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1.
Artigo em Chinês | MEDLINE | ID: mdl-32074756

RESUMO

Objective: To observe the efficacy of continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) and its affection on patients' blood gas analysis, C reactive protein(CRP) levels. Methods: This prospective study was performed from October 2016 to July 2017. Fifty hospitalized adult patients with medium or severe OSAHS, who were diagnosed by polysomnography (PSG) in Department of Otorhinolaryngology, Affiliated Hospital of Inner Mongolia Medical University, were collected as a case group. Those patients met the standards of medium or severe OSAHS, among whom 40 were male, 10 were female, the age was between 30 and 65, with a mean age of (47.24±10.28) years, and BMI was (27.94±3.43) kg/m(2). Meanwhile, 50 healthy individuals were chose in the same term as a control group, among whom 37 were male, 13 were female, the age was between 29 and 69, with a mean age of (51.28±10.58) years, body mass index(BMI) was (26.98±2.70) kg/m(2), and apnea-hypopnea index (AHI) was<5/h. The differences of blood gas analysis pH, arterial oxygen saturation (SaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), arterial partial pressure of oxygen (PaO(2)), CRP before and after the treatment of CPAP in case group and in the control group were compared. The choosing data were disposed and analyzed with statistics software of SPSS 20.0. Among which t test was adopted for measurement data, χ(2) test was adopted for enumeration data, and nonparametric rank sum test was adopted for other measurement data. Results: Before the CPAP treatment, pH, PaO(2) and SaO(2) levels in case group were lower than that in control group, respectively [7.34±0.03 vs. 7.37±0.04, (75.93±9.08) mmHg vs. (80.07±10.94) mmHg (1 mmHg=0.133 kPa), (89.71±6.09) mmHg vs.(93.29±5.36) mmHg, all P<0.05]. Both PaCO(2) level and CRP were higher than that in control group [(43.02±8.43) mmHg vs.(39.26±8.20) mmHg, 1.28[0.27,5.83] mg/L(Median[P(25),P(75)]) vs. 0.51[0.21,2.13] mg/L, both P<0.05]. After the CPAP treatment, pH(7.36±0.04), PaO(2) [(80.28±9.96) mmHg] and SaO(2) [(92.94±4.01) mmHg] level in case group were increased than pretreatment, respectively. Moreover, PaCO(2) level [(39.46±8.36) mmHg] and CRP(0.44[0.21,3.40] mg/L) are decreased than pretreatment (P<0.05), respectively. Conclusion: The CRP and blood gas analyses are significant index to evaluate the state of an illness and to estimate the prognosis of disease of OSAHS, which is deserved to generalize.


Assuntos
Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Oxigênio/sangue , Apneia Obstrutiva do Sono/sangue , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Pressão Arterial , Proteína C-Reativa/análise , Estudos de Casos e Controles , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Parcial , Estudos Prospectivos
2.
Medicine (Baltimore) ; 99(1): e18586, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895807

RESUMO

BACKGROUND: The acute respiratory distress syndrome (ARDS) is a critical illness with high mortality and a worse prognosis. Mechanical ventilation (MV) is currently considered to be one of the most effective methods of treating ARDS. In this meta-analysis, we discussed the efficacy of airway pressure release ventilation (APRV) in treating ARDS. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA), Ovid Medline, Embase, and PubMed were systematically searched with the keywords of "ARDS" and "APRV". The studies containing the treatment of APRV in ARDS were included. According to the MV protocol used in the studies, the comparison was undertaken between the APRV group vs low tidal volume (LTV) group and synchronized intermittent mandatory ventilation (SIMV) group. The relative risk (RR) and the standard mean difference with 95% confidence intervals (CI) were used for the comparison between groups. RESULTS: Fourteen studies with 2096 patients were included in the meta-analysis. The average increasing rate of PaO2/FiO2 was 75.4% in the APRV group vs 44.1% in the non-APRV group. No significant differences were found in mortality and duration of ICU stay between APRV vs LTV (P = .073 and P = .404) and APRV vs SIMV (P = .370 and P = .894). CONCLUSION: The APRV protocol would have a higher increase in the PaO2/FiO2 ratio, which was a safe protocol with a compatible effect comparing to LTV and SIMV.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Síndrome do Desconforto Respiratório do Adulto/terapia , Humanos
5.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 87-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31123057

RESUMO

OBJECTIVE: High-flow nasal cannula (HFNC) therapy is increasingly used in preterm infants despite a paucity of physiological studies. We aimed to investigate the effects of HFNC on respiratory physiology. STUDY DESIGN: A prospective randomised crossover study was performed enrolling clinically stable preterm infants receiving either HFNC or nasal continuous positive airway pressure (nCPAP). Infants in three current weight groups were studied: <1000 g, 1000-1500 g and >1500 g. Infants were randomised to either first receive HFNC flows 8-2 L/min and then nCPAP 6 cm H2O or nCPAP first and then HFNC flows 8-2 L/min. Nasopharyngeal end-expiratory airway pressure (pEEP), tidal volume, dead space washout by nasopharyngeal end-expiratory CO2 (pEECO2), oxygen saturation and vital signs were measured. RESULTS: A total of 44 preterm infants, birth weights 500-1900 g, were studied. Increasing flows from 2 to 8 L/min significantly increased pEEP (mean 2.3-6.1 cm H2O) and reduced pEECO2 (mean 2.3%-0.9%). Tidal volume and transcutaneous CO2 were unchanged. Significant differences were seen between pEEP generated in open and closed mouth states across all HFNC flows (difference 0.6-2.3 cm H2O). Infants weighing <1000 g received higher pEEP at the same HFNC flow than infants weighing >1000 g. Variability of pEEP generated at HFNC flows of 6-8 L/min was greater than nCPAP (2.4-13.5 vs 3.5-9.9 cm H2O). CONCLUSIONS: HFNC therapy produces clinically significant pEEP with large variability at higher flow rates. Highest pressures were observed in infants weighing <1000 g. Flow, weight and mouth position are all important determinants of pressures generated. Reductions in pEECO2 support HFNC's role in dead space washout.


Assuntos
Oxigenoterapia/métodos , Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Peso Corporal , Dióxido de Carbono/sangue , Pressão Positiva Contínua nas Vias Aéreas , Estudos Cross-Over , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigênio/sangue , Estudos Prospectivos , Volume de Ventilação Pulmonar , Sinais Vitais
6.
Behav Sleep Med ; 18(1): 68-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30477340

RESUMO

Background: Coping strategies are predictive of 1 week CPAP use. Coping strategies may predict longer-term CPAP use among adults with obstructive sleep apnea (OSA). Objectives: To investigate the influence of two coping styles (active and passive) and individual coping processes on CPAP use at 1 week and 1 month; and explore the association between self-efficacy and coping on CPAP use. Participants: CPAP-naïve adults (52.3% male, 90.9% White) newly diagnosed with OSA (AHI ≥ 5 events/hr) from two U.S. clinical sleep centers (n = 66). Methods: A post-hoc analysis from a prospective, longitudinal study that examined influential factors on CPAP use among CPAP-naïve patients with newly diagnosed OSA. The Ways of Coping Questionnaire and the Self-Efficacy Measure for Sleep Apnea were completed immediately after CPAP titration polysomnography. Objective 1 week and 1 month CPAP use (mean hr/night) were the primary outcomes. Descriptive analyses and stepwise multiple linear regression analyses modeling for CPAP use (mean hr/night). Results: Active coping was significantly associated with greater CPAP use (mean hr/night) at 1 week, but not at 1 month (p = 0.0397; p = 0.0556, respectively). Higher Planful Problem Solving was significantly associated with greater average CPAP use at 1 week and 1 month (p = 0.0117, p = 0.0378, respectively). Self-efficacy was significantly associated with greater average CPAP use at 1 week (p = 0.0056) and 1 month (p = 0.0056). Conclusions: Self-efficacy and Planful Problem Solving coping are promising behavioral intervention targets to promote CPAP use in newly diagnosed OSA.


Assuntos
Terapia Comportamental/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Cooperação do Paciente/psicologia , Apneia Obstrutiva do Sono/terapia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
7.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 41-49, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31872531

RESUMO

OBJECTIVE: To evaluate arterial blood gas parameters and pulmonary radiography, before and after provision of continuous positive airway pressure (CPAP) via a pediatric helmet in dogs with acute hypoxemic respiratory failure. DESIGN: Single-center, observational study conducted from 2016 to 2017. SETTING: University teaching hospital. ANIMALS: Seventeen dogs presenting with clinical signs compatible with respiratory failure, confirmed by arterial blood gas analyses. INTERVENTIONS: For each animal arterial blood samples and thoracic radiographs were performed at arrival (T0 ). Hypoxemic dogs (PaO2  <80 mm Hg), without evidence of pneumothorax or pleural effusion, received CPAP ventilation via a pediatric Helmet for at least 1 hour. At the end of CPAP ventilation, a second arterial blood gas analysis was performed at room air (T1 ). The F-shunt was also calculated. MEASUREMENT AND MAIN RESULTS: Respiratory rate, heart rate and rhythm, mean blood pressure, mucosal membrane color, and rectal temperature were recorded. Tolerance to the helmet was evaluated using a predetermined scoring system. Two dogs were excluded from the study for low tolerance to the helmet. In 15 of 17 dogs, a significant difference between T0 and T1 was noted for PaO2 (60.84 ± 3 mm Hg vs 80.2 ± 5.5 mm Hg), P(A-a)O2 (52.4 ± 4.4 mm Hg vs 35.2 ± 6 mm Hg), PaO2 /FiO2 (289.7 ± 14.3 vs 371 ± 21), and %SO2 (91.3 vs 98.8). In 15 of 17 dogs, the helmet was well tolerated. F-shunt significantly decreased following provision of CPAP (37%; range, 8.4-68% vs 6%; range, -5.6-64.3%). CONCLUSION: The use of a pediatric helmet appears to be a suitable device for delivery of CPAP in dogs with hypoxemic acute respiratory failure. The device appears to be reasonably tolerated and improved oxygenation in most dogs.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/veterinária , Doenças do Cão/terapia , Insuficiência Respiratória/veterinária , Animais , Gasometria/veterinária , Pressão Positiva Contínua nas Vias Aéreas/instrumentação , Doenças do Cão/sangue , Cães , Desenho de Equipamento , Feminino , Dispositivos de Proteção da Cabeça , Masculino , Insuficiência Respiratória/terapia , Resultado do Tratamento
8.
Tuberk Toraks ; 67(3): 205-210, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31709952

RESUMO

Introduction: In this study, changes in energy metabolism before and after treatment were compared in obstructive sleep apnea syndrome (OSAS) patients who received positive airway pressure therapy. Materials and Methods: Thirty-nine patients (22 male, 17 female) were admitted to study. Patients for PAP therapy who had moderate to severe in polysomnography were included. Values of energy metabolism were recorded during three days via metaboic holter device, before and after PAP therapy. Result: The mean age of the patients was 51.53 ± 11.16 year. In 15 (38.46%) of the patients BPAP, and in 24 (61.54%) of the patients CPAP treatment started. Three days after using metabolic holter device: the total daily energy consumption of the patients was found to be 482,4 ± 296.1 kcal/day before treatment and 524.5 ± 343.1 kcal/day after treatment (p<0.0001); patients' daily physical activity was 7867 ± 3319 steps/day before treatment and 12.416 ± 1451 steps/day after treatment, which was considered statistically significant (p<0001); the total daily resting period of the patients was 7.90 ± 1.36 hours/day before treatment and 7.44 ± 1.42 hours/day after treatment, considered statistically significant (p<0001); the total sleep duration of the patients was 5.50 ± 1.88 hours/day before treatment and 5.87 ± 1.20 hours/ day after treatment, considered statistically significant (p<0001). Conclusions: In our study, we found that daily physical activity and energy consumption increased with PAP treatment. With PAP treatment, obesity, diabetes and hypertension can be controlled. In our study, since PAP treatment was effective with effective sleep, the immobilization time was decreased and therefore the duration of daytime physical activity was prolonged. With these effects, patients' compliance with treatment increases. In conclusion, PAP treatment should be recommended in patients with moderate and severe OSAS.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Metabolismo Energético , Cooperação do Paciente , Apneia Obstrutiva do Sono/metabolismo , Apneia Obstrutiva do Sono/terapia , Adulto , Exercício , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Índice de Gravidade de Doença
9.
Pan Afr Med J ; 33: 251, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692700

RESUMO

Introduction: Acute Heart Failure (AHF) is a specific syndromic disorder grouping several heterogeneous clinical conditions frequently seen in the emergency department. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with AHF admitted to the emergency department. Methods: We conducted a prospective, descriptive study in the emergency department. It included all patients admitted with AHF. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients. Results: The study enrolled 180 patients with AHF admitted to the emergency department. Sex ratio was 1.27. The average age of patients was 66±12 years. Eighty-two percent of patients were hypertensive and 69% were known diabetic patients. The causes of decompensation included primarily hypertensive crisis (61.7% of patients), acute coronary syndrome (24% of patients). Respiratory support was mainly provided by CPAP (Continuous Positive Airway Pressure) in 73.3% of cases. Pharmacological treatment was based on nitrate derivatives (70% of cases) and diuretic (40.5% of cases). Acute heart failure incidence at one month was 21.7% (n=39 patients) and mortality rate at 3 months was 13.3%. Conclusion: Patients with AHF treated in the emergency department mainly had hypertensive crisis. Treatment is primarily based on CPAP, vasodilators and diuretics. Recurrence rate and mortality rate were high.


Assuntos
Síndrome Coronariana Aguda/complicações , Pressão Positiva Contínua nas Vias Aéreas/métodos , Insuficiência Cardíaca/epidemiologia , Hipertensão/complicações , Síndrome Coronariana Aguda/epidemiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Diuréticos/administração & dosagem , Serviço Hospitalar de Emergência , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Nitratos/administração & dosagem , Prognóstico , Estudos Prospectivos , Recidiva , Tunísia , Adulto Jovem
10.
Rev Med Suisse ; 15(671): 2100-2103, 2019 Nov 13.
Artigo em Francês | MEDLINE | ID: mdl-31742941

RESUMO

Obesity hypoventilation syndrome is an underdiagnosed pathology, whose prevalence is increasing due to the progressively higher prevalence of obesity in the general population. Early detection allows early management and lowers the risk of acute exacerbation, hospitalization and mortality. The diagnosis is done by excluding other, pulmonary or extra pulmonary, reasons of hypercapnia; a nocturnal polygraphy is mandatory to diagnose an associated obstructive sleep apnea syndrome. The pneumological treatment is a ventilatory support by CPAP or biPAP (bilevel Positive Airways Pressure).


Assuntos
Síndrome de Hipoventilação por Obesidade/terapia , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Obesidade/complicações , Síndrome de Hipoventilação por Obesidade/complicações
12.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651309

RESUMO

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.


Assuntos
Manejo da Obesidade/estatística & dados numéricos , Obesidade Mórbida/terapia , Cooperação do Paciente/estatística & dados numéricos , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Depressão/etiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
13.
Sleep Med Clin ; 14(4): 431-439, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640871

RESUMO

Obstructive sleep apnea is associated with excessive daytime sleepiness in about 50% of cases, and with increased risk of driving accidents. Treatment with continuous positive airway pressure effectively decreases such risk, but compliance with continuous positive airway pressure treatment is often suboptimal. According to the European Union Directive on driving risk, retention of a driving license in patients with obstructive sleep apnea requires assessment of sleepiness and adherence to continuous positive airway pressure treatment, but there remains uncertainty on the optimal methods to assess sleepiness on a large scale.


Assuntos
Condução de Veículo , Síndromes da Apneia do Sono/fisiopatologia , Sonolência , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Cooperação do Paciente , Fatores de Risco , Síndromes da Apneia do Sono/terapia , Vigília
14.
Sleep Med Clin ; 14(4): 491-498, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31640877

RESUMO

Sleepiness accounts for approximately 20% of major highway motor vehicle accidents (MVAs) and the most common medical disorder associated with sleepiness is obstructive sleep apnea (OSA). OSA patients are 2 to 3 times more likely to have an MVA than the general population, although continuous positive airway pressure therapy can remove this excess risk. Several jurisdictions have introduced regulations to limit driving in patients with moderate or severe OSA associated with sleepiness until the disorder is effectively treated. Successful implementation of such regulations requires education regarding risk-benefit relationships of relevant stakeholders, including patients, clinicians, and employers in the transportation industry.


Assuntos
Acidentes de Trânsito , Condução de Veículo , Pressão Positiva Contínua nas Vias Aéreas , Apneia Obstrutiva do Sono/terapia , Sonolência , Humanos , Apneia Obstrutiva do Sono/fisiopatologia
15.
Artigo em Chinês | MEDLINE | ID: mdl-31623042

RESUMO

Objective:The aim of this study is to investigate the effects of rhodiola rosea on oxidative stress, anxiety and depression in patients with OSA. Method:Ninety patients with moderate and severe OSA patients with negative emotions diagnosed by PSG, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were selected from the respiratory department of our hospital from February 2015 to February 2018. According to the random number table method, the patients were randomly divided into non-invasive ventilator group, rhodiola rosea+non-invasive ventilator group and rhodiola rosea group, with 30 cases in each group. Patients in the non-invasive ventilator group were treated with continuous positive airway pressure (CPAP) for 3 months, and those in the rhodiola rosea+non-invasive ventilator group were treated with oral rhodiola capsules for 3 months on the basis of CPAP, and those in the rhodiola rosea treatment group were treated with pure oral rhodiola capsules for 3 months. The changes of SDS and SAS before and after the three groups were compared, and the changes of serum SOD and MDA were detected by immunoenzyme-linked adsorption for comparative analysis. Result:There were no significant differences in SDS and SAS scores between the three groups (P>0.05). SDS and SAS scores of patients in the rhodiola rosea+non-invasive ventilator group decreased after treatment (P<0.05) compared with those in the non-invasive ventilator group. SDS and SAS scores of patients in the rhodiola treatment group increased after treatment (P<0.05). Compared with those in the rhodiola treatment group, SDS and SAS scores of patients in the rhodiola+non-invasive breathing group decreased after treatment (P<0.05). Three group patients were no significant difference in serum SOD and malondialdehyde (MDA) before treatment (P>0.05). Compared with before treatment, serum SOD level were all increased and MDA level were all decreased in the three groups after treatment (P<0.05). Compared with noninvasive breathing unit after treatment, rhodiola+noninvasive breathing unit after treatment in patients with elevated levels of serum SOD, MDA level decreased (P<0.05), and for the treatment group after treatment in patients with serum SOD levels drop, the MDA levels (P<0.05), and the after rhodiola rosea treatment group compared, rhodiola+noninvasive breathing unit after treatment in patients with elevated levels of serum SOD, MDA level decreased (P<0.05). Conclusion:Rhodiola may improve the negative emotions such as anxiety and depression by inhibiting oxygen free radicals and lipid peroxidation in patients with OSA.


Assuntos
Extratos Vegetais/uso terapêutico , Rhodiola , Apneia Obstrutiva do Sono/tratamento farmacológico , Estresse Psicológico/tratamento farmacológico , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Malondialdeído , Estresse Oxidativo/efeitos dos fármacos
16.
Rev Assoc Med Bras (1992) ; 65(9): 1161-1167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618331

RESUMO

OBJECTIVE: To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN: Randomized and blinded clinical trial. METHODS: We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS: In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION: Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.


Assuntos
Cirurgia Bariátrica/reabilitação , Pressão Positiva Contínua nas Vias Aéreas , Atelectasia Pulmonar/epidemiologia , Adulto , Volume de Reserva Expiratória , Feminino , Humanos , Pulmão/fisiopatologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Período Pós-Operatório , Prevalência , Atelectasia Pulmonar/prevenção & controle , Método Simples-Cego , Espirometria , Capacidade Vital
17.
Insuf. card ; 14(4): 135-140, Octubre-Diciembre 2019.
Artigo em Português | LILACS | ID: biblio-1053194

RESUMO

Introdução. Pacientes com insuficiência cardíaca (IC) portadores de apneia obstrutiva do sono (AOS) tem taxas de morbi mortalidade elevados e o tratamento com a pressão positiva contínua nas vias aéreas (CPAP) pode reduzir estes riscos. Objetivo geral. Realizar uma revisão sistemática de ensaios clínicos randomizados sobre os efeitos da terapia por CPAP em pacientes com IC portadores de AOS. Fontes de informação. Pesquisamos as bases de dados eletrônicas PubMed, Embase, Web of Science e Lilacs nos últimos 10 anos, sem limites de linguagem. Critérios de elegibilidade. Ensaios clínicos randomizados, estudos de pacientes com IC apresentando fração de ejeção do ventrículo esquerdo (FEVE) reduzida (<50%) portadores de apneia obstrutiva do sono e que fossem tratados com CPAP. Resultados. A FEVE aumentou consideravelmente nos grupos que receberam a terapia por CPAP (média basal: 30,6%; média pós CPAP: 36,7%), assim como a saturação de oxigênio (SaO2) (média basal: 94%; média pós CPAP: 95,3%) e houve redução no índice de apneia/hipopneia (média basal: 39,6; média pós CPAP: 12,3). Conclusões. Nossa revisão sistemática de ensaios clínicos randomizados confirma que a terapia por CPAP em pacientes com IC portadores de AOS melhora variáveis preditoras de morbi mortalidade.


Assuntos
Humanos , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Insuficiência Cardíaca
19.
Br Dent J ; 227(6): 470-473, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31562442

RESUMO

Introduction Mandibular replacement appliances (MRAs) can be used in the treatment of snoring, mild to moderate obstructive sleep apnoea and as a second-line treatment where continuous positive airway pressure (CPAP) fails. There is currently a paucity of evidence as to how long these appliances last.Aims Assess the replacement rate for MRAs using this as a proxy for lifespan; estimate the period prevalence of temporomandibular joint disorder (TMJD) and bruxism in the study population.Methods Prospective observational study as part of service evaluation. Data from consecutive patients seeking a replacement MRA were collected over a three-month period, yielding a sample of 60. The mean time between the provision of appliances was calculated in months. Reasons for replacement were sought, collated and categorised. Patients were asked to report any TMJD symptoms and bruxing.Results The mean replacement rate was 36.7 months. The main reasons for replacement were: device condition; fit and reduced effectiveness; and other minor reasons reported. Period prevalence of TMJD was 6.7%; bruxism was reported in 5% of patients.Conclusions A 'lifespan' of ust over three years for thermoplastic MRAs is estimated. The main reasons for replacement were: condition, poor fit and reduced effectiveness. MRAs do not appear to increase the frequency of TMJD and bruxism.


Assuntos
Longevidade , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Mandíbula , Estudos Prospectivos
20.
Med J Aust ; 211(7): 326-332, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31522464

RESUMO

Obstructive sleep apnoea (OSA) is characterised by repetitive compromise of the upper airway, causing impaired ventilation, sleep fragmentation, and daytime functional impairment. It is a heterogeneous condition encompassing different phenotypes. The prevalence of OSA among patients presenting for elective surgery is growing, largely attributable to an increase in age and obesity rates, and most patients remain undiagnosed and untreated at the time of surgery. This condition is an established risk factor for increased perioperative cardiopulmonary morbidity, heightened in the presence of concurrent medical comorbidities. Therefore, it is important to perform preoperative OSA screening and risk stratification - using the STOP-Bang screening questionnaire, nocturnal oximetry, and ambulatory and in-laboratory polysomnography, for example. Postoperative risk assessment is an evolving process that encompasses evaluation of upper airway compromise, ventilatory control instability, and pain-sedation mismatch. Optimal postoperative OSA management comprises continuation of regular positive airway pressure, a multimodal opioid-sparing analgesia strategy to limit respiratory depression, avoidance of supine position, and cautious intravenous fluid administration. Supplemental oxygen does not replace a patient's regular positive airway pressure therapy and should be administered cautiously to avoid risk of hypoventilation and worsening of hypercapnia. Continuous pulse oximetry monitoring with specified targets of peripheral oxygen saturation measured by pulse oximetry is encouraged.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Assistência Perioperatória , Apneia Obstrutiva do Sono/diagnóstico , Assistência Ambulatorial , Analgésicos não Entorpecentes/uso terapêutico , Hidratação/métodos , Humanos , Programas de Rastreamento , Síndrome de Hipoventilação por Obesidade/diagnóstico , Oximetria , Oxigenoterapia/métodos , Dor Pós-Operatória/tratamento farmacológico , Posicionamento do Paciente , Polissonografia , Cuidados Pós-Operatórios , Medição de Risco
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