Predictive equations for CPAP titration in OSAS patients.

BACKGROUND: Continuous positive airway pressure (CPAP) is the elective treatment of obstructive sleep apnea. The therapeutic level of CPAP is generally established by manual titration or an auto CPAP device, but an alternative way involves the use of predictive formulas. The aim of the present study was to test the difference between mathematical equations and CPAP or auto CPAP in terms of therapeutic pressure. METHODS: A retrospective analysis of 197 subjects with a diagnosis of obstructive sleep apnea needing a CPAP treatment was performed. The patients were divided into two groups: the first one included patients who had received CPAP after manual titration and the second one included patients who had received auto CPAP titration. The therapeutic CPAP pressure was then compared to the pressure calculated by three different equations: Eq. A by Stradling, Eq. B by Sériès, and Eq. C by Hoffstein. RESULTS: One hundred ninety-seven patients were included in the study, 110 were titrated by auto CPAP and 87 by manual titration. There was a positive correlation between the pressure defined by the three equations and both titration methods, but each equation usually gave a higher pressure with patients needing CPAP <8 and lower for patients needing CPAP >11. Equation C normally gave a lower result than the other two equations. CONCLUSIONS: Manual or auto CPAP titration remains the best way to define the appropriate CPAP. However, predictive formulas can be useful if used with caution and always after verifying the real efficacy, particularly for patients needing higher pressure.

[Clinical case of significant "reverse remodeling" after cardiac resynchronization therapy]. / Caso clinico di significativo "reverse remodeling" dopo terapia di resincronizzazione cardiaca.

A 79-year-old man refers to our echocardiolab for a normal follow-up after 2 years of biventricular pacing. Seven years before the present observation, the patient underwent a biological aortic valve replacement for severe valvular stenosis in the presence of marked systolic dysfunction of the left ventricle and advanced cardiac failure symptoms. The evaluation of the present and past clinical and echocardiographic parameters suggests that conventional surgery and full medical therapy did not elicit an improvement of both functional and clinical parameters, whereas cardiac resynchronization therapy dramatically improved in the mid term all the clinical and functional parameters.

Monoterapia con cefoperazona-sulbactam en infecciones intrabdominales / Monoteraphy with cefoperazona-sulbactam in intraabdominal infections

Se realizó un estudio clínico prospectivo no comparativo evaluando la eficacia y tolerancia de Cefoperazona-Sulbactam (CFZ-SBT) como monoterapia en infecciones intraabdominales que no fueran de origen traumático penetrante. Se incluyeron 30 pacientes que consultaron al Hospital Vargas de Caracas de julio 1995 a octubre y en quienes se diagnosticó infección intraabdominal que requería tanto de intervención quirúrgica como de antibioticoterapia. Se tomaron hemocultivos y cultivos de fluidos de la fuente de infección, determinando la sensibilidad in vitro de los gérmenes aislados. Los pacientes fueron evaluados desde el punto de vista clínico y de laboratorio antes, durante y después de finalizar el tratamiento, de 3 a 9 grs., endovenosos de CPZ-SBT fueron administrados diariamente de 7 a 14 días, de acuerdo a la severidad de la infección. El 73,3 por ciento de los gérmenes patógenos causantes de la infección intraabdominal fueron Gram negativo aerobios y anaerobios facultativos. Todos los gérmenes aislados de las diferentes fuentes de infección fueron sensibles in vitro a CPZ-SBT. Se obtuvo un 68,4 por ciento de erradicación y 31,6 por ciento de superinfección. Clinicamente, se reportó 80 por ciento de curación y 20 por ciento de fracaso. No hubo efectos adversos atribuibles al uso del antibiótico