ABSTRACT
Objective: To evaluate the efficacy of nasal continuous positiveairway pressure (nCPAP) in decreasing respiratory distress inbronchiolitis.Design: Randomized controlled trial.Setting: Tertiary-care hospital in New Delhi, India.Participants: 72 infants (age <1y) hospitalized with a clinicaldiagnosis of bronchiolitis were randomized to receive standardcare, or nCPAP in addition to standard care, in the first hour afteradmission. 23 parents refused to give consent for participation. 2infants did not tolerate nCPAP.Intervention: The outcome was assessed after 60 minutes. IfnCPAP was not tolerated or the distress increased, the infant wasswitched to standard care. Analysis was done on intention-to-treatbasis Main outcome measures: Change in respiratory rate,Silverman-Anderson score and a Modified Pediatric Society ofNew Zealand Severity Score.Results: 14 out of 32 in nCPAP group and 5 out of 35 in standardcare group had change in respiratory rate ?10 (P=0.008). Themean (SD) change in respiratory rate [8.0 (5.8) vs 5.1 (4.0),P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73),P=0.029] and in Modified Pediatric Society of New ZealandSeverity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] weresignificantly different in the nCPAP and standard care groups,respectively.Conclusion: nCPAP helped reduce respiratory distresssignificantly compared to standard care.
ABSTRACT
Numerosos pacientes con diagnóstico de SAHOS moderado severo no reciben finalmente tratamiento efectivo. El objetivo del estudio es evaluar el grado de utilización de las medidas terapéuticas necesarias entre estos enfermos y los motivos de no tratamiento o tratamiento insuficiente. Métodos: Muestra consecutiva de pacientes derivados al Laboratoriode Sueño del IADIN entre agosto y diciembre de 2006 con solicitud de Polisomnografía por síntomas de apneas del sueño, la que diagnosticó SAHOS moderado severo. Durante julio de 2007 se les realizó una encuesta telefónica. Resultados: 100 pacientes encuestados, 85 varones, IPR 51.9±30.9ev/h, edad 52,38±12.2, IMC 34.1±10.6.47 pacientes no hicieron tratamiento alguno. 52 comenzaron tratamiento con CPAP, pero 12 lo suspendieron. 2 pacientes fueron sometidos a tratamiento quirúrgico. 90 pacientespresentaban un IMC mayor de 25, 64p > 30 y 32p > 35. 30 consultaron un nutricionista, 21 pacientes bajaron de peso, solo 3 lograron bajar más del 20% del basal. Los pacientesno tratados presentaron un IPR menor (p 0.02). Conclusiones: Si bien se ha incrementado el nivel de conciencia y alerta acerca de las implicancias del SAHOS entre los médicos y en la población general, lo que acrecentó la pesquisa de estos cuadros, se detectanconsiderables fallas en la aplicación de los tratamientos necesarios para revertir el cuadro y prevenir las consecuencias que se le atribuyen.
Many patients with confirmed diagnosis of moderate to severe Sleep Apnea dont receive efective treatment. The objective of this study is to evaluate the use of specific therapeutic measures in those subjects and to detect the posible reasons of ineffective treatment.Methods: consecutive sample of patients who attended to our Sleep Lab between August and December of 2006 for a PSG because of symptoms of sleep apneas, which diagnosed moderate to severe SAS. During july of 2007 a telephonic survey was performed. Results:100 patients surveyed, 85 males, AHI 51.9±30.9ev/h, age 52,38±12.2, BMI 34.1±10.6. 47 patients dont received any treatament. 52 began nCPAP therapy, but 12 discontinued it later. 2 subjects received surgical treatment. 90 patients had a BMI >25, 64p >30 and32p >35. 30 visited a nutricionist; 21 patients were able to lose weight, but only 3 lost more than 20% from baseline. Untreated patients presented a smaller AHI (p 0.02). Conclusions: Although there is more consciusness and awareness regarding SAS and its consecuences between physicians and general population, we detected considerable failures in the onset of necesary treatment to revert the symptoms and prevent itsconsequences.