Correlation between nasal anatomical characteristics in newborns and short binasal prong dimensions

Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.

Application of Different Noninvasive Ventilation Modes Combined with Caffeine Citrate in the Treatment of Apnea of Prematurity / 医学研究杂志

Objective To explore the optimal protocol for treating apnea of prematurity by analyzing the effectiveness of different noninvasive assisted ventilation modes combined with caffeine citrate in preterm infants.Methods From October 2019 to August 2022,a total of 90 infants with apnea of prematurity(gestational age≤34 weeks)were chosen as research objects in the Neonatal Intensive Care Unit of the Second Affiliated Hospital of Bengbu Medical College,and the relevant data were retrospectively analyzed.The children were divided into nasal continuous positive airway pressure(NCPAP)combined with caffeine citrate group(44 cases),and noninvasive inter-mittent positive pressure ventilation(NIPPV)sequential NCPAP combined with caffeine citrate group(46 cases)according to the differ-ent treatment protocols adopted in the clinical treatment process.The general clinical data,apnea efficacy,treatment time,and occur-rence of adverse effects between the two groups of prematurity were compared statistically by t-test,x2test,and Mann-Whitney rank sum test.Results The total efficiency of the NIPPV sequential NCPAP combined with caffeine citrate group in treating apnea of prematu-rity was 91.30％,higher than 86.36％in NCPAP combined with caffeine citrate group,and the difference was statistically significant(P＜0.05).Statistically significant differences in failure of non-invasive ventilation and associated treatment time between the two groups(P＜0.05)were observed.The difference between the two groups in the incidence of feeding intolerance and nasal injury was sta-tistically significant(all P＜0.05).Conclusion Early adoption of NIPPV sequential NCPAP ventilation mode can achieve better clinical results,shorten treatment and hospitalization time,and have relatively fewer adverse effects than traditional NCPAP alone in treating apnea of prematurity,which is worthy of clinical promotion.

Twin pregnancies with chronic hypertension and sleep apnea-hypopnea syndrome treated with continuous positive airway pressure: report of three cases / 中华围产医学杂志

This paper reports the maternal and fetal outcomes of three twin pregnancies with chronic hypertension and obstructive sleep apnea-hypopnea syndrome (OSAHS) who were treated with continuous positive airway pressure (CPAP). All three women with twin pregnancies were diagnosed with chronic hypertension. Furthermore, symptoms such as snoring and apnea assisted the diagnosis of OSAHS through polysomnography monitoring. Case 1 was treated with CPAP at 28 gestational weeks. The blood pressure increased gradually after the first month of CPAP treatment, with an elevated urine protein concentration. At 34 gestational weeks, the pregnant woman underwent a cesarean section due to the development of hemolysis, elevated liver enzymes, and low platelet syndrome. Case 2 was treated with CPAP at 11 gestational weeks, with stable blood pressure throughout the pregnancy, and was delivered through cesarean section at 37 weeks of pregnancy. Case 3 started CPAP at 13 gestational weeks for four months, and increased blood pressure and urine protein were observed. Medication brought the blood pressure down, and urine protein became negative. At 32 gestational weeks, a cesarean section was performed because of premature rupture of the membrane. Her CPAP treatment continued till delivery with good maternal and infant outcomes. The treatment outcomes of the three cases suggest that CPAP may prolong the time of blood pressure rise among twin pregnancies where chronic hypertension and OSAHS coexist, which potentially reduces the occurrence of adverse maternal and infant outcomes.

Effects of parameters of BiPAP ventilator on compliances of chest and lung,and arterial blood gas indexes of AECOPD patients / 中国医学装备

Objective:To explore the effects of ventilator parameters on the compliances of chest and lung,and arterial blood gas indicators of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)when biphasic positive airway pressure(BiPAP)ventilation treated AECOPD patients at acute exacerbation period.Method:A total of 78 AECOPD patients who underwent non-invasive ventilation treatment by using BiPAP ventilators in Xinjiang Cardiovascular and Cerebrovascular Hospital from April 2020 to April 2021 were selected.The common range of inspiratory positive airway pressure(IPAP)was 10-25 cmH2O.Based on the specific situation and adjustment of clinical needs of patients,this study set"<15 cmH2O"as the low IPAP group(n=34),and set"≥15 cmH2O"as the high IPAP group(n=44)to analyze the correlation between IPAP of BiPAP ventilator parameters and the therapeutic effects,chest lung compliances and arterial blood gas indicators of patients.Results:The rate of therapeutic effect of patients in the high IPAP group was 93.48%,which was significantly higher than 71.88%of the low IPAP group,and the difference between the two groups was statistically significant(x2=6.766,P<0.05).Before treatment,there were no statistically significant differences in indicators included chest compliance(CTh),lung compliance(CL)and total compliance(Ct)between the two groups(P>0.05).After treatment,the Ct,CL and CTh of patients in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between the two groups were statistically significant(t=2.508,2.027,2.185,P<0.05),respectively.There was no statistically significant difference in arterial oxygen partial pressure(PaO2)value between the two groups before used mechanical ventilation(P>0.05).The PaO2 values of patients at 2,4,6 and 8h of using mechanical ventilation in the high IPAP group were significantly higher than those in the low IPAP group,and the differences between different groups were statistically significant(t=8.531,5.296,3.264,4.623,P<0.05),respectively.Both two groups of patients showed a significant increase in inflammatory mediators such as matrix metalloproteinase-9(MMP-9)and interleukin-8(IL-8)during occurring disease.After treatment,the levels of the two mediators decreased,and the high IPAP group was significantly lower than that of low IPAP group(t=2.251,5.484,P<0.05),respectively.The incidence of abdominal distension in patients of high IPAP group was 20.45%,which was significantly higher than 5.88%of low IPAP group,and the difference between groups was statistically significant(x2=3.623,P<0.05).Conclusion:The IPAP of BiPAP ventilator parameters has effect on chest lung compliance,arterial blood gas analysis and inflammatory indicators in AECOPD patients.High IPAP can improve therapeutic effect,and improve chest lung compliance and arterial blood gas analysis,but can easily cause adverse reactions such as abdominal distension.

Actualización sobre apnea obstructiva del sueño en la etapa de movimientos oculares rápidos / Update on obstructive sleep apnea in the rapid eye-movement stage

La apnea obstructiva del sueño durante los movimientos oculares rápidos del sueño (AOS REM), se define como la presencia de episodios de apnea y/o hipopnea obstructivos en la etapa del sueño REM. La epidemiología de esta patología es compleja y no existe una definición estandarizada actualmente. Aunque no se ha logrado llegar a un consenso para definir AOS REM, la evidencia señala que está asociada a factores de riesgos cardiovasculares, metabólicos y neurocognitivos de forma independiente. A pesar que su tratamiento principal es la presión positiva continua de las vías respiratorias (CPAP), los criterios de un adecuado uso de CPAP en la AOS, no son suficientes para tratar de forma adecuada la AOS REM. Es necesario estandarizar una definición universal y realizar estudios prospectivos diseñados para buscar estrategias de tratamientos específicos para la AOS REM.

Obstructive sleep apnea during rapid eye movement sleep (REM OSA) is defined as the presence of obstructive episodes of apnea and/or hypopnea in REM sleep. The epidemiology of this pathology is complex and there is currently no standardized definition. Although no consensus has been reached to define REM OSA, the evidence indicates that it is independently associated with cardiovascular, metabolic and neurocognitive risk factors. Although its main treatment is continuous positive airway pressure (CPAP), the criteria for an adequate use of CPAP in OSA are not sufficient to adequately treat REM OSA. It is necessary to standardize a universal definition and carry out prospective studies designed to search for specific treatment strategies for REM OSA.

Modeling the noninvasive bi-level positive airway pressure ventilation therapy system and simulated application / 生物医学工程学杂志

Without artificial airway though oral, nasal or airway incision, the bi-level positive airway pressure (Bi-PAP) has been widely employed for respiratory patients. In an effort to investigate the therapeutic effects and measures for the respiratory patients under the noninvasive Bi-PAP ventilation, a therapy system model was designed for virtual ventilation experiments. In this system model, it includes a sub-model of noninvasive Bi-PAP respirator, a sub-model of respiratory patient, and a sub-model of the breath circuit and mask. And based on the Matlab Simulink, a simulation platform for the noninvasive Bi-PAP therapy system was developed to conduct the virtual experiments in simulated respiratory patient with no spontaneous breathing (NSB), chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS). The simulated outputs such as the respiratory flows, pressures, volumes, etc, were collected and compared to the outputs which were obtained in the physical experiments with the active servo lung. By statistically analyzed with SPSS, the results demonstrated that there was no significant difference ( P > 0.1) and was in high similarity ( R > 0.7) between the data collected in simulations and physical experiments. The therapy system model of noninvasive Bi-PAP is probably applied for simulating the practical clinical experiment, and maybe conveniently applied to study the technology of noninvasive Bi-PAP for clinicians.

The effects of quality improvement program on the incidence of bronchopulmonary dysplasia in very preterm infants / 中国新生儿科杂志

Objective:To evaluate the effects of quality improvement (QI) program on the incidence of bronchopulmonary dysplasia (BPD) in very preterm infants (VPIs) [gestational age (GA)<32 weeks].Methods:From July to December 2017,VPIs admitted to the Department of Neonatology of Yancheng Maternity and Child Health Care Hospital were retrospectively enrolled and were assigned into pre-quality improvement program group (Pre-QI group).From July to December 2018, VPIs were assigned into post-quality improvement program group (Post-QI group). QI program included delayed umbilical cord clamping (DCC), early postnatal nasal continuous positive airway pressure ventilation (nCPAP) and minimally invasive pulmonary surfactant therapy (MIST). The clinical data and prognostic indicators of the two groups of VPIs and their mothers were compared. Independent sample t-test or continuity-adjusted Chi-square test (or Fisher's exact test) and Logistic regression were used for statistical analysis. Results:A total of 204 VPIs were enrolled, including 96 cases in Pre-QI group and 108 cases in Post-QI group. 1 min Apgar score and hematocrit on admission to the neonatal intensive care unit (NICU) in the Post-QI group were significantly higher than the Pre-QI group( P<0.05). The incidence of delivery room resuscitation, endotracheal intubation at birth and endotracheal intubation in NICU in the Post-QI group were significantly lower than the Pre-QI group( P<0.05). The application of pulmonary surfactant and mechanical ventilation, the incidence of neonatal respiratory distress syndrome and BPD in the Post-QI group were lower than the Pre-QI group ( P<0.05). After adjusting for confounding factors, Logistic regression analysis showed that DCC ( aOR=0.261,95% CI 0.091~0.718, P=0.023), nCPAP ( aOR=0.284,95% CI 0.123~0.667, P=0.015), MIST ( aOR=0.276,95% CI 0.114~0.627, P=0.011) were protective factors of BPD, and MV ( aOR=2.023,95% CI 1.048~3.918, P=0.036) was risk factor of BPD. Conclusions:The QI program consisting of DCC, early nCPAP and MIST for VPIs can reduce the incidence of BPD.

Effect of BiPAP ventilation on respiratory physiology in patients with stable COPD / 中华健康管理学杂志

Objective:To observe the physiological effect of bi-level positive airway pressure (BiPAP) ventilation among stable chronic obstructive pulmonary disease (COPD) patients.Methods:This was a small sample size, exploratory, interventional study. A total of 10 outpatients with stable COPD were included from Department of Pulmonary and Critical Care Medicine of Zhujiang Hospital, Southern Medical University between January 2018 and December 2018. The BiPAP mode of noninvasive mechanical ventilation was adopted. The inspiratory positive airway pressure was gradually increased from 10 cmH 2O (1 cmH 2O=0.098 kPa) to 24 cmH 2O, and each time by 2 cmH 2O. The expiratory positive airway pressure remained unchanged at 4 cmH 2O. Baseline and test data were collected before and during the ventilation for comparison, including total respiratory cycle time (T tot), inspiratory time (T i), inspiratory time (T e), inspiratory tidal volume (V Ti); mouth pressure (P mo), esophageal pressure (P eso), transdiaphragmatic pressure (P di), esophageal pressure time product (PTP es), diaphragm pressure time product (PTP di), root mean square of electromyography of diaphragm (RMS), V e/RMS, inspiratory capacity (IC), the change in end-expiratory lung volume (ΔEELV) and dynamic PEEPi (PEEPi dyn). Results:All the 10 patients completed the trial. Compared to calm breathing, V Ti, V e, P mo, IC, ΔEELV score and V e/RMS increased significantly with increasing pressure levels (all P<0.05); T e only increased significantly at 20-22 cmH 2O pressure levels compared to calm breathing ( P<0.05). P di, PTP es, PTP di, RMS and RMS/RMS max decreased significantly with increasing levels (all P<0.05). PTP es and PTP di converged to 0 and no longer showed significant changes after the 18 cmH 2O pressure level. RMS and RMS/RMS max flattened out at pressure level greater than 16 cmH 2O. T i/T tot only significantly decreased at the 20 cmH 2O pressure level compared to calm breathing. PEEPi dyn showed a tendency to decrease and then increase with increasing pressure levels. Conclusion:BiPAP ventilation, at appropriate pressure levels, significantly relieves pulmonary ventilation disorders and reduces the load of respiratory muscle in patients with stable COPD.

Continuous positive airway pressure treatment on blood pressure rhythm in hypertension patients with obstructive sleep apnea / 中华老年医学杂志

Objective:To investigate the effect of continuous positive airway pressure(CPAP)on blood pressure and blood pressure rhythm in hypertensive patients with sleep apnea syndrome.Methods:Hypertensive patients with obstructive sleep apnea syndrome consecutively recruited between 2020 and 2022 were randomly divided into two groups, the CPAP group and the control group.Both groups were routinely treated with antihypertensive drugs, and patients in the CPAP group were additionally treated with CPAP for more than 4 hours at night.24-hour ambulatory blood pressure monitoring was conducted following 12 weeks of treatment, and the blood pressure rhythm was analyzed according to blood pressure results.Results:A total of 104 patients(40-73 years old)were enrolled in the study, with 51 patients(mean age: 57.3±9.1)in the CPAP group(58.8% male)and 53 patients(mean age: 58.3±8.1)in the control group(54.7% male). The results of 24-hour ambulatory blood pressure monitoring showed that, compared with the control group, the CPAP group achieved more effective blood pressure reduction in mean systolic blood pressure(SBP)[(134.6±8.4)mmHg vs.(138.2±5.9)mmHg, t=-2.54, P=0.013], mean DBP[(72.4±9.3)mmHg vs.(77.0±9.0), t=-2.56, P=0.012], mean nighttime SBP[(117.2±5.1)mmHg vs.(122.0±6.2)mmHg, t=-4.283, P<0.01]and mean nighttime DBP[(63.7±6.4)mmHg vs.(66.9±5.1)mmHg, t=-2.812, P<0.01). There was a significant increase in blood pressure dippers in the CPAP group(37.25% vs.18.87%, χ2=4.370, P=0.037). Conclusions:CPAP can significantly reduce 24-hour mean blood pressure and nocturnal blood pressure, and improve blood pressure rhythm in hypertensive patients with sleep apnea syndrome.

Effect of continuous positive airway pressure ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients / 中华麻醉学杂志

Objective:To evaluate the effect of continuous positive airway pressure (CPAP) ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients.Methods:Forty-six elderly patients of either sex, aged 65-80 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective cerebrovascular intervention surgery under general anesthesia, were divided into 2 groups ( n=23 each) according to the random number table method: control group (group C) and CPAP ventilation group (group CPAP). During induction of anesthesia, CPAP was set at 5 cmH 2O during spontaneous breathing, and PEEP was set at 5 cmH 2O when spontaneous breathing disappeared, and the ventilation mode was changed to pressure-controlled ventilation (PCV) mode in group CPAP. CPAP was not set, and PEEP was set at 0 cmH 2O for PCV when spontaneous breathing disappeared in group C. During anesthesia maintenance, PCV-volume guaranteed mode was used in both groups, and PEEP was set at 5 cmH 2O. Whole lung CT scanning was performed immediately after radial artery catheterization (T 0), at 1 min after endotracheal intubation (T 1), and before tracheal extubation (T 2) at the end of operation to calculate the percentage of atelectasis area at 1 cm above the right diaphragm. At T 0, T 1, T 2 and 30 min after entering postanesthesia care unit (T 3), blood samples from the radial artery were taken to record PaO 2 and PaCO 2 and calculate the oxygenation index (OI). Results:Compared with the baseline at T 0, the percentage of atelectasis area was significantly increased at T 1 and T 2 in two groups ( P<0.05); PaO 2 was significantly increased at T 1 and T 2 and decreased to T 0 level at T 3, OI was decreased at T 1 and T 2 and increased to T 0 level at T 3 in two groups ( P<0.05). Compared with group C, the percentage of atelectasis area was significantly decreased and PaO 2 and OI were increased at T 1 and T 2 in group CPAP ( P<0.05). There was no significant difference in PaCO 2 at each time point between the two groups ( P>0.05). Conclusions:CPAP ventilation during induction of anesthesia can reduce the development of perioperative atelectasis and improve the oxygenation in elderly patients.

Effect of continuous positive pressure ventilation strategy during induction of general anesthesia on atelectasis after induction in obese patients / 中华麻醉学杂志

Objective:To evaluate the effect of continuous positive airway pressure(CPAP) ventilation strategy during induction of general anesthesia on atelectasis after induction in obese patients.Methods:A total of 86 patients, aged 30-60 yr, with body mass index of 28-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ, scheduled for elective cerebrovascular intervention under general anesthesia, were divided into 2 groups ( n=43 each) using a random number table method: CPAP group (group C) and routine group (group R). Group C received CPAP 5 cmH 2O-assisted ventilation after preoxygenation for spontaneous breathing and disappearance of spontaneous breathing. Chest CT scan and arterial blood gas analysis were performed after entering the operating room (T 1) and 5 min after endotracheal intubation (T 2) to calculate the percentage of atelectasis area and to record PaO 2. Dynamic lung compliance and plateau pressure were recorded at T 2. Mean minute ventilation under controlled breathing, P ETCO 2, and use of vasoactive drugs during induction were recorded. The occurrence of reflux and aspiration during mask ventilation was recorded. The development of pulmonary complications within 3 days after operation was recorded. Results:Compared with group R, the percentage of atelectasis area at T 2 was significantly decreased, PaO 2, dynamic lung compliance and plateau pressure were increased ( P<0.05), and no significant change was found in mean minute ventilation, P ETCO 2, requirement for vasoactive drugs and incidence of pulmonary complications in group C ( P>0.05). No reflux or aspiration was observed during mask ventilation. Conclusions:CPAP (5 cmH 2O) strategy during anesthesia induction can reduce the degree of atelectasis after induction in obese patients.

Obstructive sleep apnea in patients with ischemic stroke: mechanism, diagnosis, and treatment / 国际脑血管病杂志

Ischemic stroke is the main cause of death and disability in adults, and its incidence is increasing year by year. Obstructive sleep apnea (OSA) is the most common type of sleep-disordered breathing, which can increase the risk of ischemic stroke and affect the outcomes of patients. There is an increasing amount of research on the relationship between OSA and ischemic stroke. This article reviews the bidirectional relationship between OSA and ischemic stroke, the mechanism of OSA causing ischemic stroke, and the diagnosis and treatment of OSA in patients with ischemic stroke.

Efficacy of high-flow nasal cannula oxygen therapy in optimizing painless transesophageal echocardiography in elderly patients / 中华麻醉学杂志

Objective:To evaluate the efficacy of high-flow nasal cannula (HFNC) oxygen therapy in optimizing painless transesophageal echocardiography in elderly patients.Methods:Sixty American Society of Anesthesiologists Physical Status classification Ⅱ patients, regardless of gender, aged 60-75 yr, with body mass index of 18.5-23.9 kg/m 2, were randomized into 2 groups ( n=30 each) by a random number table method: group HFNC and conventional ventilation group (group C). Pure oxygen 10 L/min was inhaled for 3 min preoxygenation using the HFNC device in group HFNC. Group C inhaled pure oxygen at 6 L/min for 3 min preoxygenation via a nasal cannula. Sufentanil 0.1 μg/kg and remazolam 0.25-0.30 mg/kg were intravenously injected in turn. Group HFNC was connected to a high-flow humidification oxygen therapy device and inhaled pure oxygen at 60 L/min (37℃, FiO 2 100%). The flow rate of pure oxygen was maintained at 6 L/min (FiO 2 100 %) in group C. The patients were placed in left lateral decubitus position, esophageal ultrasound was performed after the eyelash reflex disappeared, and remazolam 0.1 mg/kg was intravenously injected intermittently when bucking and body movement were induced by operation stimulation. The occurrence of hypoxia-related adverse events, mandibular intervention and ventilation-related adverse events was observed during examination. The operation time, time of emergence from anesthesia and consumption of remazolam were recorded. Results:Compared with group C, the incidence of severe hypoxia and rate of mandibular intervention were significantly decreased (7%/0 and 53%/17%, P<0.05), the lowest intraoperative SpO 2 was increased ( P<0.05), and no significant change was found in the operation time, time of emergence from anesthesia and consumption of remazolam in group HFNC ( P>0.05). No ventilation-related adverse events occurred in both groups. Conclusions:HFNC can markedly optimize the ventilation management of elderly patients undergoing painless transesophageal echocardiography.

Use of noninvasive mechanical ventilation weaning protocol in neonatal intensive care units in Brazil: a descriptive study / Uso de protocolo de desmame de ventilação mecânica não invasiva em unidades de terapia intensiva neonatal no Brasil: estudo descritivo

Abstract Objective: This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. Methods: A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. Results: A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. Conclusions: Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning.

RESUMO Objetivo Investigar se as unidades de terapia intensiva neonatal (UTIN) dos hospitais brasileiros utilizam protocolo para desmame de ventilação não invasiva (VNI), de que forma é realizada a retirada desse suporte ventilatório e se há consenso entre os métodos utilizados pelas instituições. Métodos Foi realizado um estudo de corte transversal de dezembro de 2020 a fevereiro de 2021, com base nas respostas a um questionário eletrônico, preenchidas por fisioterapeutas que trabalham em UTIN de hospitais brasileiros sobre a rotina da fisioterapia, o uso de VNI e seu desmame. Resultados Preencheram os critérios do estudo 93 respostas ao questionário eletrônico: 52,7% foram de instituições públicas de saúde, com média de 15 leitos de UTIN (15,2 ±15,9); 85% dos fisioterapeutas trabalhavam exclusivamente na UTIN, 34,4% das UTIN possuíam atendimento fisioterapêutico 24 horas por dia; 66,7% das unidades utilizam o Continuous Positive Airway Pressure (CPAP) como modo ventilatório e 72% a pronga nasal como interface de VNI; 90,3% dos fisioterapeutas responderam que suas UTIN não possuíam protocolo de desmame de VNI, com métodos de desmame relatados variados, sendo mais citado o desmame de pressão. Conclusões A maior parte das UTIN brasileiras não possui protocolo de desmame de VNI; o método mais utilizado entre as instituições que possuem ou não protocolo é o desmame de pressão. Apesar de a maioria dos voluntários trabalhar exclusivamente em UTIN, muitos hospitais não possuem a carga horária recomendada, o que pode ser um dos fatores negativos na organização dos protocolos e no andamento do desmame ventilatório.

Effects of CPAP on cardiorespiratory outcomes in patients with obstructive sleep apnea and heart failure: a systematic review / Efectos de la presión positiva continua en las vías aéreas en los resultados cardiorrespiratorios en pacientes con apnea obstructiva del sueño e insuficiencia cardíaca: una revisión sistemática / Efeitos da pressão positiva contínua nas vias aéreas nos desfechos cardiorrespiratórios em pacientes com apneia obstrutiva do sono e insuficiência cardíaca: uma revisão sistemática

ABSTRACT Obstructive sleep apnea (OSA) is a public health problem with a great economic impact. It is estimated that the prevalence of patients with OSA ranges from 4% to 6% of men and 2% to 4% of women in the general population. Strong evidence suggests that both sleep disorders and heart failure (HF) are related. Continuous positive airway pressure (CPAP) is the gold standard non-pharmacological treatment for this population. However, there is still a gap in the literature and its effects in patients with OSA and HF are not entirely clear. This study aimed to evaluate, by randomized clinical trials, the effects of positive pressure on cardiorespiratory function in patients with OSA and HF. Randomized clinical trials were included, with publication in the MEDLINE, PEDro, Cochrane Library, SciELO and PubMed databases and the risk bias was assessed using the PEDro scale. Six articles were included in this study, involving 165 participants. Our findings demonstrate that CPAP in the treatment of OSA in patients with HF promotes an increase in left ventricular ejection fraction, oxygen saturation and a reduction in blood pressure, apnea/hypopnea indices and awakenings from sleep during the night. We conclude that treatment with CPAP promotes an improvement in cardiorespiratory outcomes in patients with OSA and HF, improving the prognosis and reducing the risk of sudden death. However, their data must be cautiously interpreted considering the bias of the studies and their limitations.

RESUMEN La apnea obstructiva del sueño (APS) es un problema de salud pública con gran impacto económico. Se estima que la prevalencia de portadores de AOS es del 4% al 6% en los hombres y del 2% al 4% en las mujeres en la población general. Existe una fuerte evidencia de que tanto los trastornos del sueño como la insuficiencia cardíaca (IC) tienen una asociación entre sí. La presión positiva continua en las vías respiratorias (CPAP) es el tratamiento no farmacológico estándar de oro para esta población. Sin embargo, aún existe un vacío en la literatura y sus efectos en pacientes con AOS e IC no están del todo claros. Ante esto, el objetivo de este estudio es evaluar, mediante ensayos clínicos aleatorizados, los efectos de la CPAP sobre la función cardiorrespiratoria en pacientes con AOS e IC. Se incluyeron seis ensayos clínicos aleatorizados, con publicación en las bases de datos MEDLINE, PEDro, Cochrane Library, SciELO y PubMed, con un total de 165 participantes. El riesgo de sesgo se evaluó mediante la escala PEDro. Nuestros hallazgos demuestran que la CPAP en el tratamiento de la AOS en pacientes con IC promueve un aumento de la fracción de eyección del ventrículo izquierdo y de la saturación de oxígeno, y una reducción de la presión arterial, de los índices de apnea/hipopnea y de los despertares nocturnos. Se concluye que el tratamiento con CPAP promueve una mejora en los resultados cardiorrespiratorios en pacientes con AOS e IC, mejorando el pronóstico y reduciendo el riesgo de muerte súbita. Sin embargo, sus datos deben interpretarse con cautela considerando el sesgo de los estudios y sus limitaciones.

RESUMO A apneia obstrutiva do sono (AOS) é um problema de saúde pública de grande impacto econômico. Estima-se que a prevalência de portadores de AOS seja de 4% a 6% entre os homens e de 2% a 4% entre as mulheres da população em geral. Há fortes evidências de que os distúrbios do sono e a insuficiência cardíaca (IC) estão relacionados. A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento não farmacológico padrão ouro para essa população. No entanto, ainda há uma lacuna na literatura, e seus efeitos em pacientes com AOS e IC não estão plenamente estabelecidos. Assim, o objetivo deste estudo foi avaliar através da revisão de ensaios clínicos randomizados os efeitos da CPAP na função cardiorrespiratória em pacientes com AOS e IC. Foram incluídos seis ensaios clínicos randomizados, publicados nas bases de dados MEDLINE, PEDro, Cochrane Library, SciELO e PubMed, totalizando 165 participantes. O risco de viés foi avaliado através da escala PEDro. Nossos achados demonstraram que a CPAP no tratamento da AOS em pacientes com IC promove um aumento da fração de ejeção do ventrículo esquerdo e da saturação de oxigênio e uma redução da pressão arterial, dos índices de apneia/hipopneia e dos despertares durante a noite. Concluímos que o tratamento com CPAP promove uma melhora nos desfechos cardiorrespiratórios em pacientes com AOS e IC, beneficiando o prognóstico e reduzindo os riscos de morte súbita. Porém, os resultados devem ser interpretados com cautela, considerando o viés dos estudos e suas limitações.

The use of a noninvasive positive pressure system to facilitate tracheal intubation in a difficult pediatric airway: a case report

Abstract Patients with burns to the head and neck maybe difficult to intubate or ventilate via facemask. Furthermore, post-burn scarring and microstomia may reduce the success of rescue supraglottic airway placement. While awake tracheal intubation using a flexible intubation scope is considered the optimal technique for these patients, it may not always be feasible in the pediatric population. We report a case of successful management of a difficult airway in a child with extensive post-burn head and neck deformity using a noninvasive positive pressure system to aid with inhalational induction and deep sedation during intubation using a flexible scope.

Comparison of different methods of obtaining the rapid shallow breathing index

Abstract Objective: To compare the Rapid Shallow Breathing Index (RSBI) obtained by the ventilometer and from mechanical ventilation parameters. Methods: Randomized crossover trial, including 33 intubated patients, on mechanical ventilation for at least 24 hours, undergoing spontaneous breathing test. Patients were submitted to the measurement of RSBI by four methods: disconnected from the ventilator through the ventilometer; in Pressure Support Ventilation (PSV) mode at a pressure of 7 cm H2O; in Continuous Positive Airway Pressure (CPAP) mode at a pressure of 5 cmH2O with flow trigger; in CPAP mode at a pressure of 5 cmH2O with pressure trigger. Results: No significant difference was detected between the RSBI obtained by the ventilometer and in the CPAP mode with flow and pressure triggers, however, in the PSV mode, the values were lower than in the other measurements (p < 0.001). By selecting patients from the sample with higher RSBI (≥ 80 cycles.min−1.L−1), the value of the index obtained by the ventilometer was higher than that obtained in the three options of ventilation methods. Conclusion: The RSBI obtained in the CPAP mode at a pressure of 5 cmH2O, in both triggers types, did not differ from that measured by the ventilometer; it is, therefore, an alternative when obtaining it from mechanical ventilation parameters is necessary. However, in the presence of borderline values, the RSBI measured by ventilometer is recommended, as in this method the values are significantly higher than in the three ventilation modalities investigated.

Demoras y adherencia al tratamiento de las apneas del sueño dentro de un sistema de provisión universal en un hospital público / Delays and Adherence to the Treatment of Sleep Apnea within a Universal Provision System in a Public Hospital

Introducción: El tratamiento con presión positiva es uno de los pilares del manejo de las apneas obstructivas del sueño, sin embargo, el acceso a los equipos y la adherencia a su uso no son fáciles de lograr. Objetivo: Evaluar la adherencia de los pacientes del sistema público de salud que reciben equipos de presión continua de forma gratuita para el tratamiento de las apneas obstructivas del sueño. Material y métodos: Se evaluó retrospectivamente a los pacientes con diagnóstico de apnea obstructiva del sueño que recibieron equipos de CPAP entre 2013 y 2018 a través de PAMI, Incluir Salud y Cobertura Porteña de Salud. Resultados: Los pacientes de PAMI fueron de mayor edad y tenían un Epworth más bajo. La demora entre consulta y diagnóstico fue de 1,4 ± 2,4 meses. El tiempo de diagnóstico a provisión del equipo fue de 10,2 ± 9,9 meses. Los pacientes de PAMI recibieron los equipos más rápido (2,7 ± 2,5 meses) y fueron más adherentes a las visitas de control. La adherencia a los controles clínicos el primer año fue del 46 %. Los pacientes de mayor edad, con Epworth más bajo y que usan auto-CPAP tenían una tendencia no significativa a favorecer esta adherencia. La adherencia objetiva medida por tarjeta de memoria o telemonitoreo fue del 40 %. El mayor IMC fue el único factor que la favorecía. Conclusiones: Superando la limitación económica al acceso a los equipos, no cambia la actitud hacia la adherencia y control.

Introduction: Treatment with positive airway pressure is one of the cornerstones in managing obstructive sleep apnea (OSA). However, access to the equipment and ad herence to their use are not easy to achieve. Objective: to evaluate the adherence of patients from the public health system who receive continuous pressure devices free of charge for the treatment of OSA. Materials and methods: Patients diagnosed with OSA who received continuous positive airway pressure (CPAP) devices between 2013 and 2018 through PAMI (Programa de Atención Médica Integral, Medical Services Program) , Incluir Salud, and Cobertura Porteña de Salud were retrospectively evaluated. Results: Patients from PAMI were older and had a lower score in the Epworth scale. The delay between the consultation and the diagnosis was 1.4 ± 2.4 months. The time from the diagnosis until the equipment was provided was 10.2 ± 9.9 months. Patients from PAMI received the equipment faster (2.7 ± 2.5 months) and were more adherent to follow-up visits. Adherence to clinical follow-up visits in the first year was 46%. Older patients with a lower Epworth score and those using AutoCPAP had a non-significant trend favoring this adherence. The objective adherence measured by memory card or telemonitoring was 40%. The higher body mass index (BMI) was the only factor favor ing objective adherence. Conclusions: Overcoming the economic limitation to access the equipment does not change the attitude towards adherence and follow-up.

Descripción de la frecuencia de factores de mala adherencia en la terapia con presión positiva en la vía aérea (CPAP-BPAP-APAP) en pacientes con AOS pertenecientes al Hospital Militar Central de Colombia entre 2015-2020 / Description of the frequency of poor adherence factors in positive airway pressure therapy (CPAP-BPAP-APAP) in patients with OSA belonging to the Central Military Hospital of Colombia between 2015-2020

Introducción: la apnea obstructiva del sueño (AOS) es una enfermedad de etiología multifactorial. Existen diversos factores que condicionan la baja adherencia al manejo con sistemas de presión positiva desde problemas con el equipo hasta condiciones inherentes al paciente. El objetivo de este estudio es describir la frecuencia de los factores de mala adherencia reportados en la literatura en pacientes manejados entre 2015-2020. Metodos: estudio observacional, descriptivo, tipo serie de casos. Se realizó la revisión de historia clínica y diligenciamiento de una encuesta. Se caracterizaron y describieron las variables clínicas, físicas y relacionadas con el dispositivo. Resultados: se analizaron 26 pacientes, 76,9 % de sexo masculino y 23.1% de sexo femenino (23,1 %). La edad promedio de los pacientes era de 51,2 ± 13,2 anÞos. El índice de masa corporal (IMC) promedio fue de 27,8, de los cuales solo siete pacientes tenían un índice normal (<25; 26.9%). 10 pacientes al momento de la primera consulta no tenían somnolencia diurna (38,5 %). El índice de apnea-hipopnea (IAH) fue en promedio de 37,4/hora ± 17,5. Seis pacientes con presión de tratamiento menor o igual a 8 cmH2O (30 %) y 14 pacientes con presiones superiores (70 %). El promedio de IAH residual fue de 8,3 eventos/hora ± 10,1. Conclusiones: la frecuencia de factores relacionados con baja adherencia al tratamiento sugiere la necesidad de una valoración psicosocial exhaustiva del paciente, una historia clínica detallada y un examen físico completo con el fin de identificar limitantes para la adherencia al manejo y proporcionar estrategias terapéuticas.

Introduction: Obstructive sleep apnea (OSA) is a complex condition with multiple causative factors contributing to poor adherence to positive pressure systems since problems with device and conditions inherent to the patient. This study aims to describe the frequency of such factors reported in the literature for patients treated between 2015-2020. Methods: Observational, descriptive, case series study. The medical history was reviewed, and a survey was completed. Clinical, physical, and device-related variables were characterized and described. Results: 26 patients were analyzed in this study, 76.9% were male and 23.1% female. The average age of the patients was 51.2 ± 13.2 years. The body mass index (BMI) was 27.8, of which only 7 patients had a normal index (<25; 26.9%). 10 patients at the time of the first consultation do not have daytime sleepiness (38.5%). The apnea hypopnea index (AHI) was on average 37.4/hour ± 17.5. 6 patients with treatment pressure less than or equal to 8 cmH2O (30%) and 14 patients with pressure greater (70%). The residual AHI was on average 8.3 events/hour ± 10.1. Conclusions: The fre-quency of factors associated with poor treatment adherence underscores the need for comprehensive psychosocial assessments, detailed clinical histories, and tho-rough physical assessment to identify barriers to adherence and develop effective therapeutic strategies.

Legal action for access to resources inefficiently made available in health care systems in Brazil: a case study on obstructive sleep apnea / Judicialização para acesso a recursos disponibilizados de forma ineficiente nos sistemas de saúde do Brasil: estudo de caso sobre apneia obstrutiva do sono

ABSTRACT Objective: Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, associated with morbidity and mortality. Although effective treatment for OSA is commercially available, their provision is not guaranteed by lines of care throughout Brazil, making legal action necessary. This study aimed at presenting data related to the volume of legal proceedings regarding the access to diagnosis and treatment of OSA in Brazil. Methods: This was a descriptive study of national scope, evaluating the period between January of 2016 and December of 2020. The number of lawsuits was analyzed according to the object of the demand (diagnosis or treatment). Projections of total expenses were carried out according to the number of lawsuits. Results: We identified 1,462 legal proceedings (17.6% and 82.4% related to diagnosis and treatment, respectively). The projection of expenditure for OSA diagnosis in the public and private spheres were R$575,227 and R$188,002, respectively. The projection of expenditure for OSA treatment in the public and private spheres were R$2,656,696 and R$253,050, respectively. There was a reduction in the number of lawsuits between 2017 and 2019. Conclusions: Legal action as a strategy for accessing diagnostic and therapeutic resources related to OSA is a recurrent practice, resulting in inefficiency and inequity. The reduction in the number of lawsuits between 2017 and 2019 might be explained by the expansion of local health care policies or by barriers in the journey of patients with OSA, such as difficulties in being referred to specialized health care and low availability of diagnostic resources.

RESUMO Objetivo: A apneia obstrutiva do sono (AOS) é uma doença crônica altamente prevalente, associada a morbidade e mortalidade. Embora tratamentos efetivos para a AOS estejam disponíveis comercialmente, seu fornecimento não é garantido pelos fluxos de atendimento em todo o Brasil, tornando necessária a judicialização. Este estudo teve como objetivo apresentar dados referentes ao volume de processos judiciais relacionados ao acesso ao diagnóstico e tratamento da AOS no Brasil. Métodos: Estudo descritivo de abrangência nacional, avaliando o período entre janeiro de 2016 e dezembro de 2020. O número de demandas judiciais foi analisado de acordo com o objeto da demanda (diagnóstico ou tratamento). As projeções das despesas totais foram realizadas de acordo com o número de demandas judiciais. Resultados: Foram identificados 1.462 processos judiciais (17,6% e 82,4% referentes a diagnóstico e tratamento, respectivamente). A projeção dos gastos com o diagnóstico da AOS nas esferas pública e privada foi de R$ 575.227 e R$ 188.002, respectivamente. A projeção dos gastos com o tratamento da AOS nas esferas pública e privada foi de R$ 2.656.696 e R$ 253.050, respectivamente. Houve redução do número de demandas judiciais entre 2017 e 2019. Conclusões: A judicialização como estratégia de acesso a recursos diagnósticos e terapêuticos relacionados à AOS é uma prática recorrente, resultando em ineficiência e iniquidade. A redução do número de demandas judiciais entre 2017 e 2019 pode ser explicada pela expansão das políticas locais de saúde ou por barreiras na jornada dos pacientes com AOS, como dificuldades de encaminhamento para atendimento especializado e a baixa disponibilidade de recursos diagnósticos.