCPAPas a negative regulator of ciliary length independent of its role in centrosome biogenesis. At the onset of cilium disassembly,CPAPprovides a scaffold for the cilium disassembly complex (CDC), which includes Nde1, Aurora A, andOFD1, recruited to the ciliary base for timely cilium disassembly. In contrast, mutatedCPAPfails to localize at the ciliary base associated with inefficientCDCrecruitment, long cilia, retarded cilium disassembly, and delayed cell cycle re-entry leading to premature differentiation of patientiPS-derivedNPCs. AberrantCDCfunction also promotes premature differentiation ofNPCs in SeckeliPS-derived organoids. Thus, our results suggest a role for cilia in microcephaly and its involvement during neurogenesis and brain size control.

  18. Upper airway collapsibility in anesthetized children.

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    Litman, Ronald S; McDonough, Joseph M; Marcus, Carole L; Schwartz, Alan R; Ward, Denham S

    2006-03-01

    We sought to establish the feasibility of measuring upper airway narrowing in spontaneously breathing, anesthetized children using dynamic application of negative airway pressure. A secondary aim was to compare differences in upper airway collapsibility after the administration of sevoflurane or halothane. Subjects were randomized to either drug for inhaled anesthetic induction. Each was adjusted to their 1 MAC value (0.9% for halothane and 2.5% for sevoflurane) and a blinded anesthesia provider held the facemask without performing manual airway opening maneuvers but with inclusion of an oral airway device. Inspiratory flows were measured during partial upper airway obstruction created by an adjustable negative pressure-generating vacuum motor inserted into the anesthesia circuit. Critical closing pressure of the pharynx (Pcrit) was obtained by plotting the peak inspiratory flow of the obstructed breaths against the corresponding negative pressure in the facemask and extrapolating to zero airflow using linear correlation. Fourteen children were enrolled, seven in each anesthetic group. Two children in the halothane group did not develop flow-limited airway obstruction despite negative pressures as low as -9 cm H2O. Pcrit for sevoflurane ranged from -6.7 to -11.6 (mean +/- sd, -9.8 +/- 1.9) cm H2O. Pcrit for halothane ranged from -8.1 to -33 (mean +/- sd, -19.4 +/- 9.3) cm H2O (sevoflurane versus halothane, P = 0.048). We conclude that when using dynamic application of negative airway pressure, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.

  19. Wire-guided (Seldinger technique) intubation through a face mask in urgent, difficult and grossly distorted airways.

    Science.gov (United States)

    Heier, Jake M; Schroeder, Kristopher M; Galgon, Richard E; Arndt, George A

    2012-07-01

    We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  20. Wire-guided (Seldinger technique intubation through a face mask in urgent, difficult and grossly distorted airways

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    Jake M Heier

    2012-01-01

    Full Text Available We report two cases of successful urgent intubation using a Seldinger technique for airway management through an anesthesia facemask, while maintaining ventilation in patients with difficult airways and grossly distorted airway anatomy. In both cases, conventional airway management techniques were predicted to be difficult or impossible, and a high likelihood for a surgical airway was present. This technique was chosen as it allows tracheal tube placement through the nares during spontaneous ventilation with the airway stented open and oxygen delivery with either continuous positive airway pressure and/or pressure support ventilation. This unhurried technique may allow intubation when other techniques are unsuitable, while maintaining control of the airway.

  1. Ventilación con liberación de presión en la vía aérea, en neonatos con insuficiencia respiratoria aguda Airway pressure release ventilation in newborns

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    Emmanuel Jiménez-Castro

    2013-06-01

    Full Text Available La ventilación con liberación de presión en la vía aérea (APRVes una modalidad ventilatoria que utiliza presión positiva controlada en la vía aérea, con el fin de maximizar el reclutamiento alveolar, con tiempos inspiratorios prolongados, permitiendo la respiración espontánea durante ambas fases del ciclo respiratorio. Los autores describen su experiencia en una serie de 12 casos con pacientes neonatales con insuficiencia respiratoria aguda, que fueron tratados con la APRV ventilación con liberación de presión en la vía aérea, cuando la oxigenación no mejoró con la ventilación de control de presión. La edad media de los pacientes fue de 13± 16,5 días. La fracción inspirada de oxígeno disminuyó de 62,9±23,6 cm H2O para la ventilación de control de presión, a 44±14,0 cm H2O, para la APRV. El promedio de presión parcial de oxígenoaumentó de 54,6 ± 11,9mmHg a 92±32mmH; el promedio de presión parcial de CO2 disminuyó de 53,2±15,6 mmHg a 43,1±10mmHg, y la presión pico de la vía aérea se redujo de 16,8±5,9cm H2O a 16,6±5,3 cm de H2O, respectivamente. La ventilación con liberación de presión en la vía aérea, puede mejorar la oxigenación en pacientes pediátricos con insuficiencia respiratoria aguda, cuando la ventilación mecánica convencional falla.Airway pressure release ventilation is a mechanical ventilation method that uses a controlled positive airway pressure in order to maximize alveolar recruitment, with prolonged inspiratory times, therefore allowing spontaneous breathing during both phases of the respiratory cycle. The authors describe their experience in twelve cases of newborn patients with acute respiratory failure treated with airway pressure release ventilation when oxygenation did not improve with pressure control ventilation. The mean age of patients was 13 ± 16.5 days. The fractional concentration of oxygen (FiO2 decreased from 62.9 ± 23.6 cmH2O for pressure control ventilation to 44

  2. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rashid M Khan

    2011-01-01

    Full Text Available Trauma has assumed epidemic proportion. 10% of global road accident deaths occur in India. Hypoxia and airway mismanagement are known to contribute up to 34% of pre-hospital deaths in these patients. A high degree of suspicion for actual or impending airway obstruction should be assumed in all trauma patients. Objective signs of airway compromise include agitation, obtundation, cyanosis, abnormal breath sound and deviated trachea. If time permits, one should carry out a brief airway assessment prior to undertaking definitive airway management in these patients. Simple techniques for establishing and maintaining airway patency include jaw thrust maneuver and/or use of oro- and nas-opharyngeal airways. All attempts must be made to perform definitive airway management whenever airway is compromised that is not amenable to simple strategies. The selection of airway device and route- oral or -nasal, for tracheal intubation should be based on nature of patient injury, experience and skill level.

  3. Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Sandeep Kumar Mishra

    2015-01-01

    Full Text Available Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left. The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation, lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA.

  4. Facial Pain Associated with CPAP Use: Intra-Sinusal Third Molar

    Directory of Open Access Journals (Sweden)

    Maxime Mermod

    2014-01-01

    Full Text Available Objective. This paper describes a patient with left hemifacial pain elicited by the use of a CPAP mask. Case Report. A 74-year-old man was referred with a history of pain in the left maxillary sinus related to the use of his CPAP interface, thereby prohibiting the use of the latter. Computed tomography revealed an intra-sinusal ectopic third molar in the left maxillary sinus floor corresponding to the painful area. After removal of the ectopic tooth under local anesthesia by a Caldwell-Luc approach, the patient was relieved of his symptoms. Conclusion. Although an ectopic tooth in the maxillary sinus is rare, this case points out the importance of actively looking for a regional problem if patients cannot tolerate the CPAP interface since this can lead to issues of incompliance and medical complications due to the untreated obstructive sleep apnoea syndrome.

  5. Initial Treatment of Respiratory Distress Syndrome with Nasal Intermittent Mandatory Ventilation versus Nasal Continuous Positive Airway Pressure: A Randomized Controlled Trial

    Science.gov (United States)

    Armanian, Amir-Mohammad; Badiee, Zohreh; Heidari, Ghobad; Feizi, Awat; Salehimehr, Nima

    2014-01-01

    Background: Neonatal respiratory distress syndrome (RDS) in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV) nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW) preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV) compared with early nasal continuous positive airway pressure (early NCPAP) obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. Methods: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks) with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. Results: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group). The Preventive power of MV of NIMV usage (95.5%) was not lower than the NCPAP (98.1%) strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66); P: 0.23). The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range) was 24 (18.00-48.00) h versus 48.00 (22.00-120.00) h in NIMV versus NCPAP groups; P < 0.001). Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range) was 96.00 (41.00-504.00) h versus144.00 (70.00-1130.00) h in NIMV versus NCPAP groups; P: 0.009). Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. Conclusions: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent

  6. Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Amir-Mohammad Armanian

    2014-01-01

    Full Text Available Background: Neonatal respiratory distress syndrome (RDS in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation (MV nowadays researchers in interested minimizing MV. To determine, in very low birth weight (BW preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation (early NIMV compared with early nasal continuous positive airway pressure (early NCPAP obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. Methods: In this single-center randomized control trial study, infants (BW ≤ 1500 g and/or gestational age ≤ 34 weeks with respiratory distress were considered eligible. Forty-four infants were randomly assigned to receive early-NIMV and 54 comparable infants to early-NCPAP. Surfactants were given, when FIO 2 requirement was of >30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. Results: 98 infants were enrolled (44 in the NIMV and 54 in the NCPAP group. The Preventive power of MV of NIMV usage (95.5% was not lower than the NCPAP (98.1% strength (hazard ratio: 0.21 (95% confidence interval: 0.02-2.66; P: 0.23. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP (the median (range was 24 (18.00-48.00 h versus 48.00 (22.00-120.00 h in NIMV versus NCPAP groups; P < 0.001. Similarly, the duration of dependency on oxygen was less, for NIMV (the median (range was 96.00 (41.00-504.00 h versus144.00 (70.00-1130.00 h in NIMV versus NCPAP groups; P: 0.009. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group. Conclusions: Initial treatment of RDS with NIMV was safe, and well tolerated. Furthermore, NIMV had excellent

  7. Airway distensibility in Chronic Obstructive Airway Disease

    DEFF Research Database (Denmark)

    Winkler Wille, Mathilde Marie; Pedersen, Jesper Holst; Dirksen, Asger

    2013-01-01

    -20% (mild), 20%-30% (moderate) or >30% (severe). Spirometry was performed annually and participants were divided into severity groups according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Data were analysed in a mixed effects regression model with log(airway lumen diameter......Rationale – Chronic Obstructive Pulmonary Disease (COPD) is a combination of chronic bronchitis and emphysema, which both may lead to airway obstruction. Under normal circumstances, airway dimensions vary as a function of inspiration level. We aim to study the influence of COPD and emphysema...... in causing airway narrowing, the latter most likely due to loss of elastic recoil of surrounding tissue....

  8. Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment.

    Directory of Open Access Journals (Sweden)

    Ernesto Kufoy

    Full Text Available INTRODUCTION: Obstructive Sleep Apnea (OSA is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. METHODS: Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR and heart rate variability (HRV were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. RESULTS: 39 patients (15 females, 24 males were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m(2 (31.83 males, 35.95 females. Our results showed that HRV (SDNN decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. CONCLUSIONS: These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once.

  9. 健康教育干预对阻塞性睡眠呼吸暂停低通气综合征患者CPAP治疗依从性Meta分析%Effect of Health Education on Improving CPAP Adherence in OSAHS Patients:A Meta Analysis

    Institute of Scientific and Technical Information of China (English)

    匡亚辉; 许燕玲; 易红良; 方芳

    2016-01-01

    目的:评价健康教育干预对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome, OSAHS)患者持续气道正压通气(continuous positive airway pressure, CPAP)治疗依从性的效果。方法检索 Cochrane Library、JBI循证数据库、PubMed、Medline、中国期刊全文数据库和维普数据库,搜集阻塞性睡眠呼吸暂停低通气综合征患者 CPAP治疗相关健康教育干预随机对照试验,各数据库检索时限均为建库至2015年3月8日。由2名研究员按照纳入和排除标准筛选文献、提取资料、评价质量,采用RevMan 5.2进行Meta分析。结果共纳入6项随机对照试验进行 Meta分析,且纳入的文章质量均较高, Meta分析显示,健康教育干预可提高阻塞性睡眠呼吸暂停低通气综合征患者1个月末[RR=1.45,95%CI(1.19,1.75),P=0.00],3个月末[RR=1.51,95%CI(1.18,1.93),P=0.00]及6个月及以上[RR=1.31,95%CI(1.10,1.57),P=0.00]CPAP治疗依从性,差异具有统计学意义。结论健康教育干预能提高阻塞性睡眠呼吸暂停低通气综合征患者CPAP治疗依从性。%Objective To evaluate the effect of health education on improving CPAP adherence in patients living with OSAHS. Methods We searched The Cochrane Library, The Joanna Briggs Institute Library, PubMed, Medline, CNKI and VIP to collect randomized controlled trials from the establishment of the databases to March 8th 2015. The studies were selected according to the inclusion and exclusion criteria and were critically appraised by two reviewers. Then the data of included studies were extracted. Meta-analysis was conducted by using RevMan 5.2 software. Results Six trials were included and results of meta-analysis showed that different patterns of health education in 1 month [RR=1.45,95%CI(1.19,1.75), P=0.00], 3 months [RR=1.51, 95%CI(1.18,1.93), P=0.00], 6 months and more [RR=1.31, 95%CI(1.10,1.57), P=0.00] to improve CPAP

  10. CPAP em selo d'água versus CPAP com fluxo variável em recém-nascidos com desconforto respiratório: um ensaio controlado randomizado

    Directory of Open Access Journals (Sweden)

    Ana Cristina Zanon Yagui

    2011-12-01

    Full Text Available OBJETIVO: Avaliar a eficácia e segurança da pressão positiva contínua na via aérea (CPAP utilizando aparelhos de fluxo variável e fluxo contínuo em selo d'água, quanto a falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio e tempo de internação em unidade de terapia intensiva e hospitalar em neonatos com desconforto respiratório (DR moderado e peso de nascimento (PN > 1.500 g. MÉTODOS: Quarenta recém-nascidos que necessitavam de CPAP foram randomizados em dois grupos: um grupo tratado com fluxo variável (FV e outro com fluxo contínuo (FC. O estudo foi realizado entre outubro de 2008 e abril de 2010. Foram registrados dados demográficos, falha do CPAP, ocorrência de escape de ar, tempo de uso de CPAP e de oxigênio, entre outros. Os desfechos categóricos foram analisados com o teste do qui-quadrado ou exato de Fisher e as variáveis contínuas com o teste de Mann-Whitney, com significância de p 1.500 g e DR moderado, o CPAP nasal com fluxo contínuo apresentou os mesmos benefícios do CPAP nasal com fluxo variável.

  11. The laryngeal mask airway at altitude.

    Science.gov (United States)

    Wilson, Grant D; Sittig, Steven E; Schears, Gregory J

    2008-02-01

    The Laryngeal Mask Airway (LMA) is an accepted adjunct for airway management in emergency patients. There are a number of case reports describing its use in transport medicine for infant to adult patients, including during flight. Although studies of the effect altitude has on air-filled tracheal tubes exists, we were unable to find documentation of the effect of altitude on laryngeal mask airways. Our objective was to assess the effect of altitude on the LMA in both fixed wing and rotary wing models. We performed an in vitro study of the effect of altitude on the LMA cuff. Infant and adult airway trainer mannequins with properly sized and inserted LMA-Classic laryngeal mask airways were monitored for cuff pressure changes while flown at altitudes commonly encountered during air medical transport. Both models demonstrated that LMA cuff pressures may exceed manufacturer recommended levels for safe use even at the relatively low altitudes experienced during rotor wing flight. Properly inserted and inflated laryngeal mask airways at ground level may result in overinflated LMA cuffs when flown to altitudes commonly used for rotor and fixed wing medical transport unless monitored and corrected.

  12. Engineering Airway Epithelium

    Directory of Open Access Journals (Sweden)

    John P. Soleas

    2012-01-01

    Full Text Available Airway epithelium is constantly presented with injurious signals, yet under healthy circumstances, the epithelium maintains its innate immune barrier and mucociliary elevator function. This suggests that airway epithelium has regenerative potential (I. R. Telford and C. F. Bridgman, 1990. In practice, however, airway regeneration is problematic because of slow turnover and dedifferentiation of epithelium thereby hindering regeneration and increasing time necessary for full maturation and function. Based on the anatomy and biology of the airway epithelium, a variety of tissue engineering tools available could be utilized to overcome the barriers currently seen in airway epithelial generation. This paper describes the structure, function, and repair mechanisms in native epithelium and highlights specific and manipulatable tissue engineering signals that could be of great use in the creation of artificial airway epithelium.

  13. Impact of airway morphological changes on pulmonary flows in scoliosis

    Science.gov (United States)

    Farrell, James; Garrido, Enrique; Valluri, Prashant

    2016-11-01

    The relationship between thoracic deformity in scoliosis and lung function is poorly understood. In a pilot study, we reviewed computed tomography (CT) routine scans of patients undergoing scoliosis surgery. The CT scans were processed to segment the anatomy of the airways, lung and spine. A three-dimensional model was created to study the anatomical relationship. Preliminary analysis showed significant airway morphological differences depending on the anterior position of the spine. A computational fluid dynamics (CFD) study was also conducted on the airway geometry using the inspiratory scans. The CFD model assuming non-compliant airway walls was capable of showing pressure drops in areas of high airway resistance, but was unable to predict regional ventilation differences. Our results indicate a dependence between the dynamic deformation of the airway during breathing and lung function. Dynamic structural deformation must therefore be incorporated within any modelling approaches to guide clinicians on the decision to perform surgical correction of the scoliosis.

  14. Airway management in trauma

    Directory of Open Access Journals (Sweden)

    Rao B

    2004-01-01

    Full Text Available Airway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

  15. Randomized crossover comparison of the laryngeal mask airway classic with i-gel laryngeal mask airway in the management of difficult airway in post burn neck contracture patients

    Directory of Open Access Journals (Sweden)

    Jeevan Singh

    2012-01-01

    Full Text Available Purpose: The objective of the study was to compare the performance of i-gel supraglottic airway with cLMA in difficult airway management in post burn neck contracture patients and assess the feasibility of i-gel use for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening. Methods: Prospective, crossover, randomized controlled trial was performed amongst forty eight post burn neck contracture patients with limited mouth opening and neck movement. i-gel and cLMA were placed in random order in each patient. Primary outcome was overall success rate. Other measurements were time to successful ventilation, airway leak pressure, fiberoptic glottic view, visualization of square wave pattern. Results: Success rate for the i-gel was 91.7% versus 79.2% for the cLMA. i-gel required shorter insertion time (19.3 seconds vs. 23.5 seconds, P=0.000. Airway leak pressure difference was statistically significant (i-gel 21.2 cm H20; cLMA 16.9 cm H 2 0; P=0.00. Fiberoptic view through the i-gel showed there were less epiglottic downfolding and better fiberoptic view of the glottis than cLMA. Overall agreement in insertion outcome for i-gel was 22/24 (91.7% successes and 2/24(8.3% failure and for cLMA, 19/24 (79.16% successes and 5/24 (16.7% failure in the first attempt. Conclusion: The i-gel is cheap, effective airway device which is easier to insert and has better clinical performance in the difficult airway management of the airway in the post burn contracture of the neck. Our study shows that i-gel is feasible for emergency airway management in difficult airway situation with reduced neck movement and limited mouth opening in post burn neck.

  16. Elective use of the Ventrain for upper airway obstruction during high-frequency jet ventilation.

    Science.gov (United States)

    Fearnley, Robert A; Badiger, Sheela; Oakley, Richard J; Ahmad, Imran

    2016-09-01

    The safety of high pressure source ventilation (jet ventilation) is dependent upon upper airway patency to facilitate adequate passive expiration and prevent increasing intrathoracic pressure and its associated deleterious sequelae. Distortions in airway anatomy may make passive expiration inadequate or impossible in some patients. We report the elective use of the Ventrain device to provide ventilation in a clinical setting of upper airway obstruction in a patient with post radiation fibrosis that had previously prevented passive expiration during attempted high pressure source ventilation.

  17. Indirect airway challenges

    NARCIS (Netherlands)

    Joos, GF; O'Connor, B; Anderson, SD; Chung, F; Cockcroft, DW; Dahlen, B; DiMaria, G; Foresi, A; Hargreave, FE; Holgate, ST; Inman, M; Lotvall, J; Magnussen, H; Polosa, R; Postma, DS; Riedler, J

    2003-01-01

    Indirect challenges act by causing the release of endogenous mediators that cause the airway smooth muscle to contract. This is in contrast to the direct challenges where agonists such as methacholine or histamine cause airflow limitation predominantly via a direct effect on airway smooth muscle. Di

  18. Pediatric airway nightmares.

    Science.gov (United States)

    D'Agostino, James

    2010-02-01

    Pediatric disorders that involve actual or potential airway compromise are among the most challenging cases that emergency department providers face. This article discusses the diagnosis and management of common and uncommon conditions in infants and children who may present with airway obstruction.

  19. Upper airway resistance syndrome.

    Science.gov (United States)

    Montserrat, J M; Badia, J R

    1999-03-01

    This article reviews the clinical picture, diagnosis and management of the upper airway resistance syndrome (UARS). Presently, there is not enough data on key points like the frequency of UARS and the morbidity associated with this condition. Furthermore, the existence of LIARS as an independent sleep disorder and its relation with snoring and obstructive events is in debate. The diagnosis of UARS is still a controversial issue. The technical limitations of the classic approach to monitor airflow with thermistors and inductance plethysmography, as well as the lack of a precise definition of hypopnea, may have led to a misinterpretation of UARS as an independent diagnosis from the sleep apnea/hypopnea syndrome. The diagnosis of this syndrome can be missed using a conventional polysomnographic setting unless appropriate techniques are applied. The use of an esophageal balloon to monitor inspiratory effort is currently the gold standard. However, other sensitive methods such as the use of a pneumotachograph and, more recently, nasal cannula/pressure transducer systems or on-line monitoring of respiratory impedance with the forced oscillation technique may provide other interesting possibilities. Recognition and characterization of this subgroup of patients within sleep breathing disorders is important because they are symptomatic and may benefit from treatment. Management options to treat UARS comprise all those currently available for sleep apnea/hypopnea syndrome (SAHS). However, the subset of patients classically identified as LIARS that exhibit skeletal craneo-facial abnormalities might possibly obtain further benefit from maxillofacial surgery.

  20. THE INFLUENCE OF SLEEP APNOEA SYNDROME ON AMBULATORY BLOOD PRESSURE%睡眠呼吸暂停综合征对血压的影响

    Institute of Scientific and Technical Information of China (English)

    贾海玉; 牛云枫; 曹中朝

    2011-01-01

    Objective;To investigate the influence of sleep apnoea syndrome(SAS) on 24 - hour ambulatory blood pressure (ABP) in order to provide evidence in hypertension treatment with nasal continuous positive airway pressure (nCPAP) in SAS patients. Methods; 30 SAS patients with no cardiovascular complication and 30 normal volunteers were enrolled in the study. Polysomography (PSG) during sleep,24 hours ABP and some vasoactive substances, nitric oxide (NO) and endothelin (ET) , were monitored in SAS and control groups before and after nCPAP treatment. Results: Before the treatment, ET, dMSP, RDI, LAT, nMSP, dMDP, nMDP, dMAP and nMAP were higher in SAS patients compared with the controls;however, NO, NO/ET and LSaO2 were lower than that of the controls.. Except for dMSP, all other parameters were improved after nCPAP. Conclutions: SAS patients may have the tendency of hypertension which can be prevented and treated with nCPAP.%目的:探讨睡眠呼吸暂停综合征(SAS)对24h动态血压的影响,为经鼻持续气道正压通气(nCPAP)治疗SAS引起的高血压提供依据.方法:选择无心血管疾病的SAS病人和正常对照组各30例进行多导睡眠图(PSG)、24h动态血压(ABPM)及血管活性物质一氧化氮(NO)和内皮素(ET)的监测;同时对SAS病人施以nC-PAP治疗,并进行上述指标的监测.结果:nCPAP治疗前,SAS病人ET、白天平均收缩压(dMSP)高于正常对照(P<0.05);呼吸紊乱指数(RDI)、最长呼吸暂停时间(LAT)、夜间平均收缩压(nMSP)、白天平均舒张压(dMDP)、夜间平均舒张压(nMDP)、白天平均动脉压(dMAP)、夜间平均动脉压(nMAP)明显高于正常对照(P<0.01);24h血压曲线呈非勺型;NO低于正常对照(P<0.05);NO/ET、最低血氧饱和度(LSaO2)较正常对照明显降低(P<0.01);SAS病人dMAP、nMAP与LSaO2呈负相关(Beta=-0.561 P<0.05;Beta=-0.388 P<0.05),RDI与nMAP呈显著正相关(Beta =0.512 P<0.01).nCPAP治疗后,除dMSP无变化外(P>0.05),上

  1. Compliance Measurements of the Upper Airway in Pediatric Down Syndrome Sleep Apnea Patients.

    Science.gov (United States)

    Subramaniam, Dhananjay Radhakrishnan; Mylavarapu, Goutham; McConnell, Keith; Fleck, Robert J; Shott, Sally R; Amin, Raouf S; Gutmark, Ephraim J

    2016-04-01

    Compliance of soft tissue and muscle supporting the upper airway are two of several factors contributing to pharyngeal airway collapse. We present a novel, minimally invasive method of estimating regional variations in pharyngeal elasticity. Magnetic resonance images for pediatric sleep apnea patients with Down syndrome [9.5 ± 4.3 years (mean age ± standard deviation)] were analyzed to segment airways corresponding to baseline (no mask pressure) and two positive pressures. A three dimensional map was created to evaluate axial and circumferential variation in radial displacements of the airway, dilated by the positive pressures. The displacements were then normalized with respect to the appropriate transmural pressure and radius of an equivalent circle to obtain a measure of airway compliance. The resulting elasticity maps indicated the least and most compliant regions of the pharynx. Airway stiffness of the most compliant region [403 ± 204 (mean ± standard deviation) Pa] decreased with severity of obstructive sleep apnea. The non-linear response of the airway wall to continuous positive airway pressure was patient specific and varied between anatomical locations. We identified two distinct elasticity phenotypes. Patient phenotyping based on airway elasticity can potentially assist clinical practitioners in decision making on the treatments needed to improve airway patency.

  2. 带固定新生儿鼻塞CPAP管道的小改良%A nursing study of neonates nasal CPAP fixed with bandage

    Institute of Scientific and Technical Information of China (English)

    谭维玉; 谢庆玲; 李柳青; 唐晓燕; 孙艺; 韦玉华

    2011-01-01

    Objective:To observe the effect of neonates nasal CPAP fixed with bandage. Methods:The 75 neonates' nasal CPAP were fixed with bandage. Results:The neonates' nasal CPAP were fixed well, the presure of CPAP is steady. Conclusion: The method of neonates nasal CPAP fixed with bandage well worked and provided operation . It is worthwhile for clinical use.%目的:探讨绷带固定新生儿鼻塞CPAP管道的效果.方法:对75例新生儿鼻塞CPAP管道用绷带固定.结果:管道固定效果好,压力稳定.结论:绷带固定新生儿鼻塞CPAP管道获得较好效果,操作简便,值得临床上推广.

  3. Emergency airway puncture - slideshow

    Science.gov (United States)

    ... presentations/100113.htm Emergency airway puncture - series—Normal anatomy To ... larynx is a tubular structure in the neck, through which air passes to the lungs. The thryoid and cricoid cartilage form the narrowest ...

  4. Emergency airway puncture

    Science.gov (United States)

    ... inserted into the throat, just below the Adam's apple (cricoid cartilage), into the airway. In a hospital, ... Choking Browse the Encyclopedia A.D.A.M., Inc. is accredited by URAC, also known as the ...

  5. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  6. 自动调节压力和固定压力持续正压通气呼吸机在阻塞性睡眠呼吸暂停低通气综合征治疗中的对比研究%A contrast study of auto-titrating continuous positive airway pressure and fixed continuous positive airway pressure in obstructive sleep apnea hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    许艳; 陈春

    2009-01-01

    目的 观察自动调节压力持续正压通气呼吸机(A-CPAP)和固定压力持续正压通气呼吸机(F-CPAP)在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)中平均压力的对比.方法 选择100例诊断为OSAHS的患者随机单盲分成两组,分别使用A-CPAP和F-CPAP呼吸机,观察治疗前后的平均血氧饱和度,以及两种呼吸机的平均压力值.结果 两组呼吸机治疗前后的平均血氧饱和度明显升高(P<0.01),A-CPAP治疗组平均压力较低,差异有统计学意义(P<0.01).结论 A-CPAP和F-CPAP呼吸机在治疗OSAHS中均有明显疗效,A-CPAP有更好的舒适性和耐受性.

  7. Modeling the dynamics of airway constriction: effects of agonist transport and binding.

    Science.gov (United States)

    Amin, Samir D; Majumdar, Arnab; Frey, Urs; Suki, Béla

    2010-08-01

    Recent advances have revealed that during exogenous airway challenge, airway diameters cannot be adequately predicted by their initial diameters. Furthermore, airway diameters can also vary greatly in time on scales shorter than a breath. To better understand these phenomena, we developed a multiscale model that allowed us to simulate aerosol challenge in the airways during ventilation. The model incorporates agonist-receptor binding kinetics to govern the temporal response of airway smooth muscle contraction on individual airway segments, which, together with airway wall mechanics, determines local airway caliber. Global agonist transport and deposition are coupled with pressure-driven flow, linking local airway constrictions with global flow dynamics. During the course of challenge, airway constriction alters the flow pattern, redistributing the agonist to less constricted regions. This results in a negative feedback that may be a protective property of the normal lung. As a consequence, repetitive challenge can cause spatial constriction patterns to evolve in time, resulting in a loss of predictability of airway diameters. Additionally, the model offers new insights into several phenomena including the intra- and interbreath dynamics of airway constriction throughout the tree structure.

  8. Indication of CPAP in Patients with Suspected Obstructive Sleep Apnea, Based on Clinical Parameters and a Novel Two-Channel Recording Device (ApneaLink: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Nigro

    2012-01-01

    Full Text Available Objective. To evaluate the accuracy and reliability of the medical decision based on the results of the hand scoring from a two-channel recording device (ApneaLink plus clinical data for the prescription of a CPAP assay in patients with suspected OSA. Methods. 39 subjects were assessed in the sleep laboratory with polysomnography and ApneaLink. The patients completed the Epworth sleepiness scale and a clinical history. Two blinded independent observers decided to prescribe CPAP according to the results of the PSG (gold standard, observer A, ApneaLink (alternative method, observer B, and the clinical parameters. Sensitivity and specificity of observer B on the indication of CPAP were calculated. The interobserver agreement for the indication of CPAP was assessed using kappa statistics. Results. 38 subjects were included (26 men, mean age 47.5, mean RDI 28.7, mean BMI 31.4 kg/m2. The prevalence of OSA was 84%. The sensitivity and specificity of observer B to initiate a CPAP trial were 90.6% and 100%, respectively. The interrater agreement for the prescription of CPAP was good (kappa: 0.75. Conclusion. This study has shown that the use of ApneaLink plus clinical data has made it possible to indicate CPAP reliably in most patients with high-clinical pretest for OSA.

  9. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    NARCIS (Netherlands)

    Bousquet, J.; Addis, A.; Adcock, I.; Agache, I.; Agusti, A.; Alonso, A.; Annesi-Maesano, I.; Anto, J. M.; Bachert, C.; Baena-Cagnani, C. E.; Bai, C.; Baigenzhin, A.; Barbara, C.; Barnes, P. J.; Bateman, E. D.; Beck, L.; Bedbrook, A.; Bel, E. H.; Benezet, O.; Bennoor, K. S.; Benson, M.; Bernabeu-Wittel, M.; Bewick, M.; Bindslev-Jensen, C.; Blain, H.; Blasi, F.; Bonini, M.; Bonini, S.; Boulet, L. P.; Bourdin, A.; Bourret, R.; Bousquet, P. J.; Brightling, C. E.; Briggs, A.; Brozek, J.; Buh, R.; Bush, A.; Caimmi, D.; Calderon, M.; Calverley, P.; Camargos, P. A.; Camuzat, T.; Canonica, G. W.; Carlsen, K. H.; Casale, T. B.; Cazzola, M.; Sarabia, A. M. Cepeda; Cesario, A.; Chen, Y. Z.; Chkhartishvili, E.; Chavannes, N. H.; Chiron, R.; Chuchalin, A.; Chung, K. F.; Cox, L.; Crooks, G.; Crooks, M. G.; Cruz, A. A.; Custovic, A.; Dahl, R.; Dahlen, S. E.; De Blay, F.; Dedeu, T.; Deleanu, D.; Demoly, P.; Devillier, P.; Didier, A.; Dinh-Xuan, A. T.; Djukanovic, R.; Dokic, D.; Douagui, H.; Dubakiene, R.; Eglin, S.; Elliot, F.; Emuzyte, R.; Fabbri, L.; Wagner, A. Fink; Fletcher, M.; Fokkens, W. J.; Fonseca, J.; Franco, A.; Frith, P.; Furber, A.; Gaga, M.; Garces, J.; Garcia-Aymerich, J.; Gamkrelidze, A.; Gonzales-Diaz, S.; Gouzi, F.; Guzman, M. A.; Haahtela, T.; Harrison, D.; Hayot, M.; Heaney, L. G.; Heinrich, J.; Hellings, P. W.; Hooper, J.; Humbert, M.; Hyland, M.; Iaccarino, G.; Jakovenko, D.; Jardim, J. R.; Jeandel, C.; Jenkins, C.; Johnston, S. L.; Jonquet, O.; Joos, G.; Jung, K. S.; Kalayci, O.; Karunanithi, S.; Keil, T.; Khaltaev, N.; Kolek, V.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Le, L. T.; Carlsen, K. C. Lodrup; Louis, R.; MacNee, W.; Mair, A.; Majer, I.; Manning, P.; Keenoy, E. de Manuel; Masjedi, M. R.; Meten, E.; Melo-Gomes, E.; Menzies-Gow, A.; Mercier, G.; Mercier, J.; Michel, J. P.; Miculinic, N.; Mihaltan, F.; Milenkovic, B.; Molimard, M.; Mamas, I.; Montilla-Santana, A.; Morais-Almeida, M.; Morgan, M.; N'Diaye, M.; Nafti, S.; Nekam, K.; Neou, A.; Nicod, L.; O'Hehir, R.; Ohta, K.; Paggiaro, P.; Palkonen, S.; Palmer, S.; Papadopoulos, N. G.; Papi, A.; Passalacqua, G.; Pavord, I.; Pigearias, B.; Plavec, D.; Postma, D. S.; Price, D.; Rabe, K. F.; Pontal, F. Radier; Redon, J.; Rennard, S.; Roberts, J.; Robine, J. M.; Roca, J.; Roche, N.; Rodenas, F.; Roggeri, A.; Rolland, C.; Rosado-Pinto, J.; Ryan, D.; Samolinski, B.; Sanchez-Borges, M.; Schunemann, H. J.; Sheikh, A.; Shields, M.; Siafakas, N.; Sibille, Y.; Similowski, T.; Small, I.; Sola-Morales, O.; Sooronbaev, T.; Stelmach, R.; Sterk, P. J.; Stiris, T.; Sud, P.; Tellier, V.; To, T.; Todo-Bom, A.; Triggiani, M.; Valenta, R.; Valero, A. L.; Valiulis, A.; Valovirta, E.; Van Ganse, E.; Vandenplas, O.; Vasankari, T.; Vestbo, J.; Vezzani, G.; Viegi, G.; Visier, L.; Vogelmeier, C.; Vontetsianos, T.; Wagstaff, R.; Wahn, U.; Wallaert, B.; Whalley, B.; Wickman, M.; Williams, D. M.; Wilson, N.; Yawn, B. P.; Yiallouros, P. K.; Yorgancioglu, A.; Yusuf, O. M.; Zar, H. J.; Zhong, N.; Zidarn, M.; Zuberbier, T.

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will ad

  10. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy. Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change...

  11. Comparison of Supreme Laryngeal Mask Airway and ProSeal Laryngeal Mask Airway during Cholecystectomy

    OpenAIRE

    2012-01-01

    Objective: This study compared the safety and efficacy of the Supreme Laryngeal Mask Airway (S-LMA) with that of the ProSeal-LMA (P-LMA) in laparoscopic cholecystectomy.Material and Methods: Sixty adults were randomly allocated. Following anaesthesia induction, experienced LMA users inserted the airway devices. Results: Oropharyngeal leak pressure was similar in groups (S-LMA, 27.8±2.9 cmH20; P-LMA, 27.0±4.7 cmH20; p=0.42) and did not change during the induction of and throughout pneumoperit...

  12. CPAP联合肺表面活性物质治疗早产儿呼吸困难疗效观察%Efficacy Observation on CPAP Combined with Pulmonary Surfactant for Dyspnea of Premature Infant

    Institute of Scientific and Technical Information of China (English)

    陈跃宣

    2015-01-01

    目的:探讨持续气道正压通气(CPAP)联合肺表面活性物质(珂立苏)治疗早产儿呼吸窘迫综合征(NRDS)的疗效。方法:36例呼吸困难早产儿早期均采用CPAP联合珂立苏肺表面活性物质治疗,观察患儿治疗前后的CPAP参数及临床症状的变化。结果:33例患儿治疗后呼吸困难状况得到明显改善,X线片亦显示病情明显好转;治疗2小时后,患儿的FiO2、PEEP均较治疗前显著改善(P<0.05)。结论:CPAP联合肺表面活性物质早期治疗NRDS早产儿疗效显著,可减少并发症的发生,且对胎龄<32周的早产儿疗效更佳。%Objective:To investigate the efficacy of continuous positive-pressure ventilation (CPAP) combined with pulmonary surfactant (Calsurf) for neonatal respiratory distress syndrome (NRDS). Methods:36 cases of premature infants with NRDS were all treated by CPAP combined with Cal-surf, observed the change of CPAP parameters and clinlcal symptoms before and after treatment. Results:After treatment, the dyspnea status in 33 cases of children had significantly improved, the X ray also showed that their illness had significantly turned better;2 hours after treatment, com-pared with those of before treatment, the FiO2 and PEEP of all of the children had significantly improved (P<0.05). Conclusion:The treatment of CPAP combined with pulmonary surfactant has significant curative effect on premature infants with NRDS, which can reduce the occurrence of com-plications, and the efficacy would be better if the age of premature infant is less than 32 weeks.

  13. CPAP Tips

    Medline Plus

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  14. CPAP Tips

    Medline Plus

    Full Text Available ... Sign in Share More Report Need to report the video? Sign in to report inappropriate content. Sign ... your opinion count. Sign in Loading... Loading... Transcript The interactive transcript could not be loaded. Loading... Loading... ...

  15. Airway reconstruction in children

    Directory of Open Access Journals (Sweden)

    Rao Sanjay

    2009-01-01

    Full Text Available Aim/Background : Airway anomalies are infrequent but potentially life threatening in children. A program to care for these difficult children was set up at our institution, and this paper summarizes our experience. Methods: A total of 34 children were enrolled in the program over a period of three years. These children were evaluated as per the standard protocols. Treatment was individualized. Results: Of these 34 children, 28 had their airways restored and are doing well. Four children continue to remain on tracheostomy and two will require long term tracheostomy. There were two deaths. All children are under surveillance as there is a risk of recurrence. Conclusions: Airway anomalies are complex problems with significant morbidity and mortality. Current therapeutic modalities allow for good results. Most children were successfully decannulated and did well.

  16. Paediatric airway management: basic aspects

    DEFF Research Database (Denmark)

    Holm-Knudsen, R J; Rasmussen, L S

    2009-01-01

    . Airway obstruction can be avoided by paying close attention to the positioning of the head of the child and by keeping the mouth of the child open during mask ventilation. The use of oral and nasopharyngeal airways, laryngeal mask airways, and cuffed endotracheal tubes is discussed with special reference...... to the circumstances in infants. A slightly different technique during laryngoscopy is suggested. The treatment of airway oedema and laryngospasm is described....

  17. Flow characteristics in the airways of a COPD patient with a saber-sheath trachea

    Science.gov (United States)

    Jin, Dohyun; Choi, Haecheon; Lee, Changhyun; Choi, Jiwoong; Kim, Kwanggi

    2016-11-01

    The chronic obstructive pulmonary disease (COPD) is a lung disease characterized by the irreversible airflow limitation caused by the damaged small airways and air sacs. Although COPD is not a disease of the trachea, many patients with COPD have saber-sheath tracheas. The effects of this morphological change in the trachea geometry on airflow are investigated in the present study. An unstructured finite volume method is used for the simulations during tidal breathing in normal and COPD airways, respectively. During inspiration, local large pressure drop is observed in the saber-sheath region of the COPD patient. During expiration, vortical structures are observed at the right main bronchus of the COPD airway, while the flow in the normal airway remains nearly laminar. High wall shear stress exists at convex regions of both airways during inspiration and expiration. However, due to the morphological changes in the COPD airway, relatively higher wall shear stress is observed in the patient airways.

  18. Airway Clearance Devices for Cystic Fibrosis

    Science.gov (United States)

    2009-01-01

    Executive Summary Objective The purpose of this evidence-based analysis is to examine the safety and efficacy of airway clearance devices (ACDs) for cystic fibrosis and attempt to differentiate between devices, where possible, on grounds of clinical efficacy, quality of life, safety and/or patient preference. Background Cystic fibrosis (CF) is a common, inherited, life-limiting disease that affects multiple systems of the human body. Respiratory dysfunction is the primary complication and leading cause of death due to CF. CF causes abnormal mucus secretion in the airways, leading to airway obstruction and mucus plugging, which in turn can lead to bacterial infection and further mucous production. Over time, this almost cyclical process contributes to severe airway damage and loss of respiratory function. Removal of airway secretions, termed airway clearance, is thus an integral component of the management of CF. A variety of methods are available for airway clearance, some requiring mechanical devices, others physical manipulation of the body (e.g. physiotherapy). Conventional chest physiotherapy (CCPT), through the assistance of a caregiver, is the current standard of care for achieving airway clearance, particularly in young patients up to the ages of six or seven. CF patients are, however, living much longer now than in decades past. The median age of survival in Canada has risen to 37.0 years for the period of 1998-2002 (5-year window), up from 22.8 years for the 5-year window ending in 1977. The prevalence has also risen accordingly, last recorded as 3,453 in Canada in 2002, up from 1,630 in 1977. With individuals living longer, there is a greater need for independent methods of airway clearance. Airway Clearance Devices There are at least three classes of airway clearance devices: positive expiratory pressure devices (PEP), airway oscillating devices (AOD; either handheld or stationary) and high frequency chest compression (HFCC)/mechanical percussion (MP

  19. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway.

    Science.gov (United States)

    Isono, Shiroh

    2012-01-01

    Epidemiological evidence suggests there are significant links between obesity and obstructive sleep apnoea (OSA), with a particular emphasis on the importance of fat distribution in the development of OSA. In patients with OSA, the structure of the pharyngeal airway collapses. A collapsible tube within a rigid box collapses either due to decreased intraluminal pressure or increased external tissue pressure (i.e. reduction in transmural pressure), or due to reduction in the longitudinal tension of the tube. Accordingly, obesity should structurally increase the collapsibility of the pharyngeal airway due to excessive fat deposition at two distinct locations. In the pharyngeal airway region, excessive soft tissue for a given maxillomandibular enclosure size (upper airway anatomical imbalance) can increase tissue pressure surrounding the pharyngeal airway, thereby narrowing the airway. Even mild obesity may cause anatomical imbalance in individuals with a small maxilla and mandible. Lung volume reduction due to excessive central fat deposition may decrease longitudinal tracheal traction forces and pharyngeal wall tension, changing the 'tube law' in the pharyngeal airway (lung volume dependence of the upper airway). The lung volume dependence of pharyngeal airway patency appears to contribute more significantly to the development of OSA in morbidly obese, apnoeic patients. Neurostructural interactions required for stable breathing may be influenced by obesity-related hormones and cytokines. Accumulating evidence strongly supports these speculations, but further intensive research is needed.

  20. Distinct PKA and Epac compartmentalization in airway function and plasticity

    NARCIS (Netherlands)

    Dekkers, Bart G. J.; Racke, Kurt; Schmidt, Martina

    2013-01-01

    Asthma and chronic obstructive pulmonary disease (COPD) are obstructive lung diseases characterized by airway obstruction, airway inflammation and airway remodelling. Next to inflammatory cells and airway epithelial cells, airway mesenchymal cells, including airway smooth muscle cells and (myo)fibro

  1. Conserved TCP domain of Sas-4/CPAP is essential for pericentriolar material tethering during centrosome biogenesis.

    Science.gov (United States)

    Zheng, Xiangdong; Gooi, Li Ming; Wason, Arpit; Gabriel, Elke; Mehrjardi, Narges Zare; Yang, Qian; Zhang, Xingrun; Debec, Alain; Basiri, Marcus L; Avidor-Reiss, Tomer; Pozniakovsky, Andrei; Poser, Ina; Saric, Tomo; Hyman, Anthony A; Li, Haitao; Gopalakrishnan, Jay

    2014-01-21

    Pericentriolar material (PCM) recruitment to centrioles forms a key step in centrosome biogenesis. Deregulation of this process leads to centrosome aberrations causing disorders, one of which is autosomal recessive primary microcephaly (MCPH), a neurodevelopmental disorder where brain size is reduced. During PCM recruitment, the conserved centrosomal protein Sas-4/CPAP/MCPH6, known to play a role in centriole formation, acts as a scaffold for cytoplasmic PCM complexes to bind and then tethers them to centrioles to form functional centrosomes. To understand Sas-4's tethering role, we determined the crystal structure of its T complex protein 10 (TCP) domain displaying a solvent-exposed single-layer of β-sheets fold. This unique feature of the TCP domain suggests that it could provide an "extended surface-like" platform to tether the Sas-4-PCM scaffold to a centriole. Functional studies in Drosophila, human cells, and human induced pluripotent stem cell-derived neural progenitor cells were used to test this hypothesis, where point mutations within the 9-10th β-strands (β9-10 mutants including a MCPH-associated mutation) perturbed PCM tethering while allowing Sas-4/CPAP to scaffold cytoplasmic PCM complexes. Specifically, the Sas-4 β9-10 mutants displayed perturbed interactions with Ana2, a centrosome duplication factor, and Bld-10, a centriole microtubule-binding protein, suggesting a role for the β9-10 surface in mediating protein-protein interactions for efficient Sas-4-PCM scaffold centriole tethering. Hence, we provide possible insights into how centrosomal protein defects result in human MCPH and how Sas-4 proteins act as a vehicle to tether PCM complexes to centrioles independent of its well-known role in centriole duplication.

  2. Advances in prehospital airway management.

    Science.gov (United States)

    Jacobs, Pe; Grabinsky, A

    2014-01-01

    Prehospital airway management is a key component of emergency responders and remains an important task of Emergency Medical Service (EMS) systems worldwide. The most advanced airway management techniques involving placement of oropharyngeal airways such as the Laryngeal Mask Airway or endotracheal tube. Endotracheal tube placement success is a common measure of out-of-hospital airway management quality. Regional variation in regard to training, education, and procedural exposure may be the major contributor to the findings in success and patient outcome. In studies demonstrating poor outcomes related to prehospital-attempted endotracheal intubation (ETI), both training and skill level of the provider are usually often low. Research supports a relationship between the number of intubation experiences and ETI success. National standards for certification of emergency medicine provider are in general too low to guarantee good success rate in emergency airway management by paramedics and physicians. Some paramedic training programs require more intense airway training above the national standard and some EMS systems in Europe staff their system with anesthesia providers instead. ETI remains the cornerstone of definitive prehospital airway management, However, ETI is not without risk and outcomes data remains controversial. Many systems may benefit from more input and guidance by the anesthesia department, which have higher volumes of airway management procedures and extensive training and experience not just with training of airway management but also with different airway management techniques and adjuncts.

  3. Parapharyngeal abscess following use of a laryngeal mask airway during open revision septorhinoplasty

    Directory of Open Access Journals (Sweden)

    Benjamin van der Woerd

    2015-01-01

    Conclusion: Laryngeal mask airways have a high rate of success and low rate of complications. In this reported case, pressure necrosis from over-inflation of the LMA is thought to have perforated the right pyriform fossa. The perforation created a communication into the parapharyngeal space causing infection. We report this case to highlight the importance of identifying possible complications associated with a routine method of airway management during shared airway surgeries.

  4. Upper airway imaging and its role in preoperative airway evaluation

    Directory of Open Access Journals (Sweden)

    Jagadish G Sutagatti

    2016-01-01

    Full Text Available Ultrasonography (USG is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

  5. Relationship between airway pathophysiology and airway inflammation in older asthmatics

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste M; Gibson, Peter G; Pretto, Jeffrey J;

    2013-01-01

    BACKGROUND AND OBJECTIVE: Asthma-related morbidity is greater in older compared with younger asthmatics. Airway closure is also greater in older asthmatics, an observation that may be explained by differences in airway inflammation. We hypothesized that in older adult patients with asthma......: Mean patient age was 67 years (confidence interval: 63-71) with a mean FEV1 of 78 % predicted (confidence interval: 70-85%). AHR correlated with sputum eosinophils (r = 0.68, P = 0.005) and eNO (r = 0.71, P ... or eNO. CONCLUSIONS: In older patients with asthma, airway inflammatory cells are linked to abnormal airway physiology. Eosinophilic airway inflammation is associated with AHR while neutrophilic inflammation may be an important determinant of airflow limitation at rest and airway closure during...

  6. Integrated care pathways for airway diseases (AIRWAYS-ICPs)

    DEFF Research Database (Denmark)

    Bousquet, J; Addis, A; Adcock, I

    2014-01-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy....... AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers)....

  7. Biomarkers in Airway Diseases

    Directory of Open Access Journals (Sweden)

    Janice M Leung

    2013-01-01

    Full Text Available The inherent limitations of spirometry and clinical history have prompted clinicians and scientists to search for surrogate markers of airway diseases. Although few biomarkers have been widely accepted into the clinical armamentarium, the authors explore three sources of biomarkers that have shown promise as indicators of disease severity and treatment response. In asthma, exhaled nitric oxide measurements can predict steroid responsiveness and sputum eosinophil counts have been used to titrate anti-inflammatory therapies. In chronic obstructive pulmonary disease, inflammatory plasma biomarkers, such as fibrinogen, club cell secretory protein-16 and surfactant protein D, can denote greater severity and predict the risk of exacerbations. While the multitude of disease phenotypes in respiratory medicine make biomarker development especially challenging, these three may soon play key roles in the diagnosis and management of airway diseases.

  8. Low-frequency oscillations and vasoreactivity of cortical vessels in obstructive sleep apnea during wakefulness

    DEFF Research Database (Denmark)

    Schytz, Henrik Winther; Jensen, Benedicte Ersted; Jennum, Poul;

    2013-01-01

    Effective nasal continuous positive airway pressure (CPAP) therapy reduces the cardiovascular outcomes associated with obstructive sleep apnea (OSA), but the mechanism behind this effect is unclear. We investigated if OSA patients during wakefulness showed signs of increased sympathetic activity...

  9. 不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值探析%Clinical Value of Noninvasive Bi-level Positive Airway Pressure Ventilation in Patients With Acute Respiratory Failure Caused by Different Causes

    Institute of Scientific and Technical Information of China (English)

    李晓理

    2016-01-01

    目的:对不同病因致急性呼吸衰竭患者行无创双水平气道正压通气治疗的临床价值进行评价分析。方法对68例急性呼吸衰竭患者依据病因的不同分成心源性肺水肿组和重症肺炎组,接受无创双水平气道正压通气治疗,对比分析治疗效果。结果心源性肺水肿组患者治疗后动脉血气指标、症状缓解时间、治疗时间、住院时间与对照组比较差异有统计学意义(P <0.05)。结论无创双水平气道正压通气对不同病因引起的急性呼吸衰竭具有良好的治疗效果。%Objective The different causes in patients with acute respiratory failure and clinical value of noninvasive bi-level positive airway pressure ventilation in the treatment of evaluation and analysis. Methods 68 patients with acute respiratory failure were divided according to different causes of cardiogenic pulmonary edema and severe pneumonia group, accepted non-invasive bi-level positive airway pressure therapy, comparative analysis of the treatment effect. Results Cardiogenic pulmonary edema patients arterial blood gas treatment, remission time, treatment time, duration of hospitalization with the control group was significantly different (P<0.05). Conclusion Noninvasive bi-level positive airway pressure ventilation in acute respiratory failure caused by different causes have a good therapeutic effect.

  10. 节律性压力波对家犬气道黏蛋白分泌平衡的影响及其机制%Effect of rhythmic pressure waves on balancing airway basic mucus secretion in dogs

    Institute of Scientific and Technical Information of China (English)

    刘诗兰; 尤列·皮尔曼; 维克多·科罗索夫; 周向东

    2013-01-01

    目的:观察不同压力对家犬气道黏液层黏蛋白(MUC)分泌的影响,并初步探讨其参与机制。方法:24只健康家犬行双腔支气管导管插管,并随机分为4组(n=6)。A组家犬正常呼吸的频率及压力双侧通气(A1,A2);B组一侧不通气(B1),另一侧予以过量通气(B2);C组预先张力敏感性阳离子通道4(TRPV4)阻断剂钉红(RR)后按A组通气模式通气(C1,C2);D组预先TRPV4阻断剂RR处理后按B组通气模式通气(D1,D2)。通气12 h后,ELISA检测3组支气管灌洗液(BALF)中MUC(2,5AC和5B)蛋白含量;RT-PCR检测支气管肺组织匀浆中MUC(2,5AC和5B) mRNA转录水平。结果:与正常通气的A2组比较,过量通气的B2组家犬BALF中3种MUC蛋白含量显著升高,且以MUC5AC为主(P<0.05);与A1组比较,未通气的B1组则明显下降(P<0.05)。与A1,A2组比较,给予RR处理后的C1,C2组蛋白含量均明显降低(P<0.05)。与过量通气的B2组比较,给予TRPV4特异性阻断剂处理后再过量通气的D2组3种MUC蛋白含量亦明显下降(P<0.05)。与A2组比较过量通气的B2组肺组织MUC(2,5AC和5B) mRNA表达均明显上调(P<0.05);与A1,A2比较,给予RR处理后C1,C2组肺组织3种MUC mRNA转录水平显著下降(P<0.05);给予RR预处理后与B2组相比,D2组内MUC mRNA转录水平显著下调(P<0.05)。结论:节律性压力波参与维持家犬气道上皮黏液层黏蛋白分泌平衡调控,其机制主要通过TRPV4通道实现。%Objective:To investigate the effect of different pressure on mucin (MUC) secretion in dog airway mucus layer and explore the participation mechanisms. Methods:Totally 24 healthy dogs were randomly divided into 4 groups (n=6) after double-lumen endobronchial tube intubation. In group A the dogs were ventilated bilaterally with normal breathing frequency and pressure;In group B:one side of the dog lung did not ventilate, while the other side was excessively ventilated. In

  11. Infant flow biphasic nasal continuous positive airway pressure (BP- NCPAP vs. infant flow NCPAP for the facilitation of extubation in infants' ≤ 1,250 grams: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    O'Brien Karel

    2012-04-01

    Full Text Available Abstract Background The use of mechanical ventilation is associated with lung injury in preterm infants and therefore the goal is to avoid or minimize its use. To date there is very little consensus on what is considered the "best non-invasive ventilation mode" to be used post-extubation. The objective of this study was to compare the effectiveness of biphasic nasal continuous positive airway pressure (BP-NCPAP vs. NCPAP in facilitating sustained extubation in infants ≤ 1,250 grams. Methods We performed a randomized controlled trial of BP-NCPAP vs. NCPAP in infants ≤ 1,250 grams extubated for the first time following mechanical ventilation since birth. Infants were extubated using preset criteria or at the discretion of the attending neonatologist. The primary outcome was the incidence of sustained extubation for 7 days. Secondary outcomes included incidence of adverse events and short-term neonatal outcomes. Results Sixty-seven infants received BP-NCPAP and 69 NCPAP. Baseline characteristics were similar between groups. The trial was stopped early due to increased use of non-invasive ventilation from birth, falling short of our calculated sample size of 141 infants per group. The incidence of sustained extubation was not statistically different between the BP-NCPAP vs. NCPAP group (67% vs. 58%, P = 0.27. The incidence of adverse events and short-term neonatal outcomes were similar between the two groups (P > 0.05 except for retinopathy of prematurity which was noted to be higher (P = 0.02 in the BP-NCPAP group. Conclusions Biphasic NCPAP may be used to assist in weaning from mechanical ventilation. The effectiveness and safety of BP-NCPAP compared to NCPAP needs to be confirmed in a large multi-center trial as our study conclusions are limited by inadequate sample size. Clinical Trials Registration # NCT00308789 Source of support Grant # 06-06, Physicians Services Incorporated Foundation, Toronto, Canada. Summit technologies Inc. provided

  12. 早期联合应用NCPAP和PS治疗新生儿呼吸窘迫综合征%Early Nasal Continuous Positive Airway Pressure And Pulmonary Surfactant Therapy For Neonatal Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    周媛; 杨静; 王岩岩; 王李敏

    2012-01-01

    目的 讨论经鼻持续气道正压通气(NCPAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的治疗效果.方法 应用NCPAP联合PS治疗25例呼吸窘迫综合征的新生儿,并对其临床特点、动脉血气分析进行分析.结果 23例发绀和呼吸困难症状均有所减轻或消失.X线表现肺透亮度明显改善,或病变未进展,血气分析参数明显改善.2例因病情加重放弃治疗.结论 NCPAP联合PS能迅速有效地治疗新生儿呼吸窘迫综合征.用这种方法通过阻止呼吸窘迫综合征的进展,降低了以后应用呼吸机的需要.细致观察和正确的护理也是治疗成功的关键.%Objective To investigate the effects of nasal continuous positive airway pressure ( NCPAP ) early combined with pul-monary surfactant ( PS ) on newborn with respiratory distress syndrome ( RDS ). Methods 25 cases of newborn with respiratory distress syndrome were treated by Curosurf ( 100 ~ 200 mg/kg, every times ) and then they were given breath support by NCPAP. The clinical characteristics and results of blood gas analysis were evaluated. Results The symptoms of cyanosis and breathing difficulties disappeared or were reduced in 23 cases. The lung permeability showed by X-ray was obviously improved. Because the condition became more serious, two cases gave up. Conclusions Early NCPAP combined with PS have a good effect for newborn with respiratory distress syndrome, and improving the survival rate. It can decrease the requirement for respiratory machine by preventing respiratory distress syndrome. The cor-rect nursing is the key of successful treatment.

  13. Use of the i-gel™ supraglottic airway device in a patient with subglottic stenosis -a case report-.

    Science.gov (United States)

    Lee, Ki Hwa; Kang, Eun Su; Jung, Jae Wook; Park, Jae Hong; Choi, Young Gyun

    2013-09-01

    The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. This, however, can lead to complications such as tracheal mucosal trauma, tracheal perforation or bleeding. The ASA difficult airway algorithm recommends the use of supraglottic airway devices in a failed intubation/ventilation scenario. In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel™ supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.

  14. Ultrasound of the airway

    Directory of Open Access Journals (Sweden)

    Pankaj Kundra

    2011-01-01

    Full Text Available Currently, the role of ultrasound (US in anaesthesia-related airway assessment and procedural interventions is encouraging, though it is still ill defined. US can visualise anatomical structures in the supraglottic, glottic and subglottic regions. The floor of the mouth can be visualised by both transcutaneous view of the neck and also by transoral or sublinguial views. However, imaging the epiglottis can be challenging as it is suspended in air. US may detect signs suggestive of difficult intubation, but the data are limited. Other possible applications in airway management include confirmation of correct endotracheal tube placement, prediction of post-extubation stridor, evaluation of soft tissue masses in the neck prior to intubation, assessment of subglottic diameter for determination of paediatric endotracheal tube size and percutaneous dilatational tracheostomy. With development of better probes, high-resolution imaging, real-time picture and clinical experience, US has become the potential first-line noninvasive airway assessment tool in anaesthesia and intensive care practice.

  15. Physical outcome and school performance of very-low-birthweight infants treated with minimal handling and early nasal CPAP

    DEFF Research Database (Denmark)

    Dahl, Marianne; Kamper, Jens

    2006-01-01

    AIM: To describe physical outcome and school performance in a cohort of very-low-birthweight infants treated with early nasal continuous positive airway pressure (NCPAP)/minimal handling regimen with permissive hypercapnia, in comparison to siblings of normal birthweight. MATERIAL AND METHODS...... of these differences reached statistical significance. However, the performance ratings correlated significantly with socio-economic conditions. CONCLUSION: In this study of infants treated with a regimen of early NCPAP/minimal handling, we found a relatively low incidence of handicaps and impairments. Nearly 90......% attended ordinary schools, with near-average performances in mathematics and reading/spelling, which were not statistically different to their siblings. The overall results indicate that these infants fare at least as well as survivors after conventional treatment....

  16. Obstructive sleep apnea therapy

    NARCIS (Netherlands)

    Hoekema, A.; Stegenga, B.; Wijkstra, P. J.; van der Hoeven, J. H.; Meinesz, A. F.; de Bont, L. G. M.

    2008-01-01

    In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned

  17. Anticholinergic treatment in airways diseases.

    LENUS (Irish Health Repository)

    Flynn, Robert A

    2009-10-01

    The prevalence of chronic airways diseases such as chronic obstructive pulmonary disease and asthma is increasing. They lead to symptoms such as a cough and shortness of breath, partially through bronchoconstriction. Inhaled anticholinergics are one of a number of treatments designed to treat bronchoconstriction in airways disease. Both short-acting and long-acting agents are now available and this review highlights their efficacy and adverse event profile in chronic airways diseases.

  18. Airway epithelium is a predominant source of endogenous airway GABA and contributes to relaxation of airway smooth muscle tone

    OpenAIRE

    Gallos, George; Townsend, Elizabeth; Yim, Peter; Virag, Laszlo; Zhang, Yi; Xu, Dingbang; Bacchetta, Matthew; Emala, Charles W.

    2012-01-01

    Chronic obstructive pulmonary disease and asthma are characterized by hyperreactive airway responses that predispose patients to episodes of acute airway constriction. Recent studies suggest a complex paradigm of GABAergic signaling in airways that involves GABA-mediated relaxation of airway smooth muscle. However, the cellular source of airway GABA and mechanisms regulating its release remain unknown. We questioned whether epithelium is a major source of GABA in the airway and whether the ab...

  19. Pharmacology of airway smooth muscle proliferation

    NARCIS (Netherlands)

    Gosens, Reinoud; Roscioni, Sara S.; Dekkers, Bart G. J.; Pera, Tonio; Schmidt, Martina; Schaafsma, Dedmer; Zaagsma, Johan; Meurs, Herman

    2008-01-01

    Airway smooth muscle thickening is a pathological feature that contributes significantly to airflow limitation and airway hyperresponsiveness in asthma. Ongoing research efforts aimed at identifying the mechanisms responsible for the increased airway smooth muscle mass have indicated that hyperplasi

  20. Cholinergic regulation of airway inflammation and remodelling

    NARCIS (Netherlands)

    Kolahian, Saeed; Gosens, Reinoud

    2012-01-01

    Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway disease

  1. Vibration therapy reduces CPAP need in a prospective randomised controlled trial

    NARCIS (Netherlands)

    K. Helder MScN (Onno); W.C.J. Hop (Wim); J.B. van Goudoever (Hans)

    2008-01-01

    textabstractBackground: Increased mucus production is a common phenomena following ventilatory support, which might increase morbidity. In order to reduce airway obstruction we tested the effect of vibration therapy on the duration of ventilatory support. Methodology: We conducted a randomised contr

  2. A mechanical design principle for tissue structure and function in the airway tree.

    Science.gov (United States)

    LaPrad, Adam S; Lutchen, Kenneth R; Suki, Béla

    2013-01-01

    With every breath, the dynamically changing mechanical pressures must work in unison with the cells and soft tissue structures of the lung to permit air to efficiently traverse the airway tree and undergo gas exchange in the alveoli. The influence of mechanics on cell and tissue function is becoming apparent, raising the question: how does the airway tree co-exist within its mechanical environment to maintain normal cell function throughout its branching structure of diminishing dimensions? We introduce a new mechanical design principle for the conducting airway tree in which mechanotransduction at the level of cells is driven to orchestrate airway wall structural changes that can best maintain a preferred mechanical microenvironment. To support this principle, we report in vitro radius-transmural pressure relations for a range of airway radii obtained from healthy bovine lungs and model the data using a strain energy function together with a thick-walled cylinder description. From this framework, we estimate circumferential stresses and incremental Young's moduli throughout the airway tree. Our results indicate that the conducting airways consistently operate within a preferred mechanical homeostatic state, termed mechanical homeostasis, that is characterized by a narrow range of circumferential stresses and Young's moduli. This mechanical homeostatic state is maintained for all airways throughout the tree via airway wall dimensional and mechanical relationships. As a consequence, cells within the airway walls throughout the airway tree experience similar oscillatory strains during breathing that are much smaller than previously thought. Finally, we discuss the potential implications of how the maintenance of mechanical homeostasis, while facilitating healthy tissue-level alterations necessary for maturation, may lead to airway wall structural changes capable of chronic asthma.

  3. 改良Proseal喉罩与改良普通喉罩在无痛纤维支气管镜检查中的气道管理%Comparison of modified Proseal laryngeal mask and three-way laryngeal mask airway for painless fiberoptic bronchoscopy in airway management in effect

    Institute of Scientific and Technical Information of China (English)

    王绍林; 张进; 张鹏; 殷骏; 俞蕾; 何磊; 程庆余; 刘小彬

    2012-01-01

    Objective To compare the effects of airway management with modified Proseal laryngeal mask airway and modified laryngeal mask airway in painless fiberoptic bronchoscopy. Methods Forty patients who scheduled for painless fiheroptic bronechscopy were randomly divided into two groups (n = 20): Modified Proseal laryngeal mask airway group (group P) and modified laryngeal mask airway group (group L). After induction of general anesthesia were inserted with hands. BP, HR and SpO2 were measured respectively before anesthesia laryngeal mask airway (To), immediately after inserting laryngeal mask airway (T1 ) and 3 min (T2). The laryngeal mask airway insertion time, complications, the ventilated assessment, fiberoptic bronchoscopy assessed and airway sealing pressure were also simultaneously recorded. Results There was no significant difference in laryngeal mask airway insertion time, BP. HR and SpO2 at each point Airway sealing pressure in group P was significantly higher than that in group L (P<0. 01). The excellent rates of ventilated assessment and fiberoptic bronchoscopy scores were both 100% in group P, and were much higher than those in group L (85%, 80% respectively F<0. 01). Blood staining in group P was less than that in group L (1 vs. 7 cases, respectively P<0. 05). Conclusion The modified Proseal laryngeal mask is better than modified laryngeal mask airway at the aspects of gas-tightness, assessment of ventilation and fiberoptic bronchoscopy. but no effects on hemodynamics in two groups.Objective To compare the effects of airway management with modified Proseal laryngeal mask airway and modified laryngeal mask airway in painless fiberoptic bronchoscopy. Methods Forty patients who scheduled for painless fiheroptic bronechscopy were randomly divided into two groups (n = 20): Modified Proseal laryngeal mask airway group (group P) and modified laryngeal mask airway group (group L). After induction of general anesthesia were inserted with hands. BP, HR and SpO2 were

  4. Clinical value of upper airway pressure measurement and Friedman staging system in preoperative evaluation for obstructive sleep apnea hypopnea syndrome%上气道测压与Friedman分型在上气道阻塞平面判断中的相关性研究

    Institute of Scientific and Technical Information of China (English)

    田旭; 李五一; 霍红; 余蓉; 王剑

    2011-01-01

    Objective To evaluate the clinical value of localization of upper airway obstructive site with pressure measurements and Friedman staging system in preoperative upper airway reconstructive surgery for obstructive sleep apnea-hypopnea syndrome (OSAHS), and to evaluate the value of Friedman staging system in predicting the upper airway obstructive site. Methods One hundred and three patients with snoring, daytime sleepiness diagnosed as OSAHS by polysomnography were first classified using Friedman staging system, and then examined using whole night recording, including airway continuous pressure measurements (Apnea Graph, AG). AG transducer catheter containing two pressure and two temperature sensors used for obstruction site determination and detection of apnea events during sleep. Obstructive sites were divided into upper (retropalatal region) or lower level (retroglossal region). Using constituent ratio to reflect the obstructive proportion of different levels so as to find the correlation between Friedman staging system and localization of upper airway obstructive site with pressure measurements performed during sleep,and to evaluate the clinical value of Friedman staging system in predicting the severity of OSAHS. Results There was statistically significant difference in the constituent ratio of retroglossal obstruction determined by AG, according to Friedman staging system, Friedman tongue position (FTP) and tonsil size grading ( F =13. 876, 7. 655,10. 207 respectively, P <0. 05 ). The constituent ratio of retroglossal obstruction between stage Ⅳ and Ⅰ , Ⅱ, Ⅲ(P<0.01) was significantly different. With the increasing of Friedman staging,the constituent ratio of retroglossal obstruction had the tendency of increasing. The constituent ratio of retroglossal obstruction between FTP grade 2 and grade 3, grade 4 ( P < 0. 05 ) was significantly different.With the increasing of FTP grading, the constituent ratio of retroglossal obstruction had the tendency

  5. Role of laryngeal mask airway in laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    José; M; Bele?a; Ernesto; Josué; Ochoa; Mónica; Nú?ez; Carlos; Gilsanz; Alfonso; Vidal

    2015-01-01

    Laparoscopic cholecystectomy is one of the most commonly performed surgical procedures and the laryngeal mask airway(LMA) is the most common supraglottic airway device used by the anesthesiologists to manage airway during general anesthesia. Use of LMA has some advantages when compared to endotracheal intubation, such as quick and ease of placement, a lesser requirement for neuromuscular blockade and a lower incidence of postoperative morbididy. However, the use of the LMA in laparoscopy is controversial, based on a concern about increased risk of regurgitation and pulmonary aspiration. The ability of these devices to provide optimal ventilation during laparoscopic procedures has been also questioned. The most important parameter to secure an adequate ventilation and oxygenation for the LMA under pneumoperitoneum condition is its seal pressure of airway. A good sealing pressure, not only state correct patient ventilation, but it reduces the potential risk of aspiration due to the better seal of airway. In addition, the LMAs incorporating a gastric access, permitting a safe anesthesia based on these commented points. We did a literature search to clarify if the use of LMA in preference to intubation provides inadequate ventilation or increase the risk of aspiration in patients undergoing laparoscopic cholecystectomy. We found evidence stating that LMA with drain channel achieves adequate ventilation for these procedures. Limited evidence was found to consider these devices completely safe against aspiration. However, we observed that the incidence of regurgitation and aspiration associated with the use of the LMA in laparoscopic surgery is very low.

  6. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room.

    LENUS (Irish Health Repository)

    2011-07-01

    Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.

  7. 空气 CPAP 治疗新生儿早期呼吸窘迫综合征疗效观察

    Institute of Scientific and Technical Information of China (English)

    唐晨曦; 李辉; 王平

    2016-01-01

    目的:探讨经鼻空气持续正压通气(CPAP)治疗新生儿早期呼吸窘迫综合征临床效果。方法将2013年1月至2016年3月年收治的100例 NRDS 患儿随机盲法分为空气 CPAP 组(氧浓度21%)和氧气 CPAP 组(氧浓度35-40%)各50例,观察两组治疗前后血气情况及临床效果。结果两组患者治疗后血气分析较治疗前均有改善,观察组治疗后 PaO2、PaCO2较治疗前明显差异(P<0.05),两组治疗效果后无统计学差异。结论早期空气 CPAP 与氧气CPAP 治疗 NRDS 疗效一致,但能避免氧气吸入带来相关并发症,早期空气 CPAP 值得临床推广。

  8. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

    Directory of Open Access Journals (Sweden)

    Elif Bengi Sener

    2012-01-01

    Full Text Available OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively (p<0.001. The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05. The rate pressure product values (heart rate x systolic blood pressure at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively (p<0.05. There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754. The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from

  9. Using optical coherence tomography (OCT) imaging in the evaluation of airway dynamics (Conference Presentation)

    Science.gov (United States)

    Szabari, Margit V.; Kelly, Vanessa J.; Applegate, Matthew B.; Chee, Chunmin; Tan, Khay M.; Hariri, Lida P.; Harris, R. Scott; Winkler, Tilo; Suter, Melissa J.

    2016-03-01

    Asthma is a chronic disease resulting in periodic attacks of coughing and wheezing due to temporarily constricted and clogged airways. The pathophysiology of asthma and the process of airway narrowing are not completely understood. Appropriate in vivo imaging modality with sufficient spatial and temporal resolution to dynamically assess the behavior of airways is missing. Optical coherence tomography (OCT) enables real-time evaluation of the airways during dynamic and static breathing maneuvers. Our aim was to visualize the structure and function of airways in healthy and Methacholine (MCh) challenged lung. Sheep (n=3) were anesthetized, mechanically ventilated and imaged with OCT in 4 dependent and 4 independent airways both pre- and post-MCh administration. The OCT system employed a 2.4 Fr (0.8 mm diameter) catheter and acquired circumferential cross-sectional images in excess of 100 frames per second during dynamic tidal breathing, 20 second static breath-holds at end-inspiration and expiration pressure, and in a response to a single deep inhalation. Markedly different airway behavior was found in dependent versus non-dependent airway segments before and after MCh injection. OCT is a non-ionizing light-based imaging modality, which may provide valuable insight into the complex dynamic behavior of airway structure and function in the normal and asthmatic lung.

  10. Potential role of the airway wall in the asthma of obesity.

    Science.gov (United States)

    Bates, Jason H T; Dixon, Anne E

    2015-01-01

    The pathogenesis of late-onset TH2-low asthma in obesity is thought to be related to weight-related decreases in lung volume, but why only a subset of individuals with obesity develop this condition is unknown. We tested the hypothesis that natural variations in both airway wall stiffness and airway wall thickness could lead to a subpopulation of hyperresponsive individuals exhibiting the symptoms of asthma in the setting of obesity. Increases in airway resistance (Raw) after airway smooth muscle stimulation were simulated using a computational model of an elastic airway embedded in elastic parenchyma. Using a range of randomly chosen values for both airway wall stiffness and thickness, we determined the resulting probability distributions of Raw responsiveness for a variety of different levels of transpulmonary pressure (Ptp). As Ptp decreased from 5 to 1 cmH2O, the resulting distributions of Raw moved toward progressively higher levels of responsiveness. With appropriate choices for the mean and standard deviation of the parameter that controls either airway wall stiffness or thickness, the model predicts a relationship between airway hyperresponsiveness and body mass index that is similar to that which has been reported in populations with obesity. We conclude that natural variations in airway wall mechanics and geometry between different individuals can potentially explain why an increasing percentage of the population exhibits the symptoms of asthma as the obesity of the population increases.

  11. 无创双水平气道正压通气治疗不同病因致急性呼吸衰竭的临床观察%The Clinical Observation of Noninvasive Bilevel Positive Airway Pressure Ventilation on Acute Respiratory Failure Caused by Different Etiology

    Institute of Scientific and Technical Information of China (English)

    温振杰; 陈军; 刘建凌

    2014-01-01

    目的:探讨无创双水平气道正压通气治疗不同病因致急性呼吸衰竭临床效果。方法选择急性呼吸衰竭患者共48例,根据不同病因分为观察组(心源性肺水肿)和对照组(重症肺炎)。两组均实施无创双水平气道正压通气治疗。观察两组治疗效果。结果观察组治疗后的动脉血气指标分别和对照组治疗6 h后的动脉血气指标比较,差异有统计学意义(P<0.05)。观察组患者症状缓解时间、无创双水平正压通气治疗时间、住院时间、气管插管发生分别和对照组比较,差异有统计学意义(P<0.05)。结论无创双水平气道正压通气对心源性肺水肿和重症肺炎所致急性呼吸衰竭均有显著治疗效果,但对心源性肺水肿所致急性呼吸衰竭效果更佳。%Objective To explore the effect of noninvasive bilevel positive airway pressure ventilation on acute respiratory failure caused by different etiology. Methods 48 cases with acute respiratory failure were divided into observation group (cardiogenic pulmonary edema) and control group (severe pneumonia) according to different causes. The two groups underwent noninvasive bilevel positive airway pressure ventilation. The therapeutic effect of two groups was observed . Results The arterial blood gas indexes in the observation group compared with those in control group after six hours treatment respectively,the difference was statistically significant (P<0.05).The symptoms time, noninvasive bilevel positive pressure ventilation time, hospitalization time, tracheal intubation occurred in the observation group compared with those in control group after treatment respectively, the difference was statistically significant (P<0.05).Conclusion The noninvasive bilevel positive airway pressure ventilation on acute respiratory failure caused by acute cardiogenic pulmonary edema or severe pneumonia has significant effect, but its efficacy in patients with

  12. [Acute pulmonary edema secondary to acute upper airway obstruction].

    Science.gov (United States)

    Sánchez-Ortega, J L; Carpintero-Moreno, F; Olivares-López, A; Borrás-Rubio, E; Alvarez-López, M J; García-Izquierdo, A

    1992-01-01

    We report a 72 years old woman with mild arterial hypertension and no other pathological history who presented an acute pulmonary edema due to acute obstruction of the upper airway secondary to vocal chord paralysis developing during the immediate postoperative phase of thyroidectomy. The acute pulmonary edema resolved after application of tracheal reintubation, mechanical ventilation controlled with end expiratory positive pressure, diuretics, morphine, and liquid restriction. We discuss the possible etiopathogenic possibilities of this infrequent clinical picture and we suggest that all patients who suffered and acute obstruction of the upper airways require a careful clinical surveillance in order to prevent the development of the pulmonary syndrome.

  13. Negative-Pressure Pulmonary Edema.

    Science.gov (United States)

    Bhattacharya, Mallar; Kallet, Richard H; Ware, Lorraine B; Matthay, Michael A

    2016-10-01

    Negative-pressure pulmonary edema (NPPE) or postobstructive pulmonary edema is a well-described cause of acute respiratory failure that occurs after intense inspiratory effort against an obstructed airway, usually from upper airway infection, tumor, or laryngospasm. Patients with NPPE generate very negative airway pressures, which augment transvascular fluid filtration and precipitate interstitial and alveolar edema. Pulmonary edema fluid collected from most patients with NPPE has a low protein concentration, suggesting hydrostatic forces as the primary mechanism for the pathogenesis of NPPE. Supportive care should be directed at relieving the upper airway obstruction by endotracheal intubation or cricothyroidotomy, institution of lung-protective positive-pressure ventilation, and diuresis unless the patient is in shock. Resolution of the pulmonary edema is usually rapid, in part because alveolar fluid clearance mechanisms are intact. In this review, we discuss the clinical presentation, pathophysiology, and management of negative-pressure or postobstructive pulmonary edema.

  14. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...

  15. Airway complications after lung transplantation.

    Science.gov (United States)

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C

    2015-01-01

    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  16. Airway vascular reactivity and vascularisation in human chronic airway disease

    NARCIS (Netherlands)

    Bailey, Simon R; Boustany, Sarah; Burgess, Janette K; Hirst, Stuart J; Sharma, Hari S; Simcock, David E; Suravaram, Padmini R; Weckmann, Markus

    2009-01-01

    Altered bronchial vascular reactivity and remodelling including angiogenesis are documented features of asthma and other chronic inflammatory airway diseases. Expansion of the bronchial vasculature under these conditions involves both functional (vasodilation, hyperperfusion, increased microvascular

  17. Aging increases upper airway collapsibility in Fischer 344 rats.

    Science.gov (United States)

    Ray, Andrew D; Ogasa, Toshiyuki; Magalang, Ulysses J; Krasney, John A; Farkas, Gaspar A

    2008-11-01

    The upper airway muscles play an important role in maintaining upper airway collapsibility, and the incidence of sleep-disordered breathing increases with age. We hypothesize that the increase in airway collapsibility with increasing age can be linked to changes in upper airway muscle mechanics and structure. Eight young (Y: 6 mo) and eight old (O: 30 mo) Fischer 344 rats were anesthetized and mechanically ventilated, and the pharyngeal pressure associated with flow limitation (Pcrit) was measured 1) with the hypoglossal (cnXII) nerve intact, 2) following bilateral cnXII denervation, and 3) during cnXII stimulation. With the cnXII intact, the upper airways of older rats were more collapsible compared with their younger counterparts [Pcrit = -7.1 +/- 0.6 (SE) vs. -9.5 +/- 0.7 cmH2O, respectively; P = 0.033]. CnXII denervation resulted in an increase in Pcrit such that Pcrit became similar in both groups (O: -4.2 +/- 0.5 cmH2O; Y: -5.4 +/- 0.5 cmH2O). In all rats, cnXII stimulation decreased Pcrit (less collapsible) in both groups (O: -11.3 +/- 1.0 cmH2O; Y: -10.2 +/- 1.0 cmH2O). The myosin heavy chain composition of the genioglossus muscle demonstrated a decrease in the percentage of the IIb isoform (38.3 +/- 2.5 vs. 21.7 +/- 1.7%; P collapsible with age and that the increase in upper airway collapsibility with age is likely related to altered neural control rather than to primary alterations in upper airway muscle structure and function.

  18. Effect of CPAP therapy on dynamic glucose level in OSAHS patients with newly diagnosed T2DM%持续气道正压通气对阻塞性睡眠呼吸暂停低通气综合征合并新诊断2型糖尿病患者动态血糖的影响

    Institute of Scientific and Technical Information of China (English)

    赵丽君; 惠培林; 谢宇平; 侯一平; 魏晓泉; 马薇; 王金凤; 周丽雅; 张文娟

    2015-01-01

    Objective To investigate the characteristic of dynamic glucose level in obstructive sleep apnea-hypopnea syndrome (OSAHS) patients with newly diagnosed type 2 diabetes mellitus (T2DM) and to evaluate the effect of continuous positive airway pressure (CPAP) treatment on the glucose level.Methods A total of 65 cases of patients with T2DM who were newly diagnosed by oral glucose tolerance test (OGTT) were enrolled from April 2014 to April 2015 in Gansu Provincial Hospital, and divided into simple T2DM group (n =30) and OSAHS with T2DM group (n =35) according to aponea-hypopnea index (AHI) which was monitored by polysomnography (PSG).Their general clinical data were collected, and glucose level of different periods was monitored by continuous glucose moitoring system (CGMS).Changes of glucose level were compared between two groups before and after CPAP treatment.Results Age, gender proportion, BMI, smoking and drinking history, glycosylated hemoglobin (HbA1c) and blood lipid profile had no significantly difference between two groups.Longer neck circumstance and higher waist-hip ration (WHR) ,higher systolic blood pressure and diastolic blood pressure, higher fasting plasma glucose (FPG) [(9.4 ±3.2) vs (7.3 ±2.1)mmol/L, P =0.028]and fasting insulin (FINS) [(19.2 ±8.7) vs (11.1 ±4.7) mU/L,P =0.044] level, more serious homeostasis model assessment insulin resistance (HOMA-IR) were found in OSAHS patients with T2DM when compared to patients in simple T2DM group.The average dynamic glucose level of 24 hours, daytime, nocturnal and sleep time in OSAHS with T2DM group were higher than that in the simple T2DM group (all P < 0.05).The alarming times when the average dynamic glucose level of nocturnal time was more than 0.1 mmol · L-1 · min-1 in T2DM with OSAHS was more than that in control group (P =0.001).After treatment of CPAP, the level of AHI [(5.9 ± 3.6) vs (56.7 ± 11.4) times/h, P<0.001], average dynamic glucose level of 24 hours, day, nocturnal and sleep

  19. Airway Epithelium Stimulates Smooth Muscle Proliferation

    OpenAIRE

    Malavia, Nikita K.; Raub, Christopher B.; Mahon, Sari B.; Brenner, Matthew; Reynold A Panettieri; George, Steven C.

    2009-01-01

    Communication between the airway epithelium and stroma is evident during embryogenesis, and both epithelial shedding and increased smooth muscle proliferation are features of airway remodeling. Hence, we hypothesized that after injury the airway epithelium could modulate airway smooth muscle proliferation. Fully differentiated primary normal human bronchial epithelial (NHBE) cells at an air–liquid interface were co-cultured with serum-deprived normal primary human airway smooth muscle cells (...

  20. N-CPAP在新生儿呼吸窘迫综合征治疗中的应用%Application of Nasal Continuous Positive Airway Pressure in the Treatment of Neonatal Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)

    周冬强

    2015-01-01

    目的 探讨经鼻持续气道正压通气(N-CPAP)治疗新生儿呼吸窘迫综合征(NRDS)的特点和优势.方法 将我院收治的86例新生儿呼吸窘迫综合征患者根据临床采取的通气方式不同分为无创CPAP组(采用N-CPAP方法,46例)和有创CPAP组(采用气管插管CPAP方法,40例).观察比较两组的治疗成功率、动脉血气指标、呼吸及使用时间和并发症发生率.结果 经过治疗,两组患儿的治疗成功率相比无显著差异(P>0 05);无创CPAP组血氧分压显著高于有创CPAP组,血二氧化碳分压显著低于有创CPAP组,差异均具有统计学意义(P<0.01);无创CPAP组呼吸机使用时间显著短于有创CPAP组,差异具有统计学意义(P<0.05);无创CPAP组并发症发生率为8.7%,显著低于有创CPAP组的30.0%,差异具有统计学意义(P<0.05).结论 N-CPAP治疗新生儿呼吸窘迫综合征具有较好的应用优势,其无创性、操作简单快捷等特点为尽快改善NRDS患儿缺氧情况、减少并发症和促进康复提供便利条件.

  1. Bi level positive airway pressure ( Bipap ) treatment of overlap syndrome patients quality of life%双水平气道正压( Bipap)呼吸机治疗对重叠综合征患者生存质量的影响

    Institute of Scientific and Technical Information of China (English)

    田迎春; 代云红; 何建林

    2012-01-01

    Objective To investigate the effect of bi-level positive airway pressure ( Bipap ) treatment of overlap syndrome patients quality of life. Methods A random number method 103 patients with overlap syndrome were divided into the experimental group 55 cases and control group 48 cases. Two groups of patients were implemented in routine treatment, experimental group on the basis of with bi-level positive airway pressure ( Bipap) ventilator therapy. 24 weeks later, using the health status questionnaire ( Medical Oatcome Stady Short-forn36, Mos Sf-36 ) to evaluate the patient's quality of life. Results After treatment, the health status questionnaire ( Mos Sf-36 ) in physiological function, life skills, emotional role function, mental health score increased ( P < 0. 05). Conclusion Bi-level positive airway pressure ( Bipap ) ventilator treatment can improve the patients quality of life.%目的 探讨双水平气道正压(Bipap)呼吸机治疗对重叠综合征患者生存质量的影响.方法 采用随机数字法将103例重叠综合征患者分为试验组55例和对照组48例.两组患者均实施常规治疗,试验组在此基础上配合双水平气道正压(Bipap)呼吸机治疗.24周后,采用健康状况调查问卷(Medical Oatcome Stady Short-forn36,Mos Sf-36)评定患者的生存质量.结果 试验组经过治疗后,健康状况问卷( Mos Sf-36)中生理功能、生活能力、情绪角色功能、精神健康评分增加(P<0.05).结论 双水平气道正压(Bipap)呼吸机治疗可提高患者的生活质量

  2. 双水平气道正压通气在重症支气管哮喘治疗中的临床价值%The Clinical Value of Bi-level Positive Airway Pressure Ventilation in the Treatment of Severe Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    林鸿浮

    2015-01-01

    Objective To study the clinical value of bi-level positive airway pressure ventilation in the treatment of severe bronchial asthma. Methods 62 patients admitted between January 2010 and December 2014 were divided into two groups, the observation group and the control group, with 32 cases in each by the treatment method. The observation group were treated by bi-level positive airway pressure ventilation, while the control group were treated by the conventional drugs. And the values of blood gas indexes before and after treatment and length of stay were compared between the two groups. Results After treatment, the value of PaO2, SaO2, PaCO2, length of stay was (95.6±5.6)mmHg, (92.8±4.6)%, (42.8±3.2)mmHg and (7.3±2.1)d, respectively in the observation group, and compared with the values of the above indexes in the control group, the differences were statistically significant (P<0.05). Conclusion Bi-level positive airway pressure ventilation has signifi-cant clinical effect in the treatment of severe bronchial asthma.%目的:研究双水平气道正压通气在重症支气管哮喘治疗中的临床价值。方法整群选取2010年1月-2014年12月收治的62例患者为研究对象,按治疗方法分为两组(各32例),观察组双水平气道正压通气,对照组常规药物,比较治疗前后血气指标变化状况和治疗后住院时间。结果观察组患者治疗后PaO2、SaO2、PaCO2和住院时间分别为(95.6±5.6)mmHg、(92.8±4.6)%、(42.8±3.2)mmHg、(7.3±2.1)d同对照组患者相比(P<0.05)。结论在治疗重症支气管哮喘临床上双水平气道正压通气获得显著效果。

  3. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper...... in morbidly obese patients and should be followed by actions to counteract atelectasis formation. The decision as to weather to use a rapid sequence induction, an awake intubation or a standard induction with hypnotics should depend on the thorough airway examination and comorbidity and should not be based...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...

  4. A new removable airway stent

    Directory of Open Access Journals (Sweden)

    Tore Amundsen

    2016-09-01

    Full Text Available Background: Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods: To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results: The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions: The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use.

  5. Clinical Evaluation of the Treatment of Acute Type Ⅰ Respiratory Insufficiency with Continuous Positive Airway Pressure Delivered by Face Mask in Elderly Patients%无创持续气道正压应用于老年Ⅰ型呼吸衰竭病人的临床观察研究

    Institute of Scientific and Technical Information of China (English)

    王长捷; 段皎; 罗光辉; 何群; 毛文文

    2011-01-01

    Objective To compare the physiologic effects and the clinical efficacy of CPAP, and standard oxygen therapy in patients with Type I Respiratory Insufficiency. Methods One unit, randomized, and unblinded trial of 119 elderly patients who were admitted to intensive care unit from September 2003 to December 2009 with a PaO2/FIO2 ratio of 300 mm Hg or less due to bilateral pulmonary edema. Patients were randomly assigned to receive oxygen therapy alone (re =58) or oxygen therapy plus CPAP (n =61). Main outcome measures of Improvement in PaO2/FIO2 ratio, rate of endotracheal intubation at any time during the study, adverse events, length of hospital stay and hospital mortality were compared between the CPAP and standard treatment groups. Results Both the CPAP and standard therapy groups had similar baseline characteristics. After 1 hour of treatment, subjective responses to treatment (P0.05) , hospital mortality (P>0.05) , or median intensive care unit length of stay (P > 0.05) , and more adverses events occurred with CPAP treatment (P < 0.01). Conclusion Despite early physiologic improvement, CPAP neither can reduce the need for intubation nor improve the outcomes in elderly patients with type I respiratory insufficiency primarily due to acute lung injury.%目的 研究持续气道正压(CPAP)和常规氧疗应用于老年Ⅰ型呼吸衰竭的生理效应和临床效果.方法 随机对照组和非肓研究组2003年9月至2009年12月119例Ⅰ型呼吸衰竭(氧合指数在300 mmHg以下,双侧肺水肿)的老年病人随机分为单独给氧组(n=58)和给氧加CPAP (n=61)组;比较两组病人的氧合指数改善值、研究期间的气管插管率、有害事件发生率、住院时间及院内死亡率.结果 老年Ⅰ型呼吸衰竭无创通气组与常规治疗组的基线特征一致.经过1h的治疗,CPAP组病人的主观感受(P<0.01)及氧合指数中位数较常规治疗组有所改善(P<0.05).两组间未观察到其他

  6. Vessel-guided airway tree segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Ashraf, Haseem

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... to differentiate between airway and non-airway voxels. This is in contrast to previous works that use either intensity alone or hand crafted models of airway appearance. We show that the appearance model can be trained with a set of easily acquired, incomplete, airway tree segmentations. A vessel orientation...... similarity measure is introduced, which indicates how similar the orientation of an airway candidate is to the orientation of the neighboring vessel. We use this vessel orientation similarity measure to overcome regions in the airway tree that have a low response from the appearance model. The proposed...

  7. Analysis of airways in computed tomography

    DEFF Research Database (Denmark)

    Petersen, Jens

    Chronic Obstructive Pulmonary Disease (COPD) is major cause of death and disability world-wide. It affects lung function through destruction of lung tissue known as emphysema and inflammation of airways, leading to thickened airway walls and narrowed airway lumen. Computed Tomography (CT) imaging...... have become the standard with which to assess emphysema extent but airway abnormalities have so far been more challenging to quantify. Automated methods for analysis are indispensable as the visible airway tree in a CT scan can include several hundreds of individual branches. However, automation...... of scan on airway dimensions in subjects with and without COPD. The results show measured airway dimensions to be affected by differences in the level of inspiration and this dependency is again influenced by COPD. Inspiration level should therefore be accounted for when measuring airways, and airway...

  8. [Upper airway obstruction caused by a floppy epiglottis--report of two cases of amyotrophic lateral sclerosis (ALS)].

    Science.gov (United States)

    Ito, Keiko; Chitose, Hiroko; Kobayashi, Asako

    2009-09-01

    The motor system is extensively affected in amyotrophic lateral sclerosis (ALS). Rapid disease progression almost certainly ensures that about half of thsese cases will experience respiratory muscle paralysis to breathe within about five years. We report two cases of ALS involving upper airway obstruction. Fiberoptic laryngoscopy showed floppy epiglottis, tilted posteriorly and horizontally and impacting against the posterior pharyngeal wall during inspiration. Several months later, airway obstruction grew exceedingly worse, and the tilted epiglottis did not return to its vertical resting position. Tracheostomy was conducted during this period. We found that laryngoscopy may be useful in the evaluation of upper airway obstruction, and it may be safer to avoid continuous positive airway pressure.

  9. Randomized controlled trial of two kinds of non-invasive positive pressure ventilation mode as a initial treatment in pre-mature infants with respiratory distress syndrome%两种无创正压通气模式初始治疗早产儿呼吸窘迫综合征的对照研究

    Institute of Scientific and Technical Information of China (English)

    罗庆容; 沈俊妃

    2015-01-01

    目的:比较两种无创正压通气模式在早产儿呼吸窘迫综合征(RDS)初始治疗中的优劣性。方法选取2011年9月至2014年6月在该院收治的 RDS 早产儿89例作为研究对象,按随机数字表随机分为两组,分为经鼻持续气道正压(nCPAP)通气组(44例)和同步鼻塞间歇正压(SNIPPV )通气组(45例)。记录并比较两组患儿无创正压通气前,通气后1、24、72 h 的血气分析和氧合指数(OI)结果、治疗效果以及并发症的发生情况。结果SNIPPV 组在无创呼吸支持后1、24、72 h 各时间点二氧化碳分压(PaCO2)值均低于 nCPAP 组(P <0.05),PaO2、pH 、OI 均亦在无创呼吸支持后1 h 时大于 nCPAP 组(P<0.05);SNIPPV 组在拔管后低氧血症、高碳酸血症、呼吸暂停和拔管失败率均低于 nCPAP 组(P<0.05),SNIPPV 组机械通气时间、氧疗时间也较短(P<0.05);但两组在正压通气相关并发症如肺出血、支气管肺发育不良(BPD)、呼吸机相关肺炎(VAP)、新生儿坏死性肠炎(NEC)以及气胸的发生率比较,差异均无统计学意义(P >0.05)。结论与 nCPAP 通气模式相比,SNIPPV 通气模式在提高氧合作用、减少 CO2潴留和降低拔管失败率方面具有明显优势,且不会增加并发症发生率,能更好地应用于早产儿RDS 的初始治疗。%Objective To compared the advantages and disadvantages of two modes of non‐invasive positive pressure ventilation as the initial treatment in premature infants with respiratory distress syndrome (RDS) .Methods 89 preterm infants with RDS in our hospital from September 2011 to June 2014 were selected as the research sub‐jects and randomly divided into two groups according to the random number table :nasal continuous positive airway pressure(nCPAP group ,n= 44) and the synchronized nasal intermittent positive pressure ventilation (SNIPPV group , n= 45) .The

  10. On locating the obstruction in the human upper airway

    Science.gov (United States)

    Wang, Yong; Elghobashi, S.

    2013-11-01

    The fluid dynamical properties of the air flow in the human upper airway (UA) are not fully understood at present due to the three-dimensional, patient-specific complex geometry of the airway, flow transition from laminar to turbulent and flow-structure interaction during the breathing cycle. One of the major challenges to surgeons is determining the location of the UA obstruction before performing corrective surgeries. It is quite difficult at present to experimentally measure the instantaneous velocity and pressure at specific points in the human airway. On the other hand, direct numerical simulation (DNS) can predict all the flow properties and resolve all its relevant length- and time-scales. We developed a DNS solver with lattice Boltzmann method (LBM), and used it to investigate the flow in two patient-specific UAs reconstructed from CT scan data. Inspiration and expiration flows through these two airways are studied and compared. Pressure gradient-time signals at different locations in the UAs are used to determine the location of the obstruction. This work was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).

  11. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

    Directory of Open Access Journals (Sweden)

    Tomas Henlin

    2014-01-01

    Full Text Available Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  12. Oxygenation, ventilation, and airway management in out-of-hospital cardiac arrest: a review.

    Science.gov (United States)

    Henlin, Tomas; Michalek, Pavel; Tyll, Tomas; Hinds, John D; Dobias, Milos

    2014-01-01

    Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

  13. Airflow behavior changes in upper airway caused by different head and neck positions: Comparison by computational fluid dynamics.

    Science.gov (United States)

    Wei, Wei; Huang, Shi-Wei; Chen, Lian-Hua; Qi, Yang; Qiu, Yi-Min; Li, Shi-Tong

    2017-02-08

    The feasibility of computational fluid dynamics (CFD) to evaluate airflow characteristics in different head and neck positions has not been established. This study compared the changes in volume and airflow behavior of the upper airway by CFD simulation to predict the influence of anatomical and physiological airway changes due to different head-neck positions on mechanical ventilation. One awake volunteer with no risk of difficult airway underwent computed tomography in neutral position, extension position (both head and neck extended), and sniffing position (head extended and neck flexed). Three-dimensional airway models of the upper airway were reconstructed. The total volume (V) and narrowest area (Amin) of the airway models were measured. CFD simulation with an Spalart-Allmaras model was performed to characterize airflow behavior in neutral, extension, and sniffing positions of closed-mouth and open-mouth ventilation. The comparison result for V was neutral pressure drop and velocity increasing were more obvious in neutral than sniffing or extension position at the same airflow rate. In sniffing position, pressure differences decreased and velocity remained almost constant. Recirculation airflow was generated near the subglottic region in neutral and extension positions. Sniffing position improves airway patency by increasing airway volume and decreasing airway resistance, suggesting that sniffing position may be the optimal choice for mask ventilation.

  14. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    Science.gov (United States)

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  15. Phases-of-illness paradigm: better communication, better outcomes

    Science.gov (United States)

    2011-11-28

    as making an accurate diagnosis , optimizing a treatment strategy, providing valuable family support, or attending another patient. Application A...airway pressure; CBC, complete blood count; CIN, contrast-induced nephropathy ; CPAP, continuous positive airway pressure; CRP, C-reactive protein; DSH

  16. Comparative Study of laryngeal mask airway Supreme and laryngeal mask airway Classic in paralyzed patients

    OpenAIRE

    2016-01-01

    Aim and Objectives: The present study was undertaken to compare the LMA Classic with LMA Supreme in assessing the ease of insertion, number of attempts, time for insertion, any unwanted responses, stability of device, peak airway pressure, leak volume and leak fraction and postoperative complications.Methods: A total of 274 patients of ASA grade 1 and 2 were included in the study and divided into two groups with 137 patients in each group: the LMA Classic group (group C) and LMA Supreme group...

  17. 鼻塞式CPAP治疗新生儿肺透明膜病疗效观察%Efficacy of Hyaline Membrane Disease Nasal CPAP Treatment

    Institute of Scientific and Technical Information of China (English)

    艾力甫

    2015-01-01

    目的:观察鼻塞式CPAP(NCPAP)治疗新生儿肺透明膜病的疗效。方法对20例早期新生儿肺透明膜病进行X线检查,根据血气分析结果调整呼吸机参数。结果20例患儿放弃治疗1例,转上级医院治疗1例,余18例顺利撤除鼻塞式CPAP。结论鼻塞式CPAP治疗早期新生儿肺透出明膜病能明显的提高治疗效果,对早产儿非常适用。%Objective To observe the nasal CPAP (NCPAP)therapy hyaline membrane disease.Methods 20 cases of early neonatal hyaline membrane disease,X-ray inspection,adjustment of ventilator parameters based on the results of blood gas analysis.Results 20 patients gave up treatment one case,turn higher hospital one case,more than 18 cases of successful removal of nasal CPAP.Conclusion Nasal CPAP treatment early neonatal lung disease,revealed a clear film can significantly improve the therapeutic ef ect,very suitable for preterm children.

  18. Simulation of turbulent airflow using a CT based upper airway model of a racehorse.

    Science.gov (United States)

    Rakesh, Vineet; Datta, Ashim K; Ducharme, Normand G; Pease, Anthony P

    2008-06-01

    Computational model for airflow through the upper airway of a horse was developed. Previous flow models for human airway do not hold true for horses due to significant differences in anatomy and the high Reynolds number of flow in the equine airway. Moreover, models that simulate the entire respiratory cycle and emphasize on pressures inside the airway in relation to various anatomical diseases are lacking. The geometry of the airway was created by reconstructing images obtained from computed tomography scans of a thoroughbred racehorse. Different geometries for inhalation and exhalation were used for the model based on the difference in the nasopharynx size during the two phases of respiration. The Reynolds averaged Navier-Stokes equations were solved for the isothermal flow with the standard k-epsilon model for turbulence. Transient pressure boundary conditions for the entire breathing cycle were obtained from past experimental studies on live horses. The flow equations were solved in a commercial finite volume solver. The flow rates, computed based on the applied pressure conditions, were compared to experimentally measured flow rates for model validation. Detailed analysis of velocity, pressure, and turbulence characteristics of the flow was done. Velocity magnitudes at various slices during inhalation were found to be higher than corresponding velocity magnitudes during exhalation. The front and middle parts of the nasopharynx were found to have minimum intraluminal pressure in the airway during inhalation. During exhalation, the pressures in the soft palate were higher compared to those in the larynx, epiglottis, and nasopharynx. Turbulent kinetic energy was found to be maximum at the entry to the airway and gradually decreased as the flow moved inside the airway. However, turbulent kinetic energy increased in regions of the airway with abrupt change in area. Based on the analysis of pressure distribution at different sections of the airway, it was concluded

  19. Influence by lidocaine by intravenous injection on airway pressure during intubation anesthesia by double-lumen tube%利多卡因静脉注射对双腔气管导管插管麻醉期间气道压力的影响

    Institute of Scientific and Technical Information of China (English)

    胡秀才; 齐英凯; 韩倩; 王雷; 单士强

    2016-01-01

    Objective To investigate influence by lidocaine by intravenous injection on airway pressure during intubation anesthesia by double-lumen tube. Methods A total of 80 peripheral lung cancer patients, who received thoracoscopic lobectomy, were randomly divided into group Ⅰ and group Ⅱ, with 40 cases in each group. Group Ⅰ received lidocaine by intravenous injection before anesthesia, and continuous intravenous pumping of lidocaine after anesthesia intubation. Group Ⅱ received normal saline by intravenous injection at corresponding time point before anesthesia, and continuous intravenous pumping of normal saline after anesthesia intubation. Observation was made on plateau pressure and peak airway pressure at the time of lateral two-lung ventilation (T1), one-lung ventilation (T2), intraoperative broken bronchus (T3), and intraoperative two-lung ventilation (T4). Results Group Ⅰ had all lower plateau pressure as (15±3), (24±3), (23±3) and (21±4) cm H2O (1 cm H2O=0.098 kPa) and peak airway pressure as (18±4), (25±5), (25±3) and (23±3) cm H2O at T1, T2, T3 and T4 than group Ⅱ (P<0.05). Conclusion Preventive implement of lidocaine by intravenous injection before anesthesia induction can effectively reduce ventilation pressure and barotraumas during one-lung ventilation in thoracoscopic lobectomy patients, as well as improve one-lung ventilation effect.%目的:探讨利多卡因静脉注射对双腔气管导管插管麻醉期间气道压力的影响。方法80例周围型肺癌行胸腔镜肺叶切除术患者,随机分为组Ⅰ和组Ⅱ,各40例。组Ⅰ患者在麻醉前静脉注射利多卡因,麻醉插管后持续静脉泵注利多卡因。组Ⅱ患者在麻醉前相应时间点静脉注射生理盐水,麻醉插管后持续静脉泵注生理盐水。观察侧卧位双肺通气(T1)、单肺通气(T2)、术中离断支气管(T3)、术后双肺通气(T4)时的平台压和气道峰压。结果组Ⅰ患者 T1、T2、T3、T4时平台压(15±3)、(24±3)

  20. Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method

    Science.gov (United States)

    Sun, Xiuzhen; Yu, Chi; Wang, Yuefang; Liu, Yingxi

    2007-08-01

    In this paper, the authors present airflow field characteristics of human upper airway and soft palate movement attitude during breathing. On the basis of the data taken from the spiral computerized tomography images of a healthy person and a patient with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), three-dimensional models of upper airway cavity and soft palate are reconstructed by the method of surface rendering. Numerical simulation is performed for airflow in the upper airway and displacement of soft palate by fluid-structure interaction analysis. The reconstructed three-dimensional models precisely preserve the original configuration of upper airways and soft palate. The results of the pressure and velocity distributions in the airflow field are quantitatively determined, and the displacement of soft palate is presented. Pressure gradients of airway are lower for the healthy person and the airflow distribution is quite uniform in the case of free breathing. However, the OSAHS patient remarkably escalates both the pressure and velocity in the upper airway, and causes higher displacement of the soft palate. The present study is useful in revealing pathogenesis and quantitative mutual relationship between configuration and function of the upper airway as well as in diagnosing diseases related to anatomical structure and function of the upper airway.

  1. Numerical simulation of soft palate movement and airflow in human upper airway by fluid-structure interaction method

    Institute of Scientific and Technical Information of China (English)

    Xiuzhen Sun; Chi Yu; Yuefang Wang; Yingxi Liu

    2007-01-01

    In this paper, the authors present airflow field characteristics of human upper airway and soft palate move-ment attitude during breathing. On the basis of the data taken from the spiral computerized tomography images of a healthy person and a patient with Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS), three-dimensional models of upper air-way cavity and soft palate are reconstructed by the method of surface rendering. Numerical simulation is performed for airflow in the upper airway and displacement of soft palate by fluid-structure interaction analysis. The reconstructed three-dimensional models precisely preserve the original config-uration of upper airways and soft palate. The results of the pressure and velocity distributions in the airflow field are quantitatively determined, and the displacement of soft palate is presented. Pressure gradients of airway are lower for the healthy person and the airflow distribution is quite uniform in the case of free breathing. However, the OSAHS patient remarkably escalates both the pressure and velocity in the upper airway, and causes higher displacement of the soft palate. The present study is useful in revealing pathogenesis and quantitative mutual relationship between configuration and function of the upper airway as well as in diagnosing diseases related to anatomical structure and function of the upper airway.

  2. A RANDOMIZED CROSSOVER COMPARISON OF THE LARYNGEAL MASK AIRWAY PROSEAL AND LARYNGEAL MASK AIRWAY SUPREME IN ANESTHETIZED ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    Vinayaka

    2015-10-01

    Full Text Available BACKGROUND : Newer supraglottic airway devices have been recently introduced, motivated by the need for a single use equivalent to the reusable LMA Proseal. LMA Supreme is a new single use laryngeal mask airway with gastric access providing an easy, reliable airway and good airway seal. The objectives of the present study were to compare LMA Proseal and LMA Supreme for ease of insertion, oropharyn geal leak pressure and fibre - optic position in anesthetized adult patients. MATERIAL AND METHODS : We conducted a prospective randomized study in 60 ASA grade I and II adult patients posted for elective surgeries under general anesthesia. Both devices were inserted into each patient in random order. Two attempts were allowed. Digital insertion was used for the first attempt and guided insertion for the second attempt. The ease of insertion, oropharyngeal leak pressure and fibre - optic position were determined . RESULTS : First attempt and overall success of insertion were similar (LMA Proseal 93.33% and 100%; LMA Supreme 96.66% and 100%. Guided insertion was always successful following failed digital insertion. There was no difference in the mean duration of insertion for both the devices (23.92±1.44 vs 23.44±1.72seconds. The mean oropharyngeal leak pressure was significantly higher for the LMA Proseal than the LMA Supreme (23.24 vs 19.37cm of H 2 O (p<0.05. The fibre - optic view of the glottis was similar for both the devices. CONCLUSION : In this study, the ease of insertion and fibre - optic position were similar for the LMA Proseal and LMA Supreme, but oropharyngeal leak pressure is higher for the LMA Proseal. The LMA Proseal provides a more effective seal tha n LMA Supreme for positive pressure ventilation.

  3. Treating asthma means treating airway smooth muscle cells

    NARCIS (Netherlands)

    Zuyderduyn, S; Sukkar, M B; Fust, A; Dhaliwal, S; Burgess, J K

    2008-01-01

    Asthma is characterised by airway hyperresponsiveness, airway inflammation and airway remodelling. Airway smooth muscle cells are known to be the main effector cells of airway narrowing. In the present paper, studies will be discussed that have led to a novel view of the role of airway smooth muscle

  4. 神经肽Y与阻塞性睡眠呼吸暂停低通气综合征所致高血压的相关性%Study on the relationship between blood pressure and plasma neuropeptide Y among patients with obstructive sleep apnea-hypopnea syndrome

    Institute of Scientific and Technical Information of China (English)

    陈瑀; 林其昌

    2010-01-01

    Objective To investigate the role of plasma neuropeptide Y (NPY) in physiopathologic process of obstructive sleep apnea-hypopnea syndrome (OSAHS) accompanied by hypertension. Methods Thirty-one patients with OSAHS were placed into the OSAHS group,and 30 normal subjects into the control group. First, the plasma concentrations of NPY, right upper extremity arteria brachialis blood pressure,apnea-hypopnea index ( AHI) , minimal saturation of pulse oxygen ( MinSpO2 ) and time when percent of nocturnal oxygen saturation lower than 90% (T-SaO2<90%) were measured respectively. And the relationship between NPY and the other variables were analyzed in both groups. Second,26 OSAHS patients accepted nasal continuous positive airway pressure (nCPAP) therapy. After 3-month treatment with nCPAP,plasma concentration of NPY,right upper extremity arteria brachialis blood pressure, AHI,MinSpO2 and T-SaO2<90% were remeasured and compared with the OSAHS group. Results Our study indicated that compared to the control subjects the patients with OSAHS had higher mean arterial pressure (MAP) and the NPY level in plasma ( P <0. 01). After the 3-month nCPAP therapy both MAP and the NPY level were significantly decreased(P <0. 01). And the decrease of MAP and the plasma level of NPY had positive correlation with AHI ( P <0. 01). The decrease of MAP also had positive correlation with the decrease of the plasma level of NPY ( P <0. 05). In all groups. MAP and the plasma level of NPY both had positive correlation with AHI, T-SaO2 < 90% (P < 0. 01), and negative correlation with MinSpO2 ( P <0. 01). MAP exhibited positive correlation with the plasma level of NPY in all groups (P<0. 01). Stepwise multiple regression analysis showed that regression equation was: NPY= 2. 229 X AHI-2. 928 X MinSpO2 + 1. 729 X MAP+ 279. 321. Conclusions Our research suggests that there is a close relationship between the plasma NPY level and the OSAHS combined with hypertension. nCPAP therapy

  5. Airway surface liquid volume expansion induces rapid changes in amiloride-sensitive Na+ transport across upper airway epithelium-Implications concerning the resolution of pulmonary edema

    Science.gov (United States)

    Azizi, Fouad; Arredouani, Abdelilah; Mohammad, Ramzi M

    2015-01-01

    During airway inflammation, airway surface liquid volume (ASLV) expansion may result from the movement of plasma proteins and excess liquid into the airway lumen due to extravasation and elevation of subepithelial hydrostatic pressure. We previously demonstrated that elevation of submucosal hydrostatic pressure increases airway epithelium permeability resulting in ASLV expansion by 500 μL cm−2 h−1. Liquid reabsorption by healthy airway epithelium is regulated by active Na+ transport at a rate of 5 μL cm−2 h−1. Thus, during inflammation the airway epithelium may be submerged by a large volume of luminal liquid. Here, we have investigated the mechanism by which ASLV expansion alters active epithelial Na+ transport, and we have characterized the time course of the change. We used primary cultures of tracheal airway epithelium maintained under air interface (basal ASLV, depth is 7 ± 0.5 μm). To mimic airway flooding, ASLV was expanded to a depth of 5 mm. On switching from basal to expanded ASLV conditions, short-circuit current (Isc, a measure of total transepithelial active ion transport) declined by 90% with a half-time (t1/2) of 1 h. 24 h after the switch, there was no significant change in ATP concentration nor in the number of functional sodium pumps as revealed by [3H]-ouabain binding. However, amiloride-sensitive uptake of 22Na+ was reduced by 70% upon ASLV expansion. This process is reversible since after returning cells back to air interface, Isc recovered with a t1/2 of 5–10 h. These results may have important clinical implications concerning the development of Na+ channels activators and resolution of pulmonary edema. PMID:26333829

  6. Multiscale Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; de Bruijne, Marleen

    2009-01-01

    that is trained to differentiate between airway and non-airway voxels. Vessel and airway orientation information are used in the form of a vessel orientation similarity measure, which indicates how similar the orientation of the an airway candidate is to the orientation of the neighboring vessel. The method...... is evaluated within EXACT’09 on a diverse set of CT scans. Results show a favorable combination of a relatively large portion of the tree detected correctly with very few false positives....

  7. Mouth-opening increases upper-airway collapsibility without changing resistance during midazolam sedation.

    Science.gov (United States)

    Ayuse, T; Inazawa, T; Kurata, S; Okayasu, I; Sakamoto, E; Oi, K; Schneider, H; Schwartz, A R

    2004-09-01

    Sedative doses of anesthetic agents affect upper-airway function. Oral-maxillofacial surgery is frequently performed on sedated patients whose mouths must be as open as possible if the procedures are to be accomplished successfully. We examined upper-airway pressure-flow relationships in closed mouths, mouths opened moderately, and mouths opened maximally to test the hypothesis that mouth-opening compromises upper-airway patency during midazolam sedation. From these relationships, upper-airway critical pressure (Pcrit) and upstream resistance (Rua) were derived. Maximal mouth-opening increased Pcrit to -3.6 +/- 2.9 cm H2O compared with -8.7 +/- 2.8 (p = 0.002) for closed mouths and -7.2 +/- 4.1 (p = 0.038) for mouths opened moderately. In contrast, Rua was similar in all three conditions (18.4 +/- 6.6 vs. 17.7 +/- 7.6 vs. 21.5 +/- 11.6 cm H2O/L/sec). Moreover, maximum mouth-opening produced an inspiratory airflow limitation at atmosphere that was eliminated when nasal pressure was adjusted to 4.3 +/- 2.7 cm H2O. We conclude that maximal mouth-opening increases upper-airway collapsibility, which contributes to upper-airway obstruction at atmosphere during midazolam sedation.

  8. Pharmacogenetics, pharmacogenomics and airway disease

    Directory of Open Access Journals (Sweden)

    Hall Ian P

    2001-11-01

    Full Text Available Abstract The availability of a draft sequence for the human genome will revolutionise research into airway disease. This review deals with two of the most important areas impinging on the treatment of patients: pharmacogenetics and pharmacogenomics. Considerable inter-individual variation exists at the DNA level in targets for medication, and variability in response to treatment may, in part, be determined by this genetic variation. Increased knowledge about the human genome might also permit the identification of novel therapeutic targets by expression profiling at the RNA (genomics or protein (proteomics level. This review describes recent advances in pharmacogenetics and pharmacogenomics with regard to airway disease.

  9. Evaluación del Empleo de CPAP de Boussignac en un Sistema de Emergencias Médicas

    OpenAIRE

    Pérez Regueiro, Irene

    2012-01-01

    Introducción: La CPAP de Boussignac® es un dispositivo de Ventilación no Invasiva portátil, ligero y fácil de usar que permite aplicar una presión positiva continua en la vía aérea a los pacientes con sospecha de Edema agudo de Pulmón y/o Insuficiencia Cardiaca, fundamentalmente, con el objetivo de conseguir un reclutamiento alveolar y con ello una mejora de la oxigenación. Sin embargo, también están descritas otras indicaciones de uso como: neumonía, EPOC, pacientes semiahogados, etc. ...

  10. Functional phenotype of airway myocytes from asthmatic airways

    NARCIS (Netherlands)

    Wright, David B.; Trian, Thomas; Siddiqui, Sana; Pascoe, Chris D.; Ojo, Oluwaseun O.; Johnson, Jill R.; Dekkers, Bart G. J.; Dakshinamurti, Shyamala; Bagchi, Rushita; Burgess, Janette K.; Kanabar, Varsha

    2013-01-01

    In asthma, the airway smooth muscle (ASM) cell plays a central role in disease pathogenesis through cellular changes which may impact on its microenvironment and alter ASM response and function. The answer to the long debated question of what makes a 'healthy' ASM cell become 'asthmatic' still remai

  11. Prolonged ozone exposure in an allergic airway disease model: Adaptation of airway responsiveness and airway remodeling

    Directory of Open Access Journals (Sweden)

    Park Chang-Soo

    2006-02-01

    Full Text Available Abstract Background Short-term exposure to high concentrations of ozone has been shown to increase airway hyper-responsiveness (AHR. Because the changes in AHR and airway inflammation and structure after chronic ozone exposure need to be determined, the goal of this study was to investigate these effects in a murine model of allergic airway disease. Methods We exposed BALB/c mice to 2 ppm ozone for 4, 8, and 12 weeks. We measured the enhanced pause (Penh to methacholine and performed cell differentials in bronchoalveolar lavage fluid. We quantified the levels of IL-4 and IFN-γ in the supernatants of the bronchoalveolar lavage fluids using enzyme immunoassays, and examined the airway architecture under light and electron microscopy. Results The groups exposed to ozone for 4, 8, and 12 weeks demonstrated decreased Penh at methacholine concentrations of 12.5, 25, and 50 mg/ml, with a dose-response curve to the right of that for the filtered-air group. Neutrophils and eosinophils increased in the group exposed to ozone for 4 weeks compared to those in the filtered-air group. The ratio of IL-4 to INF-γ increased significantly after exposure to ozone for 8 and 12 weeks compared to the ratio for the filtered-air group. The numbers of goblet cells, myofibroblasts, and smooth muscle cells showed time-dependent increases in lung tissue sections from the groups exposed to ozone for 4, 8, and 12 weeks. Conclusion These findings demonstrate that the increase in AHR associated with the allergic airway does not persist during chronic ozone exposure, indicating that airway remodeling and adaptation following repeated exposure to air pollutants can provide protection against AHR.

  12. The human airway epithelial basal cell transcriptome.

    Directory of Open Access Journals (Sweden)

    Neil R Hackett

    Full Text Available BACKGROUND: The human airway epithelium consists of 4 major cell types: ciliated, secretory, columnar and basal cells. During natural turnover and in response to injury, the airway basal cells function as stem/progenitor cells for the other airway cell types. The objective of this study is to better understand human airway epithelial basal cell biology by defining the gene expression signature of this cell population. METHODOLOGY/PRINCIPAL FINDINGS: Bronchial brushing was used to obtain airway epithelium from healthy nonsmokers. Microarrays were used to assess the transcriptome of basal cells purified from the airway epithelium in comparison to the transcriptome of the differentiated airway epithelium. This analysis identified the "human airway basal cell signature" as 1,161 unique genes with >5-fold higher expression level in basal cells compared to differentiated epithelium. The basal cell signature was suppressed when the basal cells differentiated into a ciliated airway epithelium in vitro. The basal cell signature displayed overlap with genes expressed in basal-like cells from other human tissues and with that of murine airway basal cells. Consistent with self-modulation as well as signaling to other airway cell types, the human airway basal cell signature was characterized by genes encoding extracellular matrix components, growth factors and growth factor receptors, including genes related to the EGF and VEGF pathways. Interestingly, while the basal cell signature overlaps that of basal-like cells of other organs, the human airway basal cell signature has features not previously associated with this cell type, including a unique pattern of genes encoding extracellular matrix components, G protein-coupled receptors, neuroactive ligands and receptors, and ion channels. CONCLUSION/SIGNIFICANCE: The human airway epithelial basal cell signature identified in the present study provides novel insights into the molecular phenotype and biology of

  13. Positive expiratory pressure and oscillatory positive expiratory pressure therapies.

    Science.gov (United States)

    Myers, Timothy R

    2007-10-01

    Airway clearance techniques, historically referred to as chest physical therapy, have traditionally consisted of a variety of breathing maneuvers or exercises and manual percussion and postural drainage. The methods and types of airway clearance techniques and devices have rapidly increased in an effort to find a more efficacious strategy that allows for self-therapy, better patient adherence and compliance, and more efficient durations of care. Mechanically applied pressure devices have migrated from European countries over the last several decades to clinical practice in the United States. I conducted a comprehensive MEDLINE search of two such devices: positive expiratory pressure (PEP) and oscillatory positive expiratory pressure (OPEP) and their role in airway clearance strategies. This was followed by a comprehensive search for cross-references in an attempt to identify additional studies. The results of that search are contained and reported in this review. From a methods standpoint, most of the studies of PEP and OPEP for airway clearance are limited by crossover designs and small sample sizes. While PEP and OPEP do not definitively prove superiority to other methods of airway clearance strategies, there is no clear evidence that they are inferior. Ultimately, the correct choice may be an airway clearance strategy that is clinically and cost effective, and is preferred by the patient so that adherence and compliance can be at the very least supported.

  14. Incidence of unanticipated difficult airway using an objective airway score versus a standard clinical airway assessment

    DEFF Research Database (Denmark)

    Nørskov, Anders Kehlet; Rosenstock, Charlotte Valentin; Wetterslev, Jørn

    2013-01-01

    the examination and registration of predictors for difficult mask ventilation with a non-specified clinical airway assessment on prediction of difficult mask ventilation.Method/Design: We cluster-randomized 28 Danish departments of anaesthesia to airway assessment either by the SARI or by usual non...... reduction equalling a number needed to treat of 180. Sample size estimation is adjusted for the study design and based on standards for randomization on cluster-level. With an average cluster size of 2,500 patients, 70,000 patients will be enrolled over a 1-year trial period. The database is programmed so...

  15. Vessel-guided Airway Tree Segmentation

    DEFF Research Database (Denmark)

    Lo, P.; Sporring, J.; Ashraf, H.;

    2010-01-01

    This paper presents a method for airway tree segmentation that uses a combination of a trained airway appearance model, vessel and airway orientation information, and region growing. We propose a voxel classification approach for the appearance model, which uses a classifier that is trained...... method is evaluated on 250 low dose computed tomography images from a lung cancer screening trial. Our experiments showed that applying the region growing algorithm on the airway appearance model produces more complete airway segmentations, leading to on average 20% longer trees, and 50% less leakage...

  16. Inflammatory bowel disease and airway diseases

    Science.gov (United States)

    Vutcovici, Maria; Brassard, Paul; Bitton, Alain

    2016-01-01

    Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact. PMID:27678355

  17. The Lung Microbiome and Airway Disease.

    Science.gov (United States)

    Lynch, Susan V

    2016-12-01

    A growing body of literature has demonstrated relationships between the composition of the airway microbiota (mixed-species communities of microbes that exist in the respiratory tract) and critical features of immune response and pulmonary function. These studies provide evidence that airway inflammatory status and capacity for repair are coassociated with specific taxonomic features of the airway microbiome. Although directionality has yet to be established, the fact that microbes are known drivers of inflammation and tissue damage suggests that in the context of chronic inflammatory airway disease, the composition and, more importantly, the function, of the pulmonary microbiome represent critical factors in defining airway disease outcomes.

  18. Mucus hypersecretion in the airway

    Institute of Scientific and Technical Information of China (English)

    WANG Ke; WEN Fu-qiang; XU Dan

    2008-01-01

    @@ Mucus hypersecretion is a distinguishing feature of Chronic intlammation diseases,such as asthma,1chronic bronchitis.2 bronchiectasis3 and cystic fibrosis.4Mucus hypersecretion leads to impairment of mucociliary clearance,abnormal bacterial plantation,mucus plug in the airway,and dysfunction of gas exchange.5

  19. Airway nerves: in vitro electrophysiology.

    Science.gov (United States)

    Fox, Alyson

    2002-06-01

    Recording the activity of single airway sensory fibres or neuronal cell bodies in vitro has allowed detailed characterisation of fibre types and membrane properties. Fibre types can be identified by their conduction velocities and further studied by the application of drugs to their receptive field. C-fibres are sensitive to mechanical stimuli and a range of irritant chemicals (bradykinin, capsaicin, low pH, platelet-activating factor), whereas Adelta-fibres are relatively insensitive to chemical stimuli and appear to correlate to the rapidly adapting receptors identified in airways in vivo. Their site of origin also differs: upper airway C-fibres arise predominantly from the jugular ganglion and Adelta-fibres from the jugular and nodose ganglia. Intracellular recording from cell bodies in the ganglia has revealed a calcium-dependent potassium current common to many putative C-fibre cell bodies. This slow after hyperpolarisation current may be inhibited by stimuli that excite and sensitise C-fibres - this could be an important mechanism underlying the sensitisation of C-fibres in airway irritability.

  20. Comparação dos níveis de pressão positiva contínua nas vias aéreas através de dois sistemas A comparison of the continuous positive airway pressures produced by two systems

    Directory of Open Access Journals (Sweden)

    Marcela Raquel de Oliveira Lima

    2004-01-01

    = 0,000. CONCLUSÃO: Através dos nossos registros, foi possível observar que o sistema pressão positiva contínua nas vias aéreas no Inter 3® comportou-se de forma mais estável e linear do que a pressão positiva contínua nas vias aéreas no selo d'água, uma vez que esta apresentou grandes variações pressóricas.OBJECTIVE: To compare the generation of continuous positive airway pressure using a hand-made device (underwater seal or a ventilator (Inter 3®. METHODOLOGY: Two positive airway pressure generation systems were compared through laboratory simulations. Measurements were not considered if the mechanical ventilator required calibration or in the presence of gas flow variation (flowmeter sphere oscillation. Recordings were assessed in terms of the capacity to produce the desired pressure (3, 5 and 6 cmH2O when submitted to three different flow values (8, 10 and 12 l/min. For that end, Student's t test for paired samples and the nonparametric Man-Whitney test for independent samples were employed. RESULTS: We verified that the systems behave in different manners under the same conditions of flow and positive end expiratory pressure. For the mechanical ventilator, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 2.26±0.41, 2.22±0.37, 2.04±0.41, respectively; under positive end-expiratory pressure at 5 cmH2O we found 3.96±0.41, 3.87±0.43 and 3.75±0.52; and under positive end-expiratory pressure at 6 cmH2O the values recorded were 4.94±0.40, 4.85±0.41 and 4.72±0.37. For the underwater seal, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 4.24±0.24, 4.46±0.26, 4.72±0.37, respectively; at 5 cmH2O the values were 5.97±0.17, 6.28±0.18, 6.47±0.31; and at 6 cmH2O we recorded 6.85±0.20, 7.17±0.29 and 7.53±0.31. All the comparisons were statistically significant (p = 0.000. CONCLUSION: Through our recordings it

  1. Possible role of differential growth in airway wall remodeling in asthma

    KAUST Repository

    Moulton, D. E.

    2011-01-20

    Possible role of differential growth in airway wall remodeling in asthma. J Appl Physiol 110: 1003-1012, 2011. First published January 20, 2011; doi:10.1152/japplphysiol.00991.2010.- Airway remodeling in patients with chronic asthma is characterized by a thickening of the airway walls. It has been demonstrated in previous theoretical models that this change in thickness can have an important mechanical effect on the properties of the wall, in particular on the phenomenon of mucosal folding induced by smooth muscle contraction. In this paper, we present a model for mucosal folding of the airway in the context of growth. The airway is modeled as a bilayered cylindrical tube, with both geometric and material nonlinearities accounted for via the theory of finite elasticity. Growth is incorporated into the model through the theory of morphoelasticity. We explore a range of growth possibilities, allowing for anisotropic growth as well as different growth rates in each layer. Such nonuniform growth, referred to as differential growth, can change the properties of the material beyond geometrical changes through the generation of residual stresses. We demonstrate that differential growth can have a dramatic impact on mucosal folding, in particular on the critical pressure needed to induce folding, the buckling pattern, as well as airway narrowing. We conclude that growth may be an important component in airway remodeling. Copyright © 2011 the American Physiological Society.

  2. 探讨CPAP在新生儿呼吸疾病中的应用价值%Exploring application value of CPAP in neonatal respiratory diseases

    Institute of Scientific and Technical Information of China (English)

    韩小月

    2015-01-01

    Objective To explore application value of CPAP in neonatal respiratory diseases.Methods divide 60 neonatal patients with respiratory failure into CPAP group and control group. CPAP group received nasal CPAP treatment, and control group received oxygen inhalation by head net combined with medicine.Results after treatment, PaCO2 of CPAP group and control group was (5.3± 1.8) vs (6.6± 0.7), PaO2 was (10.7± 1.3) vs (8.6±1.8), the cure rate was 86.67% vs 53.33%, (P < 0.05).Conclusion CPAP treatment for neonatal respiratory disease may avoid negative effects of mechanical ventilation, and improve effect of breathing obviously with effective improvement of cure rate and high clinical application value.%目的:探讨CPAP在新生儿呼吸疾病中的应用价值。方法将60例呼吸衰竭新生儿平均分为CPAP组和对照组, CPAP组接受鼻塞式 CPAP治疗,对照组接受头罩吸氧联合药物治疗。结果治疗后CPAP组与对照组PaCO2为(5.3±1.8) vs(6.6±0.7),PaO2为(10.7±1.3)vs(8.6±1.8),治愈率为86.67%vs53.33%,(P<0.05)。结论对呼吸疾病的新生儿应用 CPAP治疗避免了机械通气带来的负性影响,改善呼吸的效果十分明显,可有效提高治愈率,临床应用价值高。

  3. Sarcoidosis of the upper and lower airways.

    Science.gov (United States)

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.

  4. Airway remodeling in asthma: what really matters.

    Science.gov (United States)

    Fehrenbach, Heinz; Wagner, Christina; Wegmann, Michael

    2017-03-01

    Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and "endotyped" human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.

  5. Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways

    Institute of Scientific and Technical Information of China (English)

    XUE Fu-shan; HE Nong; LIAO Xu; XU Xiu-Zheng; XU Yachao; YANG Quan-yong; LUO Mao-ping; ZHANG Yan-ming

    2009-01-01

    Background There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation (ETI), therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways.Methods Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic (two doses) and laryngotracheal areas (one dose) using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores (VAS), and objective assessments by an independent investigator using patients' tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters.Results Of 210 airway sprays, 197 (93.8%) were successfully completed on the first attempt. The total time for airway spray was (14.6±1.5) minutes. During airway topical anesthesia, the average patients' tolerance scores were 1.7-2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients' reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were less

  6. 自动持续正压系统对睡眠呼吸暂停综合征的诊治分析%Analysis of Auto Set CPAP System for Diagnosis and Therapy of Sleep Apnea Syndrome

    Institute of Scientific and Technical Information of China (English)

    汪鸿; 毛丽华; 王红英

    2003-01-01

    Objective To investigate the application of a convenient, reliable and effective method for diagnosis and therapy of sleepbreathing disorders in clinic. Methods 52 snorers who were suspected of having sleep apnea syndrome (SAS) were monitored by Auto setCPAP system in diagnost ic mode. We divided 43 cases who accorded with SAS diagnostic standard into two groups by AHI or LOSAT, which werelight to moderate SAS group and sever SAS group. Their relied parameters were compared 10 patients with moderate - sever SAS we re treated byAuto set CPAP system in therapeutic mode. Results Auto set CPAP system could record main parameters to diagnose SAS in diagnostic modeSimultaneously SAS were distinguished into different degrees according to the monitoring results After treatment, patients' sleep quality wereimproved, AHI dropped and LOSAT ascended significantly and the time for Flating Index (FI) below 0. 15 or 0. 10 was reduced ( P < 0. 001 ).Average leak for nasal mask is below 0. 4L/sec. Conclusion Auto set CPAP system is convenient in its manipulation, the work strength fortechnician is low and disturbance to patient's sleep is little. Auto CPAP titration can raise patient's compliance to CPAP treatment so it is worthto be applied to clinical work widespreadly.

  7. Role of cholinergic neural transmission on airway resistance in the dog.

    Science.gov (United States)

    Kondo, T; Kobayashi, I; Hayama, N; Tazaki, G; Ohta, Y

    2000-04-12

    The unique contractile profiles of bronchial smooth muscle (Kondo et al., 1995) and its neural control were investigated by comparing responses of the bronchus and trachea to acute hypercapnia, stimulation of vagus efferent fibers before and after intravenous atropine, and intravenous acetylcholine in decerebrated and paralyzed dogs. During acute hypercapnia, airway resistance represented by peak airway pressure (Pedley et al., 1970) significantly increased as well as tracheal tension (Ttr). During electric stimulation of the vagal efferent fibers, Ttr increased and was sustained throughout the simulation period while the peak airway pressure was not maintained at the peak level. The peak Ttr and the airway resistance (Raw) calculated from ventilatory flow and airway pressure increased with increases in intensity of electric stimulation. Ttr reached its maximal level at an intensity 16 times of the threshold (T), while Raw became maximal at 4T. Although both the Ttr-stimulus intensity and Raw-intensity curves were shifted to the right by administration of intravenous atropine, the Raw curve shifted more to the right than the Ttr curve with the same dose of atropine. When muscular muscarinic receptors were directly stimulated by intravenous acetylcholine, Ttr once increased and then decreased promptly while peak airway pressure remained at a high level for a few minutes. These findings suggested that the bronchus is more sensitive to vagal efferent stimulation and susceptible to competitive antagonist of actylcholine than the trachea. In conclusion, the contractile profiles of the fifth-order bronchus we have reported (Kondo et al., 1995) were reflected in airway resistance, and the neuromuscular junction may be the site of adaptation of bronchoconstrictor response to motor nerve adaptation.

  8. Comparison of laryngeal mask airway use with endotracheal intubation during anesthesia of western lowland gorillas (Gorilla gorilla gorilla).

    Science.gov (United States)

    Cerveny, Shannon N; D'Agostino, Jennifer J; Davis, Michelle R; Payton, Mark E

    2012-12-01

    The laryngeal mask airway is an alternative to endotracheal intubation that achieves control of the airway by creating a seal around the larynx with an inflatable cuff. This study compared use of the laryngeal mask airway with endotracheal intubation in anesthetized western lowland gorillas (Gorilla gorilla gorilla). Eight adult gorillas were immobilized for routine and diagnostic purposes for a total of nine anesthetic events. During each anesthetic event, gorillas were either intubated (n = 4; group A) or fitted with a laryngeal mask airway (n= 5; group B). Time required to place each airway device, physiologic parameters, and arterial blood gas were measured and compared between the two groups. There were no significant differences between the two groups for time required to place airway device, heart rate, hemoglobin oxygen saturation, end-tidal carbon dioxide, arterial partial pressure of carbon dioxide, or arterial pH between the two groups. Mean arterial partial pressure of oxygen was significantly greater in group B, 15 (group A: 94 +/- 44 mm Hg; group B: 408 +/- 36 mm Hg; P= 0.0025) and 45 (group A: 104 +/- 21 mm Hg; group B: 407 +/- 77 mm Hg; P = 0.0026) min after airway device placement. Mean respiratory rate was significantly greater in group A at multiple time points. Mean arterial pressure (group A: 129 +/- 16 mm Hg; group B: 60 +/- 8 mm Hg) and diastolic blood pressure (group A: 115 +/- 21 mm Hg; group B: 36 +/- 10 mm Hg) were significantly greater in group A at the time of airway device placement. The laryngeal mask airway maintained oxygenation and ventilation effectively in all gorillas and is a useful alternative to endotracheal intubation in western lowland gorillas.

  9. Plethysmographic measurements of specific airway resistance in young children

    DEFF Research Database (Denmark)

    Bisgaard, Hans; Nielsen, Kim G

    2005-01-01

    children. This article reviews the method, and proposes a protocol and criteria for quality assurance for assessment of sRaw in preschool children from 2 years of age. sRaw measurements offers a method for clinical monitoring and research during this critical period of growth and development early in life.......Validated methods for lung function measurements in young children are lacking. Plethysmographic measurement of specific airway resistance (sRaw) provides such a method applicable from 2 years of age. sRaw gauges airway resistance from the measurements of the pressure changes driving the airflow...... also been documented by this technique, and sRaw has recently been used in longitudinal studies of young children with chronic pulmonary diseases. Future developments should provide improved algorithms for thermal correction of the respired volumes and adapt the equipment to the special needs of young...

  10. 经鼻面罩持续气道正压治疗重症心源性肺水肿的疗效观察%Treatment of Severe Cardiogenic Pulmonary Edema with Continuous Positive Airway Pressure by Nasal Face Mask

    Institute of Scientific and Technical Information of China (English)

    赫朝霞; 罗显荣; 刘咏梅

    2002-01-01

    目的:为了评价经鼻面罩持续气道正压(CPAP)对心源性肺水肿急性发作的疗效.方法:51例病人随机分为两组:治疗组25例,吸氧浓度为45%加用CPAP;对照组26例,单用吸氧6 L/min.结果:CPAP治疗30 min后PaO2(P<0.005)明显升高,而呼吸频率和心率明显降低(P<0.05,P<0.05);治疗12 h后,显效率为52%(13/25),总有效率为88%(22/25),明显高于对照组(P<0.01、P<0.05).结论:CPAP能明显提高PaO2,显著改善心源性肺水肿病人的心肺功能,减少对气管插管机械通气的需要.

  11. Airway injury during emergency transcutaneous airway access: a comparison at cricothyroid and tracheal sites.

    LENUS (Irish Health Repository)

    Salah, Nazar

    2009-12-01

    Oxygenation via the cricothyroid membrane (CTM) may be required in emergencies, but inadvertent tracheal cannulation may occur. In this study, we compared airway injury between the tracheal and CTM sites using different techniques for airway access.

  12. Effective gas exchange in paralyzed juvenile rabbits using simple, inexpensive respiratory support devices.

    Science.gov (United States)

    Diblasi, Robert M; Zignego, Jay C; Smith, Charles V; Hansen, Thomas N; Richardson, C Peter

    2010-12-01

    We have developed two devices: a high-amplitude bubble continuous positive airway pressure (HAB-CPAP) and an inexpensive bubble intermittent mandatory ventilator (B-IMV) to test the hypotheses that simple, inexpensive devices can provide gas exchange similar to that of bubble CPAP (B-CPAP) and conventional mechanical ventilation (CMV). Twelve paralyzed juvenile rabbits were intubated, stabilized on CMV, and then switched to CPAP. On identical mean airway pressures (MAPs), animals were unable to maintain pulse oximeter oxygen saturation (SpO2) >80% on conventional B-CPAP, but all animals oxygenated well (97.3 ± 2.1%) on HAB-CPAP. In fact, arterial partial pressures of O2 (Pao2) were higher during HAB-CPAP than during CMV (p = 0.01). After repeated lung lavages, arterial partial pressures of CO2 (Paco2) were lower with B-IMV than with CMV (p < 0.0001), despite identical ventilator settings. In lavaged animals, when HAB-CPAP was compared with CMV at the same MAP and 100% O2, no differences were observed in Pao2, but Paco2 levels were higher with HAB-CPAP (70 ± 7 versus 50 ± 5 mm Hg; p < 0.05). Arterial blood pressures were not impaired by HAB-CPAP or B-IMV. The results confirm that simple inexpensive devices can provide respiratory support in the face of severe lung disease and could extend the use of respiratory support for preterm infants into severely resource-limited settings.

  13. Computational modeling of unsteady surfactant-laden liquid plug propagation in neonatal airways

    Science.gov (United States)

    Olgac, Ufuk; Muradoglu, Metin

    2013-07-01

    Surfactant-free and surfactant-laden liquid plug propagation in neonatal airways in various generations representing the upper and lower airways are investigated computationally using a finite-difference/front-tracking method. Emphasis is placed on the unsteady surfactant-laden plug propagation as a model for Surfactant Replacement Therapy (SRT) and airway reopening. The numerical method is designed to solve the evolution equations of the interfacial and bulk surfactant concentrations coupled with the incompressible Navier-Stokes equations. Available experimental data for surfactant Survanta are used to relate surface tension coefficient to surfactant concentration at the interface. It is found that, for the surfactant-free case, the trailing film thickness is in good agreement with Taylor's law for plugs with plug length greater than the airway width. Mechanical stresses that could be injurious to epithelial cells such as pressure and shear stress and their gradients are maximized on the front and rear menisci with increasing magnitudes in the lower generations. These mechanical stresses, especially pressure and pressure gradient, are diminished with the introduction of surfactants. Surfactant is absorbed onto the trailing film and thickens it, eventually leading to either plug rupture or, if totally consumed prior to rupture, to steadily propagating plug. In the upper airways, initially small plugs rupture rapidly and plugs with comparable initial plug length with the airway width persist and propagate steadily. For a more effective SRT treatment, we recommend utilization of plugs with initial plug length greater than the airway width. Increasing surfactant strength or increasing the initially instilled surfactant concentration is found to be ineffective.

  14. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    Science.gov (United States)

    Nirupa, R; Gombar, Satinder; Ahuja, Vanita; Sharma, Preeti

    2016-01-01

    Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar.

  15. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    Directory of Open Access Journals (Sweden)

    R Nirupa

    2016-01-01

    Full Text Available Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™ in children scheduled for surgery under general anaesthesia (GA with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2-6 years of American Society of Anesthesiologists Physical Status I-II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH 2 O as compared to 26.1 ± 3.8 cmH 2 O in PLMA™ group (P = 0.002. The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007. The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar.

  16. Comparison of the streamlined pharynx airway liner with the conventional laryngeal mask airway for airway management during general anesthesia%SLIPA~(TM)喉罩与普通喉罩用于全麻气道管理的比较

    Institute of Scientific and Technical Information of China (English)

    徐建设; 陈辉; 傅卫军; 唐靖

    2010-01-01

    Objective To compare the performance of the streamlined pharynx airway liner (SLIPA~(TM)) with the conventional laryngeal mask airway(LMA) for airway management in minor surgery under general anesthesia. Methods Sixty fasted adult patients with ASA status Ⅰ~Ⅱ were randomly designed to establish SLIPA~(TM) airway (SLIPA~(TM) group) or LMA airway(LMA group) for airway management during anesthesia. Article airway handling, pharynx sealing, ventilation maintenance and adverse reactions with SLIPA~(TM) group and LMA group were assessed. Results SLIPA~(TM) had comparable total rate of successful insertion and airway placement difficulty to LMA(P>0.05). Maximum seal pressure was (22±5) cm H_20 and (24±6) cm H_2O in SLIPA~(TM) group and LMA group (P>0.05), respectively. A leak was noticed in 20% and 16.7% of patiemts in LMA group when patients' lungs were ventilated using intermittent positive pressure ventilation mode after airway mask placment and during surgery, and 3.3% and 0 in SLIPA~(TM) group (P0.05).通气道插入后SLIPA~(TM)组1例患者(3.3%)、LMA组6例患者(20%)需进一步调整位置方可行间歇正压通气;术中lJMA组5例患者(16.7%)需重新调整方可维持间歇正压通气,SLIPA~(TM)组均顺利完成手术全程间歇正压通气(P<0.05).2种喉罩通气道喉损伤的发生率差异无统计学意义.结论 SLIPA~(TM)喉罩的临床性能与LMA相似,是一种可替代LMA的通气道.SLIPA~(TM)喉罩操作简便,对咽喉损伤较小,维持间歇正压通气较LMA更为稳定.

  17. Análise do clearance mucociliar nasal e dos efeitos adversos do uso de CPAP nasal em pacientes com SAHOS

    Directory of Open Access Journals (Sweden)

    Ferri Ricardo Gimenes

    2004-01-01

    Full Text Available Desde 1981, o uso da pressão aérea positiva através do CPAP nasal vem sendo considerado o principal tratamento clínico da síndrome da apnéia-hipopnéia obstrutiva do sono (SAHOS, apesar de sua adesão parcial a longo prazo. Alguns autores referem que as queixas nasais provenientes do fluxo de ar sob pressão positiva na cavidade nasal são as principais responsáveis pela interrupção do tratamento. Isto ocorreria porque o uso do CPAP levaria a alterações na mucosa e mudanças no transporte mucociliar e, conseqüentemente, um maior número de infecções nasosinusais. OBJETIVO: Avaliar o clearance mucociliar nasal em pacientes com SAHOS em uso de CPAP nasal através do teste de sacarina e correlacionar os efeitos adversos desta terapia com o tempo de tratamento e o nível de pressão utilizada no mesmo. FORMA DE ESTUDO: Estudo clínico caso-controle. MATERIAL E MÉTODO: Foram avaliados 25 pacientes com SAHOS entre 18 a 70 anos em uso de CPAP nasal a partir de um mês acompanhados no Instituto do Sono (UNIFESP-EPM e submetidos ao teste de sacarina cujos resultados foram comparados com um grupo de 25 indivíduos sem doenças nasosinusais. RESULTADOS: Não houve diferença estatística entre os grupos em relação ao teste de sacarina.Os efeitos adversos estavam presentes em 84% da amostra, sendo 60% ressecamento e 36% obstrução nasal. Não houve correlação entre estas queixas e o tempo de tratamento ou a pressão aplicada pelo aparelho. CONCLUSÕES: O clearance mucociliar nasal no grupo com SAHOS em uso de CPAP nasal foi semelhante ao grupo controle e a obstrução nasal e o ressecamento não apresentaram correlação com o tempo de tratamento e o nível de pressão utilizada pelo aparelho.

  18. Method for 3D Airway Topology Extraction

    Directory of Open Access Journals (Sweden)

    Roman Grothausmann

    2015-01-01

    Full Text Available In lungs the number of conducting airway generations as well as bifurcation patterns varies across species and shows specific characteristics relating to illnesses or gene variations. A method to characterize the topology of the mouse airway tree using scanning laser optical tomography (SLOT tomograms is presented in this paper. It is used to test discrimination between two types of mice based on detected differences in their conducting airway pattern. Based on segmentations of the airways in these tomograms, the main spanning tree of the volume skeleton is computed. The resulting graph structure is used to distinguish between wild type and surfactant protein (SP-D deficient knock-out mice.

  19. Airway Tree Extraction with Locally Optimal Paths

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Sporring, Jon; Pedersen, Jesper Johannes Holst

    2009-01-01

    This paper proposes a method to extract the airway tree from CT images by continually extending the tree with locally optimal paths. This is in contrast to commonly used region growing based approaches that only search the space of the immediate neighbors. The result is a much more robust method...... for tree extraction that can overcome local occlusions. The cost function for obtaining the optimal paths takes into account of an airway probability map as well as measures of airway shape and orientation derived from multi-scale Hessian eigen analysis on the airway probability. Significant improvements...

  20. Anatomic Optical Coherence Tomography of Upper Airways

    Science.gov (United States)

    Chin Loy, Anthony; Jing, Joseph; Zhang, Jun; Wang, Yong; Elghobashi, Said; Chen, Zhongping; Wong, Brian J. F.

    The upper airway is a complex and intricate system responsible for respiration, phonation, and deglutition. Obstruction of the upper airways afflicts an estimated 12-18 million Americans. Pharyngeal size and shape are important factors in the pathogenesis of airway obstructions. In addition, nocturnal loss in pharyngeal muscular tone combined with high pharyngeal resistance can lead to collapse of the airway and periodic partial or complete upper airway obstruction. Anatomical optical coherence tomography (OCT) has the potential to provide high-speed three-dimensional tomographic images of the airway lumen without the use of ionizing radiation. In this chapter we describe the methods behind endoscopic OCT imaging and processing to generate full three dimensional anatomical models of the human airway which can be used in conjunction with numerical simulation methods to assess areas of airway obstruction. Combining this structural information with flow dynamic simulations, we can better estimate the site and causes of airway obstruction and better select and design surgery for patients with obstructive sleep apnea.

  1. AIRWAY VISUALIZATION: EYES SEE WHAT MIND KNOWS.

    Science.gov (United States)

    Sorbello, Massimiliano; Frova, Giulio; Zdravković, Ivana

    2016-03-01

    Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation. Nevertheless, each new technology needs time to be tested and considered reliable, and pitfalls and limitations may come out with careful and long lasting analysis, so it is probably not the right time yet to promote video assisted approach as a new gold standard for airway visualization, despite the fact that it certainly offers some new prospects. In any case, whatever the visualization approach, no patient dies because of missed airway visualization or failed intubation, but due to failed ventilation, which remains without doubt the gold standard of any patient safety goal and airway management technique.

  2. Cholinergic Regulation of Airway Inflammation and Remodelling

    Directory of Open Access Journals (Sweden)

    Saeed Kolahian

    2012-01-01

    Full Text Available Acetylcholine is the predominant parasympathetic neurotransmitter in the airways that regulates bronchoconstriction and mucus secretion. Recent findings suggest that acetylcholine regulates additional functions in the airways, including inflammation and remodelling during inflammatory airway diseases. Moreover, it has become apparent that acetylcholine is synthesized by nonneuronal cells and tissues, including inflammatory cells and structural cells. In this paper, we will discuss the regulatory role of acetylcholine in inflammation and remodelling in which we will focus on the role of the airway smooth muscle cell as a target cell for acetylcholine that modulates inflammation and remodelling during respiratory diseases such as asthma and COPD.

  3. Ultrasonography in the management of the airway

    DEFF Research Database (Denmark)

    Kristensen, M S

    2011-01-01

    In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick...... or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management...

  4. Airway smooth muscle dynamics : a common pathway of airway obstruction in asthma

    NARCIS (Netherlands)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-01-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series o

  5. Pim1 kinase protects airway epithelial cells from cigarette smoke-induced damage and airway inflammation

    NARCIS (Netherlands)

    de Vries, M.; Heijink, Hilde; Gras, R.; den Boef, L. E.; Reinders-Luinge, M.; Pouwels, S. D.; Hylkema, Machteld; van der Toorn, Marco; Brouwer, U.; van Oosterhout, A. J. M.; Nawijn, M. C.

    2014-01-01

    Exposure to cigarette smoke (CS) is the main risk factor for developing chronic obstructive pulmonary disease and can induce airway epithelial cell damage, innate immune responses, and airway inflammation. We hypothesized that cell survival factors might decrease the sensitivity of airway epithelial

  6. Effects of Continuous Posittive Airway Pressure therapy on the Concentrations of Norepinephrine in Exhaled breath condensate and Blood of patients with obstructive sleep apnea/hypopnea syndrome%正压通气治疗对OSAHS患者EBC和血清中去甲肾上腺素水平的影响

    Institute of Scientific and Technical Information of China (English)

    杨猛; 陶一江; 陈建荣; 朱杰; 姚苏梅

    2013-01-01

    目的 探讨auto-CPAP治疗对OSAHS患者交感神经兴奋性的影响.方法 根据PSG确诊的42例OSAHS患者,随机分为治疗组和对照组,对治疗组进行auto-CPAP治疗,对所有患者采取常规治疗,测定治疗组及对照组治疗前后EBC和血清中的NE.结果 (1)治疗组患者EBC和血清中NE治疗前高于治疗后(P0.05);(3)OSAHS患者EBC和血清中NE水平与AHI呈正相关关系,与LPSO2、MPSO2呈负相关关系(P<0.01).结论 OSAHS患者常伴有交感神经兴奋性的增强,并且可以通过auto-CPAP治疗得以改善.%Objective To investigate the effect of auto-CPAP therapy on the sympathetic nerve activation in patients with obstructive sleep apnea/hypopnea syndrome ( OSAHS ). Methods 42 patients with OSAHS diagnosed by polysomnograpgy monitoring were randomly allocated to the active group ( n = 22 ) or the control group ( n = 20 ) respectively. The active group received the treatment of auto-CPAP and all of the subjects received general treatment. Norepinephrine levels in EBC and plasma were measured by enzyme linked im-munosorbent assay ( ELISA ) before and after 3 months. Results ( 1 ) The concentrations of norepinephrine in EBC and plasma in the active group before treatment were higher than the after;( 2 ) Before and after the treatment,there was no statistical difference of the concentrations of norepinephrine in EBC and plasma in the control group;( 3 ) Norepinephrine levels in plasma and EBC were positively related with apnea hypoventilation index( AHI), and were inversely related with the lowest blood oxygen saturation( LSPO2 ) and average blood oxygen saturation( MSPO2 ). Conclusion OSAHS patients often accompanied by higher sympathetic nerve activation and can be improved by auto-CPAP treatment.

  7. Patient Perspective on Use of an Interactive Website for Sleep Apnea

    Directory of Open Access Journals (Sweden)

    Carl Stepnowsky

    2013-01-01

    Full Text Available Incomplete patient adherence with nasal continuous positive airway pressure (CPAP limits the effectiveness of treatment and results in suboptimal obstructive sleep apnea (OSA outcomes. An interactive website specifically designed for patients with OSA was designed and utilized in a randomized clinical trial to test its effect on increasing CPAP adherence. The goal of this paper is to report on CPAP adherence, internet use, privacy concerns and user satisfaction in using the website. The original project was designed as a randomized, controlled clinical trial of Usual Care (UC, control versus MyCPAP group (intervention. Questionnaires were administered to evaluate the patient perspective of using the MyCPAP website. Participation in the MyCPAP intervention resulted in higher CPAP adherence at the two-month time point relative to participation in the UC group (3.4  ±  2.4 and 4.1  ±  2.3 hrs/nt; P=0.02; mean  ±  SD. Participants randomized to the MyCPAP website increased their use of the internet to obtain OSA related information, but did not increase their use of the internet to get information on general health or medical conditions. Users had very little concern about their CPAP data being viewed daily or being sent over the internet. Future studies should consider the use of newer evaluation criteria for collaborative adaptive interactive technologies.

  8. Airway blood flow response to dry air hyperventilation in sheep

    Energy Technology Data Exchange (ETDEWEB)

    Parsons, G.H.; Baile, E.M.; Pare, P.D.

    1986-03-01

    Airway blood flow (Qaw) may be important in conditioning inspired air. To determine the effect of eucapneic dry air hyperventilation (hv) on Qaw in sheep the authors studied 7 anesthetized open-chest sheep after 25 min. of warm dry air hv. During each period of hv the authors have recorded vascular pressures, cardiac output (CO), and tracheal mucosal and inspired air temperature. Using a modification of the reference flow technique radiolabelled microspheres were injected into the left atrium to make separate measurements after humid air and dry air hv. In 4 animals a snare around the left main pulmonary artery was used following microsphere injection to prevent recirculation (entry into L lung of microspheres from the pulmonary artery). Qaw to the trachea and L lung as measured and Qaw for the R lung was estimated. After the final injection the sheep were killed and bronchi (Br) and lungs removed. Qaw (trachea plus L lung plus R lung) in 4 sheep increased from a mean of 30.8 to 67.0 ml/min. Airway mucosal temp. decreased from 39/sup 0/ to 33/sup 0/C. The authors conclude that dry air hv cools airway mucosa and increases Qaw in sheep.

  9. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

    Science.gov (United States)

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-05-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

  10. Ingestion of a Foreign Body in a Preterm Infant

    OpenAIRE

    Duran, Rıdvan; İnan, Mustafa; Vatansever, Ülfet; Acunaş, Betül

    2004-01-01

    Ingestion of a foreign body is very rare in newborn infants. Ingestion of the endotracheal tube during nasal continuous positive airway pressure (CPAP) treatment in low birth weight preterm infants is even rarer. A preterm male infant who underwent nasal CPAP treatment on the first postnatal day for prematurity and respiratory insufficiency was found to ingest the distal part of the entubation tube. Direct radiography showed the tube residing between the lower end of the esophagus and the ent...

  11. Comparison of Cobra perilaryngeal airway (CobraPLA TM with flexible laryngeal mask airway in terms of device stability and ventilation characteristics in pediatric ophthalmic surgery

    Directory of Open Access Journals (Sweden)

    Rani A Sunder

    2012-01-01

    Full Text Available Background: Supraglottic airway devices play an important role in ophthalmic surgery. The flexible laryngeal mask airway (LMA TM is generally the preferred airway device. However, there are no studies comparing it with the Cobra perilaryngeal airway (CobraPLA TM in pediatric ophthalmic procedures. Aims: To analyze the intraoperative device stability and ability to maintain normocarbia of CobraPLA TM and compare it to that with flexible LMA TM . Materials and Methods: Ninety children of American Society for Anesthesiologists physical status 1 and 2, aged 3-15 years scheduled for elective ophthalmic surgeries were randomly assigned to either the CobraPLA TM or the flexible LMA TM group. After placement of each airway device, oropharyngeal leak pressure (OLP was noted. Adequate seal of the devices was confirmed at an inspired pressure of 15 cm H 2 O and pressure-controlled ventilation was initiated. Device displacement was diagnosed if there was a change in capnograph waveform, audible or palpable gas leak, change in expired tidal volume to 6 kPa, or need to increase inspired pressure to >18 cm H 2 O to maintain normocarbia. Results: Demographic data, duration, and type of surgery in both the groups were similar. A higher incidence of intraoperative device displacement was noted with the CobraPLA TM in comparison to flexible LMA TM (P < 0.001. Incidence of displacement was higher in strabismus surgery (7/12. Insertion characteristics and ventilation parameters were comparable. The OLP was significantly higher in CobraPLA TM group (28 ± 6.8 cm H 2 O compared to the flexible LMA TM group (19.9 ± 4.5 cm H 2 O (P < 0.001. Higher surgeon dissatisfaction (65.9% was seen in the CobraPLA TM group. Conclusion: The high incidence of device displacement and surgeon dissatisfaction make CobraPLA TM a less favorable option than flexible LMA TM in ophthalmic surgery.

  12. A randomised crossover trial comparing a single-use polyvinyl chloride laryngeal mask airway with a single-use silicone laryngeal mask airway.

    Science.gov (United States)

    Bell, S F; Morris, N G; Rao, A; Wilkes, A R; Goodwin, N

    2012-12-01

    We compared insertion rates of single-use polyvinyl chloride laryngeal mask airways (LMAs) vs single-use silicone LMAs in 72 anaesthetised patients. Both airways were produced by Flexicare Medical. Laryngeal mask airway insertion was successful on the first attempt in 68/72 (94%) polyvinyl chloride LMAs vs 64/72 (89%) silicone LMAs (p = 0.39). Overall insertion rates were 72/72 (100%) for the polyvinyl chloride LMAs and 71/72 (99%) for the silicone LMAs (p = 1.0). Mean (SD) insertion times were similar for polyvinyl chloride and silicone LMAs: 24.3 (5.1)s vs 24.8 (7.8)s (p = 0.64). Laryngeal mask airway position, as assessed using a fibrescope, was not different (p = 0.077). The median (IQR [range]) leak pressure was 16 (12-20 [6-30]) cmH(2) O for the polyvinyl LMA and 18 (13-22 [6-30]) cmH(2) O or the silicone LMA (p = 0.037). In conclusion, we did not find any important differences between polyvinyl chloride and silicone laryngeal mask airways.

  13. Extraction of Airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin; Ginneken, Bram van; Reinhardt, Joseph M.;

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standar...

  14. Endothelin receptor antagonist and airway dysfunction in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    Borst Mathias M

    2009-12-01

    Full Text Available Abstract Background In idiopathic pulmonary arterial hypertension (IPAH, peripheral airway obstruction is frequent. This is partially attributed to the mediator dysbalance, particularly an excess of endothelin-1 (ET-1, to increased pulmonary vascular and airway tonus and to local inflammation. Bosentan (ET-1 receptor antagonist improves pulmonary hemodynamics, exercise limitation, and disease severity in IPAH. We hypothesized that bosentan might affect airway obstruction. Methods In 32 IPAH-patients (19 female, WHO functional class II (n = 10, III (n = 22; (data presented as mean ± standard deviation pulmonary vascular resistance (11 ± 5 Wood units, lung function, 6 minute walk test (6-MWT; 364 ± 363.7 (range 179.0-627.0 m, systolic pulmonary artery pressure, sPAP, 79 ± 19 mmHg, and NT-proBNP serum levels (1427 ± 2162.7 (range 59.3-10342.0 ng/L were measured at baseline, after 3 and 12 months of oral bosentan (125 mg twice per day. Results and Discussion At baseline, maximal expiratory flow at 50 and 25% vital capacity were reduced to 65 ± 25 and 45 ± 24% predicted. Total lung capacity was 95.6 ± 12.5% predicted and residual volume was 109 ± 21.4% predicted. During 3 and 12 months of treatment, 6-MWT increased by 32 ± 19 and 53 ± 69 m, respectively; p Conclusion This study gives first evidence in IPAH, that during long-term bosentan, improvement of hemodynamics, functional parameters or serum biomarker occur independently from persisting peripheral airway obstruction.

  15. Extraction of airways from CT (EXACT’09)

    DEFF Research Database (Denmark)

    Lo, Pechin Chien Pau; Ginneken, Bram van; Reinhardt, Joseph M.

    2012-01-01

    This paper describes a framework for establishing a reference airway tree segmentation, which was used to quantitatively evaluate 15 different airway tree extraction algorithms in a standardized manner. Because of the sheer difficulty involved in manually constructing a complete reference standard...... or not it is a correctly segmented part of the airway tree. Finally, the reference airway trees are constructed by taking the union of all correctly extracted branch segments. Fifteen airway tree extraction algorithms from different research groups are evaluated on a diverse set of 20 chest computed tomography (CT) scans...... from the evaluation showed that no single algorithm could extract more than an average of 74% of the total length of all branches in the reference standard, indicating substantial differences between the algorithms. A fusion scheme that obtained superior results is presented, demonstrating...

  16. Vocal Function and Upper Airway Thermoregulation in Five Different Environmental Conditions

    Science.gov (United States)

    Sandage, Mary J.; Connor, Nadine P.; Pascoe, David D.

    2014-01-01

    Purpose: Phonation threshold pressure and perceived phonatory effort were hypothesized to increase and upper airway temperature to decrease following exposure to cold and/or dry air. Greater changes were expected with mouth versus nose breathing. Method: In a within-participant repeated measures design, 15 consented participants (7 men, 8 women)…

  17. Pressão expiratória positiva na via aérea por máscara facial na hemodinâmica de pós-operatórios cardíacos Expiratory positive airway pressure in postoperative cardiac hemodynamics

    Directory of Open Access Journals (Sweden)

    Ana Claudia Borges dos Santos Sena

    2010-10-01

    Full Text Available FUNDAMENTOS: A pressão expiratória positiva na via aérea por máscara facial (EPAP é utilizada no pós-operatório de cirurgias cardíacas, entretanto, seus efeitos hemodinâmicos não foram claramente estudados. OBJETIVO: Avaliar as alterações hemodinâmicas causadas pela EPAP em pacientes pós-cirurgia cardíaca monitorados por cateter de Swan-Ganz. MÉTODOS: Foram incluídos no estudo, pacientes no primeiro ou segundo pós-operatório de cirurgia cardíaca, estáveis hemodinamicamente e com cateter de Swan-Ganz. Eles foram avaliados em repouso e após o uso de 10 cmH2O de EPAP, de forma randomizada. As variáveis estudadas foram: saturação de oxigênio, frequências cardíaca e respiratória, pressões arteriais médias sistêmica e pulmonar (PAM e PAMP, pressões venosa central (PVC e de oclusão da atéria pulmonar (POAP, débito e índice cardíacos, e resistências vasculares sistêmica e pulmonar. Os pacientes foram divididos em subgrupos (com fração de ejeção 50% e os dados foram comparados por teste t e ANOVA. RESULTADOS: Vinte e oito pacientes