Is there any relationship between nCPAP therapy and signs of sinus hyperpneumatization?

OBJECTIVES: Both nasal continuous positive airway pressure (nCPAP) therapy and nose blowing can generate high pressures in the nose and sinuses. Nose blowing generates higher pressures than nCPAP therapy, but the duration of nCPAP therapy is considerably longer than the duration of nose blowing. Therefore, nCPAP could cause bone deformation. The aim of this study was to document the influence of the pressure generated by nCPAP therapy on the structure and dimensions of the sinuses and on the nose-blowing patterns of the patients. METHODOLOGY: The study included nine patients, who had recently been diagnosed with obstructive sleep apnea syndrome (OSAS) and had not received any previous treatment for OSAS. Before nCPAP therapy was started, they all underwent computer tomography (CT) in the prone position with sequential coronal slices followed by pressure measurements during nose blowing. After the initial measurements, nCPAP therapy commenced. All of the patients were treated with a fixed-pressure device and nasal mask for 6 mo. nCPAP therapy compliance was checked after 6 mo. At the end of the 6 mo treatment with nCPAP, coronal CT scans of the sinuses and pressure measurements during nose blowing were repeated. RESULTS AND CONCLUSION: Although CPAP therapy provides continuous positive pressure for several hours at night, bone structure and sinus dimensions appeared to be unchanged after 6 mo of therapy. However, CPAP therapy seemed to have an effect on the nose-blowing pattern of the patients, with a significant decrease in nose blowing pressure after 6 mo of CPAP treatment.

Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease.

Central airway obstruction can cause severe respiratory insufficiency leading to mechanical ventilation (MV) or artificial airway (AA) dependency. Interventional bronchoscopic procedures have been reported to be of help in weaning patients with malignant airway stenoses from mechanical ventilation, whereas their use in benign disease is only anecdotal. The objectives of this study are to evaluate early, intermediate and long-term outcome of interventional bronchoscopy and stent placement in the treatment of MV/AA dependency due to benign airway obstruction. In a retrospective cohort analysis for the period 1999-2004, we evaluated 15 consecutive ICU patients with documented benign central airway obstruction, who were referred for bronchoscopic management of their condition after multiple failed attempts at weaning from MV or decannulation of the AA. Indications for bronchoscopic treatment were surgery refusal, medical or surgical inoperability, or absence of alternative treatment options. Malacia, post-intubation stenosis and goiter were the main causes of airway obstruction and MV/AA dependency. All patients were treated by means of rigid bronchoscopy, dilatation procedures and stent insertion. All but one patient (93.3%) were successfully and permanently extubated/decanulated immediately after the bronchoscopy. Minor complications occurred in 6 patients (40%) leading to a second intervention. All complications could be managed endoscopically and long-term follow up was uneventful. Interventional bronchoscopy with stent insertion can allow successful withdrawal from MV/AA and can offer longstanding airway patency in selected ventilator- or tracheostomy-dependant individuals with benign airway stenoses,when surgery in not feasable or contra-indicated.