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1.
BMC Anesthesiol ; 21(1): 9, 2021 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419396

RESUMO

BACKGROUND: Pneumonia induced by 2019 Coronavirus (COVID-19) is characterized by hypoxemic respiratory failure that may present with a broad spectrum of clinical phenotypes. At the beginning, patients may have normal lung compliance and be responsive to noninvasive ventilatory support, such as CPAP. However, the transition to more severe respiratory failure - Severe Acute Respiratory Syndrome (SARS-CoV-2), necessitating invasive ventilation is often abrupt and characterized by a severe V/Q mismatch that require cycles of prone positioning. The aim of this case is to report the effect on gas exchange, respiratory mechanics and hemodynamics of tripod (or orthopneic sitting position) used as an alternative to prone position in a patient with mild SARS-CoV-2 pneumonia ventilated with helmet CPAP. CASE PRESENTATION: A 77-year-old awake and collaborating male patient with mild SARS-CoV-2 pneumonia and ventilated with Helmet CPAP, showed sudden worsening of gas exchange without dyspnea. After an unsuccessful attempt of prone positioning, we alternated three-hours cycles of semi-recumbent and tripod position, still keeping him in CPAP. Arterial blood gases (PaO2/FiO2, PaO2, SaO2, PaCO2 and A/a gradient), respiratory (VE, VT, RR) and hemodynamic parameters (HR, MAP) were collected in the supine and tripod position. Cycles of tripod position were continued for 3 days. The patient had a clinically important improvement in arterial blood gases and respiratory parameters, with stable hemodynamic and was successfully weaned and discharged to ward 10 days after pneumonia onset. CONCLUSIONS: Tripod position during Helmet CPAP can be applied safely in patients with mild SARS-CoV-2 pneumonia, with improvement of oxygenation and V/Q matching, thus reducing the need for intubation.


Assuntos
/diagnóstico por imagem , Pressão Positiva Contínua nas Vias Aéreas/métodos , Posicionamento do Paciente/métodos , Mecânica Respiratória/fisiologia , Idoso , Humanos , Masculino , Resultado do Tratamento
2.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 52(1): 28-32, 2021 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33474885

RESUMO

Post-traumatic stress disorder (PTSD) is characterized by intrusive emotional memory, alertness and avoidance after individuals suffer from one or more traumatic events. With the exception of manifestations, sleep disturbances are also considered to be the core symptoms of PTSD. This article mainly discussed insomnia, nightmares, obstructive sleep apnea (OSA), and periodic limb movement during sleep (PLMS) in patients with PTSD. Existing evidence suggested that insomnia is a predictor of the development of PTSD. Cognitive behavioral therapy for insomnia is an important research direction for treating insomnia in PTSD patients. Nightmares are also the core symptom of PTSD. Prazosin and image rehearsal therapy are effective therapies to treat post-traumatic nightmares. The co-occurrence of obstructive sleep apnea (OSA) is over 40% in patients with PTSD. Preliminary studies have shown that continuous positive airway pressure therapy can improve PTSD symptoms in patients with PTSD comorbid OSA. In the process of diagnosis and treatment of PTSD patients, it is important to firstly evaluate whether PTSD patient comorbid OSA or insomnia, and then clinicians could further develop an appropriate treatment plan for these patients.


Assuntos
Transtornos do Sono-Vigília , Transtornos de Estresse Pós-Traumáticos , Pressão Positiva Contínua nas Vias Aéreas , Sonhos , Humanos , Sono , Transtornos do Sono-Vigília/etiologia , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia
3.
Scand J Trauma Resusc Emerg Med ; 29(1): 16, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436033

RESUMO

OBJECTIVE: Despite critical hypoxemia, Covid-19 patients may present without proportional signs of respiratory distress. We report three patients with critical respiratory failure due to Covid-19, in which all presented with severe hypoxemia refractory to supplemental oxygen therapy. We discuss possible strategies for ventilatory support in the emergency pre-hospital setting, and point out some pitfalls regarding the management of these patients. Guidelines for pre-hospital care of critically ill Covid-19 patients cannot be established based on the current evidence base, and we have to apply our understanding of respiratory physiology and mechanics in order to optimize respiratory support. METHODS: Three cases with similar clinical presentation were identified within the Norwegian national helicopter emergency medical service (HEMS) system. The HEMS units are manned by a consultant anaesthesiologist. Patient's next of kin and the Regional committee for medical and health research ethics approved the publication of this report. CONCLUSION: Patients with Covid-19 and severe hypoxemia may pose a considerable challenge for the pre-hospital emergency medical services. Intubation may be associated with a high risk of complications in these patients and should be carried out with diligence when considered necessary. The following interventions are worth considering in Covid-19 patients with refractory hypoxemia before proceeding to intubation. First, administering oxygen via a tight fitting BVM with an oxygen flow rate that exceeds the patient's ventilatory minute volume. Second, applying continuous positive airway pressure, while simultaneously maintaining a high FiO2. Finally, assuming the patient is cooperative, repositioning to prone position.


Assuntos
/terapia , Cuidados Críticos/métodos , Estado Terminal/terapia , Oxigenoterapia/métodos , Insuficiência Respiratória/terapia , /complicações , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Insuficiência Respiratória/etiologia
4.
Anaesthesia ; 76(1): 27-35, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32776518

RESUMO

It is recognised that high-flow nasal therapy can prevent desaturation during airway management. Studies in spontaneously breathing patients show an almost linear relationship between flow rate and positive airway pressure in the nasopharynx. Positive airway pressure has been suggested as one of the possible mechanisms explaining how high-flow nasal therapy works. However, data on pressures generated by high-flow nasal therapy in apnoeic adults under general anaesthesia are absent. This randomised controlled crossover trial investigated airway pressures generated by different flow rates during high-flow nasal therapy in anaesthetised and paralysed apnoeic patients, comparing pressures with closed and open mouths. Following induction of anaesthesia and neuromuscular blockade, a continuous jaw thrust was used to enable airway patency. Airway pressure was measured in the right main bronchus, the middle of the trachea and the pharynx, using a fibreoptically-placed catheter connected to a pressure transducer. Each measurement was randomised with respect to closed or open mouth and different flow rates. Twenty patients undergoing elective surgery were included (mean (SD) age 38 (18) years, BMI 25.0 (3.3) kg.m-2 , nine women, ASA physical status 1 (35%), 2 (55%), 3 (10%). While closed mouths and increasing flow rates demonstrated non-linear increases in pressure, the pressure increase was negligible with an open mouth. Airway pressures remained below 10 cmH2 O even with closed mouths and flow rates up to 80 l.min-1 ; they were not influenced by catheter position. This study shows an increase in airway pressures with closed mouths that depends on flow rate. The generated pressure is negligible with an open mouth. These data question positive airway pressure as an important mechanism for maintenance of oxygenation during apnoea.


Assuntos
Manuseio das Vias Aéreas/métodos , Apneia/terapia , Pressão Positiva Contínua nas Vias Aéreas/métodos , Nasofaringe , Adulto , Pressão do Ar , Anestesia , Estudos Cross-Over , Procedimentos Cirúrgicos Eletivos , Feminino , Tecnologia de Fibra Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Boca , Bloqueio Neuromuscular , Transdutores de Pressão , Resultado do Tratamento , Adulto Jovem
6.
Ter Arkh ; 92(9): 39-43, 2020 Oct 14.
Artigo em Russo | MEDLINE | ID: mdl-33346429

RESUMO

AIM: To study the effectiveness of prolonged use of PAP therapy (positive airway pressure therapy) in eliminating sleep respiratory disorders and associated cardiac conduction disturbances. MATERIALS AND METHODS: We included 21 patients who were examined at the Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology, regarding cardiac rhythm and conduction disturbances, as well as obstructive sleep apnea and who have been on PAP therapy for more than 12 months. The average age was 66.5 [63.5; 73.2] years, body mass index 33.0 [30.2; 38.5] kg/m2, apnea-hypopnea index 65.0 [59.0; 86.3]/h. At the time of analysis, 15 patients continued to use PAP therapy (mean time of use: 6.0 years [4.7; 9.2]) and 6 patients refused long-term use of PAP therapy, mean time to use PAP therapy until failure amounted to 2.82.1 years. RESULTS: PAP therapy lead to a persistent decrease in apnea-hypopnea index of 63.6/h to 3.7/h was (p=0.0002). 86% of patients met the criteria for adherence to PAP therapy (use 4 hours/night, more than 70% of nights). Initially, before the use of PAP therapy, all cardiac conduction disorders were during sleep and exceeded 3 seconds, with fluctuations from 3.1 to 10.6 seconds. PAP therapy appeared to be effective in all patients: no asystoles, duration of more than 3 seconds, were detected. CONCLUSION: In obstructive sleep apnea patients with concomitant nighttime cardiac conduction disturbances, the long-term use of PAP therapy is effective and with good adherence.


Assuntos
Cooperação do Paciente , Apneia Obstrutiva do Sono , Idoso , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Respiração , Sono , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/terapia
7.
PLoS One ; 15(12): e0244857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382796

RESUMO

BACKGROUND: Continuous positive airway pressure (CPAP) ventilation may be used as a potential bridge to invasive mechanical ventilation (IMV), or as a ceiling-of-care for persistent hypoxaemia despite standard oxygen therapy, according to UK guidelines. We examined the association of mode of respiratory support and ceiling-of-care on mortality. METHODS: We conducted a retrospective cohort analysis of routinely collected de-identified data of adults with nasal/throat SARs-CoV-2 swab-positive results, at the Calderdale and Huddersfield NHS Foundation Trust between 10th March-19th April 2020 (outcomes determined on 22nd May). FINDINGS: Of 347 patients with SARs-CoV-2 swab-positive results, 294 (84.7%) patients admitted for Covid-19 were included in the study. Sixty-nine patients were trialled on CPAP, mostly delivered by face mask, either as an early ceiling of care instituted within 24 hours of admission (N = 19), or as a potential bridge to IMV (N = 44). Patients receiving a ceiling of care more than 24 hours after admission (N = 6) were excluded from the analysis. Two hundred and fifteen patients (73.1%) maximally received air/standard oxygen therapy, and 45 (15.3%) patients maximally received CPAP. Thirty-four patients (11.6%) required IMV, of which 24 had received prior CPAP. There were 138 patients with an early ceiling-of-care plan (pre-admission/within 24h). Overall, 103(35.0%) patients died and 191(65.0%) were alive at study end. Among all patients trialled on CPAP either as a potential bridge to IMV (N = 44) or as a ceiling-of-care (N = 19) mortality was 25% and 84%, respectively. Overall, there was strong evidence for higher mortality among patients who required CPAP or IMV, compared to those who required only air/oxygen (aOR 5.24 95%CI: 1.38, 19.81 and aOR 46.47 95%CI: 7.52, 287.08, respectively; p<0.001), and among patients with early ceiling-of-care compared to those without a ceiling (aOR 41.81 95%CI: 8.28, 211.17; p<0.001). Among patients without a ceiling of care (N = 137), 10 patients required prompt intubation following failed oxygen therapy, but 44 patients received CPAP. CPAP failure, defined as death (N = 1) or intubation (N = 24), occurred in 57% (N = 25) of patients. But in total, 75% (N = 33) of those started on CPAP with no ceiling of care recovered to discharge-19 without the need for IMV, and 14 following IMV. CONCLUSION: Our data suggest that among patients with no ceiling-of-care, an initial trial of CPAP as a potential bridge to IMV offers a favourable therapeutic alternative to early intubation. In contrast, among patients with a ceiling-of care, CPAP seems to offer little additional survival benefit beyond oxygen therapy alone. Information on ceilings of respiratory support is vital to interpreting mortality from Covid-19. STRENGTHS AND LIMITATIONS OF THIS STUDY: Sample size relatively small.Study sample representative of hospitalised Covid-19 patients in UK.Previously unreported data on role of ceilings-of-care in hospitalised Covid-19 patients.Novel data on use of CPAP separated by indication.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/economia , Hospitalização/economia , Oxigênio/administração & dosagem , Adulto , /epidemiologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Recurso educacional aberto em Português | CVSP - Regional | ID: oer-3923

RESUMO

Conteúdo da Aula: -Tabela Simplificada para cálculo de Ventilação -Ventilação Protetora -Estratégias de Ventilação Mecânica -Índice de Oxigenação -Estratégias de Ventilação Protetora/Prona -Ajustes de VM em PCR


Assuntos
Respiração Artificial , Mecânica Respiratória , Estratégias , Pressão Positiva Contínua nas Vias Aéreas , Coronavirus
10.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(11): 953-957, 2020 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-33137862

RESUMO

Objective: To establish a noninvasive method for measuring upper airway critical closing pressure (Pcrit), so as to evaluate collapsibility of the upper airway during sleep. Methods: Pcrit was determined through the use of a noninvasive positive/negative pressure (CPAP/CPNP) ventilator(with independent intellectual property rights) during stageⅡ of non-rapid eye movement sleep. For the direct measurement, Pcrit was the pressure below which the upper airway occluded. For the indirect measurement, nasal pressure was plotted against maximum inspiratory flow (Vimax), and linear regression was used to interpolate the pressure (i.e., Pcrit) at which zero flow occurred. Pcrit was attained from 19 subjects without obstructive sleep apnea syndrome(OSAS), and the correlation between direct and indirect measurement methods was analyzed. Results: Directly measured and indirectly measured Pcrit showed no significant difference [(-7.02±2.74 vs (-7.26±2.96) cmH2O, 1 cmH2O=0.098 kPa; t=1.667, P>0.05] and had a highly significant correlation (r=0.986, P=0.000). Bland-Altman analysis revealed that the mean between-method difference was (0.24±0.53) cmH2O, and 95% limits of agreement ranged from -0.80 to 1.27 cmH2O, and all points except one were within limits of agreement. Conclusion: Pcrit derived from the direct and indirect measurement methods does not differ, and both methods could be used for evaluating the upper airway collapsibility.


Assuntos
Faringe , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Polissonografia , Sono , Apneia Obstrutiva do Sono/diagnóstico
11.
Clin Med (Lond) ; 20(6): e262-e263, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33199333

RESUMO

Why we only infrequently detect or report two or more respiratory viruses co-infecting an adult host is poorly understood. We report a rare case where influenza B and SARS-CoV-2 caused viral pneumonia in a 74-year-old man diagnosed during the UK winter epidemic/pandemic for these organisms and discuss concepts of co-infection.


Assuntos
Coinfecção , Infecções por Coronavirus , Vírus da Influenza B , Influenza Humana , Pandemias , Pneumonia Viral , Idoso , Betacoronavirus , Infecções Comunitárias Adquiridas , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino
12.
Dental Press J Orthod ; 25(5): 44-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33206828

RESUMO

INTRODUCTION: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. OBJECTIVE: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. METHODS: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. RESULTS: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. CONCLUSION: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono , Pressão Positiva Contínua nas Vias Aéreas , Humanos , Polissonografia , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
13.
BMJ Open Respir Res ; 7(1)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33148777

RESUMO

OBJECTIVE: To evaluate the role of continuous positive air pressure (CPAP) in the management of respiratory failure associated with COVID-19 infection. Early clinical management with limited use of CPAP (3% of patients) was compared with a later clinical management strategy which had a higher proportion of CPAP use (15%). DESIGN: Retrospective case-controlled service evaluation for a single UK National Health Service (NHS) Trust during March-June 2020 designed and conducted solely to estimate the effects of current care. SETTING: The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized English NHS Trust. PARTICIPANTS: 206 patients with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 and 3 April 2020 for the early group (controls), and between 10 April 2020 and 11 May 2020 for the late group (cases). Follow-up for all cases was until 11 June by which time all patients had a final outcome of death or discharge. Both groups were composed of 103 patients. Cases and controls were matched by age and sex. OUTCOME MEASURE: The outcome measure was the proportion of patients surviving at time t (time from the positive result of COVID-19 test to discharge/death date). The predictors were CPAP intervention, intubation, residence in care homes and comorbidities (renal, pulmonary, cardiac, hypertension and diabetes). A stratified Cox proportional hazard for clustered data (via generalised estimating equations) and model selection algorithms were employed to identify the effect of CPAP on patients' survival and the effect on gas exchange as measured by alveolar arterial (A-a) gradient and timing of CPAP treatment on CPAP patients' survival. RESULTS: CPAP was found to be significantly (HR 0.38, 95% CI 0.36 to 0.40) associated with lower risk of death in patients with hospital stay equal to, or below 7 days. However, for longer hospitalisation CPAP was found to be associated with increased risk of death (HR 1.72, 95% CI 1.40 to 2.12). When CPAP was initiated within 4 days of hospital admission, the survival probability was above 73% (95% CI 53% to 99%). In addition, lower A-a gradient was associated with lower risk of death in CPAP patients (HR 1.011, 95% CI 1.010 to 1.013). The selected model (best fit) was stratified by sex and clustered by case/control groups. The predictors were age, intubation, hypertension and the residency from care homes, which were found to be statistically significantly associated with patient's death/discharge. CONCLUSIONS: CPAP is a simple and cost-effective intervention. It has been established for care of other respiratory disorders but not for COVID-19 respiratory failure. This evaluation establishes that CPAP as a potentially viable treatment option for this group of patients during the first days of hospital admission. As yet there is limited availability of quantitative research on CPAP use for COVID-19. Whist this work is hampered by both the relatively small sample size and retrospective design (which reduced the ability to control potential confounders), it represents evidence of the significant benefit of early CPAP intervention. This evaluation should stimulate further research questions and larger study designs on the potential benefit of CPAP for COVID-19 infections. Globally, this potentially beneficial low cost and low intensity therapy could have added significance economically for healthcare provision in less developed countries.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Fatores Etários , Idoso , Betacoronavirus , Estudos de Casos e Controles , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Pacientes Internados/estatística & dados numéricos , Intubação Intratraqueal , Tempo de Internação , Masculino , Casas de Saúde , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Modelos de Riscos Proporcionais , Troca Gasosa Pulmonar , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/virologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
14.
Sleep Med Clin ; 15(3S): e1-e7, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33008491

RESUMO

Prior to the COVID-19 pandemic, few pediatric sleep medicine clinicians routinely engaged in telemedicine visits because thorough examinations were difficult to perform; there was lack of consistent reimbursement; and many clinicians were busy with their in-office practices. This article reviews how telemedicine has been explored in pediatric sleep medicine prior to the pandemic, current applications of telemedicine, challenges, and reimagining pediatric sleep within the realm of telemedicine.


Assuntos
Pediatria , Medicina do Sono , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Telemedicina/métodos , Betacoronavirus , Criança , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus , Humanos , Otolaringologia , Pandemias , Pneumonia Viral , Polissonografia , Encaminhamento e Consulta , Síndrome das Pernas Inquietas/diagnóstico , Síndrome das Pernas Inquietas/terapia , Sono , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Distúrbios do Início e da Manutenção do Sono/terapia
17.
J Clin Sleep Med ; 16(10): 1811-1813, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33063660

RESUMO

None: A middle-aged man with obstructive sleep apnea who had been treated with continuous positive airway pressure developed COVID-19. An analysis of airflow records from the continuous positive airway pressure machine revealed a rise in his respiratory rate on the night before the onset of COVID-19-related symptoms, while his nocturnal respiratory rate had been stable during the 18-month period prior to the presently reported episode. The present case suggests that a rise in respiratory rate detected using continuous positive airway pressure machine data could be an important sign of impending acute illness, such as COVID-19. Studies to elucidate the usefulness of this method are warranted.


Assuntos
Betacoronavirus , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Taxa Respiratória/fisiologia , Apneia Obstrutiva do Sono/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Polissonografia/métodos
18.
Ther Adv Respir Dis ; 14: 1753466620963016, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33070706

RESUMO

The worldwide spread of coronavirus disease 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization (WHO) in March 2020. According to clinical studies carried out in China and Italy, most patients experience mild or moderate symptoms; about a fifth of subjects develop a severe and critical disease, and may suffer from interstitial pneumonia, possibly associated with acute respiratory distress syndrome (ARDS) and death.In patients who develop respiratory failure, timely conventional oxygen therapy through nasal catheter plays a crucial role, but it can be used only in mild forms. Continuous positive airway pressure (CPAP) support or non-invasive mechanical ventilation (NIV) are uncomfortable, and require significant man-machine cooperation. Herein we describe our experience of five patients with COVID-19, who were treated with high-flow nasal cannula (HFNC) after failure of CPAP or NIV, and discuss the role of HFNC in COVID-19 patients. Our findings suggest that HFNC can be used successfully in selected patients with COVID-19-related ARDS.The reviews of this paper are available via the supplemental material section.


Assuntos
Betacoronavirus , Cânula , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Oxigenoterapia/instrumentação , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Insuficiência Respiratória/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva , Pandemias , Pneumonia Viral/diagnóstico , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/virologia , Resultado do Tratamento
19.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 169-178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093780

RESUMO

Rationale: An increased incidence of Obstructive Sleep Apnea (OSA) in sarcoidosis has been described in small sample size studies. Fatigue is common in sarcoidosis and OSA could be a relevant, treatable comorbidity. To date, the effect of Continuous Positive Airway Pressure (CPAP) on fatigue has never been assessed. Objectives: To investigate the prevalence of OSA in sarcoidosis, fatigue status and daytime sleepiness in patients of our center. To explore the effect of CPAP in fatigue and daytime sleepiness after 3 months using validated questionnaires. Method: Single group, one center, open-label prospective cohort study. Measurements and main result: We enrolled 68 patients and OSA was diagnosed in 60 (88.2%): 25 (36.8%) were mild while 35 (51.5%) were moderate-to-severe. 38 (55.9%) patients received CPAP but only 20 (30.9%) were compliant at 3-month evaluation. Questionnaires demonstrated fatigue in 34 (50%) and daytime sleepiness in 21 (30.9%). In multivariate regression analysis, Scadding stage and FAS behave as predictors of Apnea-Hypopnea Index (AHI) severity while sleepiness and steroids weren't associated. FAS score (ΔFAS = 6.3; p = 0.001) and ESS score (ΔESS = 2.8; p = 0.005) improved after three months of CPAP. Conclusions: OSA is highly prevalent in patients affected by sarcoidosis. ESS questionnaire is not reliable for OSA screening and other pre-test probability tool should be evaluated in further studies. CPAP leads to a significative reduction of fatigue and daytime sleepiness at three-month. Further studies are needed to confirm the high prevalence of OSA in sarcoidosis and the positive role of CPAP in fatigue. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 169-178).


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Fadiga/prevenção & controle , Pulmão/fisiopatologia , Respiração , Sarcoidose/epidemiologia , Apneia Obstrutiva do Sono/terapia , Transtornos do Sono-Vigília/prevenção & controle , Sono , Idoso , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Roma/epidemiologia , Sarcoidose/diagnóstico , Sarcoidose/fisiopatologia , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
20.
Rev Med Suisse ; 16(709): 1865-1869, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026729

RESUMO

Obstructive sleep apnea syndrome (OSAS) is a respiratory disorder affecting up to 49 % and 23 % of middle to older aged men and women respectively. CPAP (continuous positive airway pressure) is the gold-standard treatment for severe apneas. In mild and moderate forms of OSAS, mandibular advancement devices (MAD) are equally a first line of treatment. Both CPAP and MAD have their advantages and side effects. Patient tolerance to these two therapies varies according to different patient-parameters. In order to guide physicians and patients in choosing between these two treatments, we present a description of both treatment modalities.


Assuntos
Tomada de Decisão Clínica , Pressão Positiva Contínua nas Vias Aéreas , Avanço Mandibular , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Avanço Mandibular/efeitos adversos , Placas Oclusais/efeitos adversos
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