1,721,068 research outputs found
Is it safe for patients with chronic hypercapnic respiratory failure undergoing home noninvasive ventilation to discontinue ventilation briefly?
No full textA brief discontinuation (< 1 week) of long-term ventilation may be necessary in patients who are not totally ventilator-dependent in cases of technical problems, intolerable nasal irritation, upper airway congestion, or travel. We examined the incidence, timing, and causes of possible clinical deterioration after a brief withdrawal of ventilation in patients with chronic respiratory failure (CRF) who were well-established on long-term noninvasive mechanical ventilation (NIMV)
Sleep Apnea, Sleepiness, and Driving Risk
Full text linkObstructive 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
Commentary from the Italian Association of Sleep Medicine on the AASM manual for the scoring of sleep and associated events: For debate and discussion
No full textIn 2007, the American Academy of Sleep Medicine (AASM) completed a new manual for the scoring of sleep and associated events. The AASM manual is divided into separate sections relative to the parameters reported for polysomnography. The present commentary, accomplished by a Task Force of the Italian Association of Sleep Medicine, focuses on sleep scoring data, arousal rules, movement and respiratory events. Comparisons with the previous Rechtschaffen and Kales system are detailed and a number of methodological weaknesses are pointed out. Major comments address the 30-s scoring epochs, the restrictive approach to arousals and EEG activating patterns, the incomplete quantification of motor events and the thresholds for the definition of hypopnea. Since the new AASM manual is an iterative process, proposals for discussion and re-examination of the agreed criteria with other national and international organizations are encouraged. (C) 2009 Elsevier B.V. All rights reserved
Delirium in patients admitted to a step-down unit: analysis of incidence and risk factors.
No full textBACKGROUND: Delirium is a rather common complication among patients admitted in intensive care units (ICUs), and rather than a single entity, it can be considered a spectrum of diseases where, besides overt cases, there are also many subsyndromal forms. Although there are many data about ICU delirium, there are few data concerning this complication in patients transferred from the ICU to a step-down unit (SDU) once clinically stable.
OBJECTIVES: With the present study, we wanted to assess the incidence of and risk factors for delirium and subsyndromal forms and their impact on clinical outcome in a group of patients transferred from an ICU to an SDU.
METHODS: All patients transferred from an ICU to our SDU over a 2-year period were screened for delirium and subsyndromal delirious forms using the Intensive Care Delirium Screening Checklist, a simple tool already validated in the ICU. The following data were also recorded: demographic data, severity score (SAPS II), reason for admission to the SDU, length of stay, death rate, use of sedatives, impact of delirium on weaning from mechanical ventilation (MV).
RESULTS: Among the 234 patients, the incidence of delirium and subsyndromal forms was 7.6% and 20%, respectively. Subsyndromal forms diagnosed at admission represented a risk factor for the subsequent development of delirium (odds ratio [OR], P < .0001). A previous episode of brain failure during ICU stay and older age were risks factors for the development of subsyndromal forms, whereas not needing MV was a protective factor. Delirium significantly prolonged the stay in the SDU but did not influence survival and the process of weaning from MV. Overall, the percentage of patients with an abnormal Intensive Care Delirium Screening Checklist score at discharge (5%) was reduced compared with that recorded at admission (18%).
CONCLUSIONS: Delirium may still occur after discharge from an ICU in patients who are transferred to an SDU. The strategy of care adopted in the SDU seems to positively affect the recovery from a delirious state. Patients with subsyndromal forms should be promptly recognized and treated because of the risk of developing delirium. Weaning from MV is not hindered by delirium
SALBUTAMOL DELIVERY DURING NON-INVASIVE MECHANICAL VENTILATION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A RANDOMIZED, CONTROLLED STUDY
No full textObjective: We investigated the clinical response to equivalent doses of salbutamol delivered, via metered dose inhaler (MDI) during non-invasive mechanical ventilation (NIMV-MDI), during spontaneous breathing using a spacer (MDI-Spacer), and also during intermittent positive pressure breathing (IPPB). Setting: A respiratory intensive care unit. Design: Prospective, randomized, and placebo-controlled study. Patients: Eighteen stable patients with chronic obstructive pulmonary disease (mean FEV1 = 38.5 ± 8.8 % predicted). Results: Overall salbutamol administration induced, compared to placebo, a significant improvement in FEV1, irrespective of the mode of administration (+7.9 ± 7.1% or +108 ± 91 ml for IPPB, +9.6 ± 8.8 % or 112 ± 67 ml for MDI-NIMV (inspiratory pressure = 14.3 ± 1.8 cmH2O; expiratory pressure = none), and +10.8 ± 11.4 % or 119 ± 114 ml for MDI-Spacer, respectively). ΔAFVC significantly increased from placebo only in MDINIMV (+214 ± 182 ml P = 0.02). A second set of experiments performed in eight patients to ascertain the possible effect of NIMV on pulmonary function tests, showed a significant improvement from baseline values in FVC both after the delivering of placebo or salbutamol via NIMV-MDI (+206 ± 147 ml and 208 ± 145, respectively). FEV1 significantly increased only after salbutamol. No changes in gas exchange were observed after bronchodilator delivery. Conclusions: We show that delivery of bronchodilators via MDI with a spacer chamber during NIMV is feasible and induces a significant bronchodilator effect compared to placebo, even though it may be slightly less effective than the classical delivery system (MDI-Spacer)
Physiologic evaluation of 4 weeks of nocturnal nasal positive pressure ventilation in stable hypercapnic patients with chronic obstructive pulmonary disease
No full textValutazione dell'efficacia degli apparecchi di avanzamento mandibolare nella terapia dell'apnea ostruttiva del sonno
No full textLa sindrome delle apnee ostruttive nel sonno, nota anche con l’acronimo OSAS (Obstructive Sleep Apnea Syndrome), è una condizione caratterizzata da pause nella respirazione durante il sonno, dovute all’ostruzione parziale o totale delle prime vie aeree. L’interruzione temporanea della respirazione causa una riduzione della concentrazione di ossigeno nel sangue. Dal punto di vista clinico, è caratterizzata da sonnolenza diurna e/o alterazioni delle performance diurne e da russamento nel sonno. L’utilizzo di apparecchi orali è consigliato per il trattamento di OSAS lieve, moderato e nei casi gravi quando il trattamento con CPAP (Continuous Positive Airway Pressure) non è tollerato.Lo scopo del presente studio è la valutazione dell’efficacia di due dispositivi intraorali di avanzamento mandibolare (OA) (SOMNODENT® e MyTAP®) nel trattamento dei pazienti OSAS
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