The impact of continuous positive airway pressure on radiation dose to heart and lung during left-sided postmastectomy radiotherapy when deep inspiration breath hold technique is not applicable: a case report

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

The Effects of the Treatment with CPAP on Auditory Functions in Patients with Severe OSAHS / 听力学及言语疾病杂志

Objective To investigate the auditory features in patients with severe obstructive sleep apnea hy-popnea syndrome(OSAHS) and the effects of continuous positive airway pressure (CPAP) on auditory functions . Methods Pure tone audiometry thresholds ,auditory brainstem responses (ABR) and distortion product otoacoustic emissions(DPOAE) were performed in three groups with 12 observed objects in each group ,which were the OS-AHS group(before and after treatment of CPAP) ,the simple snoring group and the normal control group .Results In the OSAHS group ,the high frequency auditory thresholds(at 8000 Hz) were greatly higher and the amplitudes of DPOAE reduced ;the detection rates of DPOAE were obviously declined .The peak latencies of Ⅰ ,Ⅲ and Ⅴ , and interpeak latencies of Ⅲ - Ⅴ andⅠ - Ⅴ were longer than those of in the other two groups .The differences were statistically significant(P<0 .05) .The differences of the interpeak latencies of Ⅰ - Ⅲ ,common pure tone au-ditory thresholds (125～4000 Hz) and the thresholds of Ⅴ -wave reaction in the OSAHS group did not change sig-nificantly compared with the other two groups(P>0 .05) .The amplitudes and the detection rates of DPOAEs (0 .5～8 kHz) increased after treatment with CPAP .The differences were statistically significant except the amplitudes of 500 ,750 and 1500 Hz (P<0 .05) .Pure tone audiometry and ABRs did not changed significantly after treatment with CPAP (P> 0 .05) .Conclusion The auditory functions of patients diagnosed with severe OSAHS were im-paired .Treatments with CPAP can partly improve the patients' auditory functions .

Effect of continuous positive airway pressure on glycosylated hemoglobin levels in patients with obstructive sleep apnea syndrome / 中国生化药物杂志

Objective To observe the effect of obstructive sleep apnea syndrome (OSAHS) patients with glycosylated hemoglobin (HbA1c) levels, assessment of continuous positive airway pressure (CPAP) effect on the level of HbA1c in patients with OSAHS. Methods From January 2013 to December 2016, eighty patients with OSAHS were divided into mild group, eighteen cases, moderate group twenty cases, severe group forty-two cases according to the apnea hypopnea index (AHI). Thirty healthy subjects were chosen as the control group. All the treatment groups were treated with CPAP for three months. Overnight polysomnography and HbA1c test were performed before and after treatment, and the control group was examined by HbA1c before treatment. Results The level of glycosylated hemoglobin in the middle and severe group was higher than that of the control group(P<0.05). After treatment, the glycated hemoglobin levels in the moderate and severe groups were significantly lower(P<0.05), and the sleep apnea hypopnea index, the lowest SaO2 and the average SaO2 level were significantly improved(P<0.01). Conclusion Glycated hemoglobin levels increased significantly in patients with moderate and severe OSAHS, and decreased HbA1c levels in patients with moderate and severe OSAHS after CPAP treatment.

Efeitos hemodinâmicos agudos da pressão positiva contínua na via aérea (CPAP) em indivíduos com cardiomiopatia hipertrófica / Acute hemodynamic effects of continuous positive airway pressure (CPAP) in individuals with hypertrophic cardiomyopathy

Introdução: Apneia obstrutiva do sono (AOS) é uma doença comum em pacientes com cardiomiopatia hipertrófica (CMH) e está associada de forma independente a piora nos seus parâmetros cardíacos. O tratamento da AOS com CPAP (continuous positive airway pressure) é considerado benéfico em pacientes sem CMH. Contudo, o CPAP pode agudamente piorar o desempenho cardíaco em pacientes com CMH e obstrução na via de saída do ventrículo esquerdo (VSVE). Métodos: Foram estudados 26 pacientes com CMH, estáveis, divididos em 12 não-obstrutivos (CMHN-Obst) e 14 obstrutivos (CMHObst), de acordo com seu gradiente de VSVE menor ou maior que 30mmHg, respectivamente. Pacientes foram continuamente monitorados pela pressão arterial (PA) batimento-a-batimento e eletrocardiograma, em vigília e posição supina. Um ecocardiograma bidimensional foi realizado durante o repouso (Basal) a após 20 minutos de CPAP nas pressões de 1,5cmH2O e 10cmH2O, que foram aplicadas em ordem randomizada, interpostas por 10 minutos de intervalo sem CPAP. Em outra data os pacientes foram submetidos a uma polissonografia completa para diagnóstico de AOS. Resultados: Variáveis hemodinâmicas como PA, débito cardíaco, volume sistólico, frequência cardíaca, fração de ejeção do ventrículo esquerdo e gradiente de VSVE permaneceram estáveis ao longo do estudo em ambos os grupos. Em pacientes não-obstrutivos, o CPAP em 10cmH2O reduziu área do átrio direito, a complacência do ventrículo esquerdo, bem como o relaxamento de ambos os ventrículos. Nos pacientes obstrutivos, o CPAP em 10cmH2O provocou efeitos similares no coração direito e também elevou as pressões na artéria pulmonar. No coração esquerdo, houve uma redução na área e volume do átrio esquerdo, com aumento nas áreas e volumes do jato e frações regurgitantes. A polissonografia completa demonstrou que a AOS (índice de apneia e hipopneia >= 15 eventos/hora) estava presente em 58% dos pacientes. Conclusões: O CPAP se mostrou uma alternativa...

Background: Obstructive sleep apnea (OSA) is a common disease and is independently associated with a worse in cardiac parameters among patients with hypertrophic cardiomyopathy (HCM). The treatment of OSA with CPAP (Continuous positive airway pressure) is beneficial among patients without CMH. However, CPAP may acutely impair cardiac performance in patients with HCM and left ventricular outflow tract (LVOT) obstruction. Methods: We studied 26 stable HCM patients divided in 12 nonobstructive-HCM and 14 obstructive-HCM according to their LVOT pressure gradient lower or higher than 30 mmHg, respectively. Patients were continuously monitored by beatto- beat blood pressure (BP) and electrocardiogram in the supine position while awake. A 2-dimensional echocardiography was performed at resting (Baseline) and after 20 minutes of nasal CPAP at 1.5cmH2O and 10cmH2O, that was applied in a random order interposed by 10 minutes without CPAP. In another day all patients underwent full Polysomnography for OSA diagnosis. Results: Hemodynamic variables such as BP, cardiac output, stroke volume, heart rate, left ventricular ejection fraction and LVOT gradient did not change along the study period in both groups. CPAP at 10cmH2O in nonobstructive-HCM patients decreased right atrial area, left ventricular compliance, right and left ventricular relaxation. In obstructive-HCM patients, CPAP at 10cmH2O promoted similar effects in the right heart, and also raised pulmonary artery pressure. In the left heart, there was a decrease in left atrial area and volume with increased area and volume of both, regurgitant jet and regurgitant fraction. Full Polysomnography showed that OSA (apneahypopnea index >=15 events/h) was present in 58% of HCM patients. Conclusions: CPAP showed to be safe to treat OSA and did not acutely change hemodynamics in patients with HCM. However, CPAP may acutely impair cardiac dynamics in obstructive-HCM patients and this finding should be carefully considered.

Application of continuous positive airway pressure in the delivery room: a multicenter randomized clinical trial

This study evaluated whether the use of continuous positive airway pressure (CPAP) in the delivery room alters the need for mechanical ventilation and surfactant during the first 5 days of life and modifies the incidence of respiratory morbidity and mortality during the hospital stay. The study was a multicenter randomized clinical trial conducted in five public university hospitals in Brazil, from June 2008 to December 2009. Participants were 197 infants with birth weight of 1000-1500 g and without major birth defects. They were treated according to the guidelines of the American Academy of Pediatrics (APP). Infants not intubated or extubated less than 15 min after birth were randomized for two treatments, routine or CPAP, and were followed until hospital discharge. The routine (n=99) and CPAP (n=98) infants studied presented no statistically significant differences regarding birth characteristics, complications during the prenatal period, the need for mechanical ventilation during the first 5 days of life (19.2 vs 23.4%, P=0.50), use of surfactant (18.2 vs 17.3% P=0.92), or respiratory morbidity and mortality until discharge. The CPAP group required a greater number of doses of surfactant (1.5 vs 1.0, P=0.02). When CPAP was applied to the routine group, it was installed within a median time of 30 min. We found that CPAP applied less than 15 min after birth was not able to reduce the need for ventilator support and was associated with a higher number of doses of surfactant when compared to CPAP applied as clinically indicated within a median time of 30 min.

Long-term Effectiveness of Post-operative Continuous Positive Airway Pressure(CPAP) Therapy for Treating Hypernasality: Case Report

PURPOSE: In some patients with velopharyngeal insufficiency(VPI), Hypernasality can persist after surgical management. Continuous Positive Airway Pressure(CPAP) is applied to these patients for treating hypernasality. The purpose of this study is to report follow-up results of postoperative CPAP therapy. METHODS: After performing palatal lengthening, CPAP therapy was applied to three patients for eight weeks from July of 2008 to November of 2009. Perceptual evaluation, nasometry, and nasopharyngeal endoscopy were performed to evaluate hypernasality, nasalance and size of the gap at velopharyngeal port. Each evaluation was made before surgery, right after CPAP therapy and during follow- up of more than a year after CPAP therapy. RESULTS: All of the patients showed improvement in hypernasality right after CPAP therapy according to the auditory perceptual evaluation, nasometry and nasopharyngeal endoscopy. But the improvement in hypernasality in these patients did not last during follow-up. CONCLUSION: In this study, our results suggest that CPAP therapy is effective in reducing hypernasality for postoperative VPI patients immediately after the therapy, but hypernasality may be worsen in some patients during follow-up. Therefore we recommend follow-ups after CPAP therapy to see if the efficacy of CPAP therapy lasts.

Effects of continuous positive airway pressure on right and left ventricular function in patients with CHF / Монголын Анагаах Ухаан

Background: Continuous positive airway pressure (CPAP) can improve left and right ventricular (LV and RV) func¬tion in patients with congestive heart failure (CHF). Material and Methods: We have chosen 30 patients with CHF who were treated in Department of Cardiology, Shastin’s Central hospital. CHF etiology was ischemic and dilatation cardiomyopathy. Baseline respiratory rate, SpO2, heart rate, systolic and diastolic blood pressure, cardiac output, ejection fraction and Tricuspid Annular Plane Systolic Excursion (TAPSE) values were noted. All the measurements were repeated at the end of CPAP. Statistical analysis: Statistical analysis performed by SPSS 17.0 program and we compared pre and post CPAP findings. P<0.05 was considered to be significant. Results: After CPAP patients respiratory rate decreased from 23.63±4.72 to 20±3.74 per minute (р=0.01), SpO2 increased from 91.25±4.1% to 98.25±1.16%, heart rate decreased from 86.75±8.28 to 77.38±7.35 per minute (p=0.05), systolic blood pressure decreased from 107.88±17.94 mmHg to 97.75±14.78 mmHg (p=0.01), diastolic blood pressure decreased from 81.13±17.16 mmHg to 73.38±15.89 mmHg (p=0.01), cardiac output increased from 5.57±1.55 l/min to 5.76±1.86 l/min (p=0.01), ejection fraction increased from 27.81±7.66% to 31.7±7.97% (p=0.05), TAPSE increased from 1.49±0.25 mm to 1.69±0.23 mm (p=0.01) respectively. Pearson’s coefficient between dia¬stolic blood pressure and cardiac output is -0.282, between diastolic blood pressure and ejection fraction is -0,493, between diastolic blood pressure and TAPSE is -0.581 respectively. Conclusion: CPAP improves LV, RV function and some respiratory parameters in patients with CHF

Continuous positive airway pressure therapy: New generations.

Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS). However, CPAP is not tolerated by all patients with OSAS and alternative modes of pressure delivery have been developed to overcome pressure intolerance, thereby improving patient comfort and adherence. Auto-adjustable positive airway pressure (APAP) devices may be utilised for the long-term management of OSAS and may also assist in the initial diagnosis of OSAS and titration of conventional CPAP therapy. Newer modalities such as C-Flex and A-Flex also show promise as treatment options in the future. However, the evidence supporting the use of these alternative modalities remains scant, in particular with regard to long-term cardiovascular outcomes. In addition, not all APAP devices use the same technological algorithms and data supporting individual APAP devices cannot be extrapolated to support all. Further studies are required to validate the roles of APAP, C-Flex and AFlex. In the interim, standard CPAP therapy should continue as the mainstay of OSAS management.

Post-operative Continuous Positive Airway Pressure (CPAP) Therapy in Velopharyngeal Insufficiency Patient

PURPOSE: There are several surgical methods for correcting a velopharyngeal insufficiency (VPI) but in some cases, it is not possible to achieve complete recovery of the velopharyngeal function. This paper introduces a new therapy for treating hypernasality without further surgery using continuous positive airway pressure (CPAP). METHODS: CPAP therapy was applied to seven VPI patients for eight weeks from April of 2007 to September of 2009. All patients underwent palatoplasty for the cleft palate and six patients underwent palatal lengthening for VPI before CPAP therapy. A speech pathologist performed an auditory perceptual evaluation to evaluate the improvement in hypernasality after 8-week CPAP therapy. RESULTS: Six patients showed an improvement in hypernasality after CPAP therapy according to the auditory perceptual evaluation. One patient with severe hypernasality responded to the early part of therapy but the hypernasality did not improve after therapy. CONCLUSION: CPAP therapy might be effective in reducing the hypernasality in patients with VPI by providing resistance training to strengthen the velopharyngeal closure muscles. In particular, CPAP therapy could be more effective for patients who show mild to moderate hypernasality after surgery.

The Arterial Oxygenation Effects According to Different Ventilatory Modes during One Lung Ventilation / 대한마취과학회지

Among patients scheduled for elective surgery at the Kyung Hee University Hospital, 15 patients undergoing open thoracotomy were selected. Two different ventilatory modes were employed and compared to the one-lung ventilation(control). First, 10 cmH2O of continuous positive airway pressure was applied to the unventilated lung while patients were under one lung ventilation with 50% oxygen(CPAP 10 cmH2O). Second, 10 cmH2O of positive end expiratory pressure to the ventilated lung and 10 cmH2O of continuous positive airway pressure to the unventilated lung were applied while patients were under one lung ventilation with 50% oxygen(CPAP/PEEP). Arterial oxygen tension, alveolar-arterial oxygen difference (A-aDO2) and intrapulmonary shunt fraction of two different ventilatory modes were observed and compared to control group, and CPAP/PEEP group to CPAP 10 cmHO group. The RESULTs were as followed: 1) Mean PaO2 in CPAP 10 cmH2O and CPAP/PEEP were 138+/-42 mmHg and 177+/-44 mmHg, respectively, and were significantly increased as compared to 100+/-29 mmHg of control group(P<0.05). Comparing the PaO2 of CPAP 10 cmH2O and CPAP/PEEP, there was statistically significant increase in CPAP/PEEP(P<0.05). 2) A-aDO2 in CPAP 10 cmH2O and CPAP/PEEP were 175+/-43 mmHg and 131+42 mmHg, respectively, and were significantly decreased as compared to 213+/-32 mmHg of control group(P<0.05). Shunt percentages(Qsp/QT) were measured as 23.7+/-5.8% in control group, 18.3+/-6.0% in CPAP 10 cmH2O, 13.0+/-4.3% in CPAP/PEEP. Shunt percentages of CPAP 10 cmH2O and CPAP/PEEP were decreased significantly as compared to the control group(P<0.05). Comparing the A-a DO2 and the shunt percentages of CPAP 10 cmH2O and CPAP/PEEP, there was statistically significant decrease in CPAP/PEEP(P<0.05). Based on the above RESULTs, the application of appropriate continuous positive airway pressure to the unventilated lung and 10 cmH2O of positive end expiratory pressure to the ventilated lung during one lung ventilation is thought to be more effective than only continuous positive airway pressure to the unventilated lung in preventing hypoxemia.

The Changes in Arterial Oxygen Tension ( PaO2 ) after Application of Selective Continuous Positive Airway Pressure ( CPAP ) to Nondenpendent Lung during One - Lung Ventilation / 대한마취과학회지

Anesthesia for thoracic surgery is most commonly performed with the patient in the lateral decubitus position, with nondependent hemithorax comprising the operation field. When one-lung ventilation is employed, the nondependent lung is nonventilated and collapsed, while the dependent lung is ventilated. Consequently one-lung ventilation creates an obligatory right to left transpulmonary shunt through the nondependent nonventilated lung. Therefore one-lung ventilation results in a much larger alveolar-arterial oxygen tension-difference P(A-a)O2 and lower PaO2 than does two-lung ventilation. The present study was to evaluate oxygenation effect of selective CPAP to nondependent lung in the 17 thoracic surgical patients. Arterial blood gases were analysed, systolic blood pressures and heart rates were measured at following stages. Stage I; lateral decubitus position before chest opening Stage II; 15 min after chest opening and one lung ventilation stage III; 15 min after application of selective CPAP 5 cmHO to the nondependent lung stage IV; 40 min after application of selective CPAP 5 cmHO to the nondependent lung The results were as follows: 1) In stage II, the value of PaO2 was significantly lower as compared to that in stage I(224.9+/-78.0 vs 418.2+/-63.1 mmHg, P<0.01). 2) In stage III and IV, the values of PaC4 were significantly higher.as compared to that in stage II(333.8+/-97.1, 364.5+/-88.6 vs 224,9+/-78.0 mmHg, P<0.01). 3) In stage III, the value of PaCO2 was significantly lower as compared to that in stage II(37.1+/-2.9 vs 38.2+/-2.7 mmHg, P<0.05). 4) In stage IV, the value of pH was significantly lower as compared to that in stage III(7.37+/-0.05 vs 7.38+/-0.05 P<0.05). 5) Systolic blood pressures and heart rates remained unchanged at all times. We concluded that application of 5 cmHO CPAP to the nondependent lung during one-lung ventilation is one of most efficacious maneuvers to increase PaO2, accompanying less surgical interference.