ABSTRACT
Helium is known to reduce airflow limitation. Our hypothesis was that severe COPD patients undertaking exercise would show greater improvement in endurance under a heliox mixture (80/20%) than under air alone. This hypothesis was tested in a double-blinded, randomized study. METHODS: Out of the 53 patients included, 45 were randomly assigned to two groups : Heliox (n= 23) and Air (n= 22). Patients were assessed with spirometry under air and heliox, incremental exercise test, constant workload (80% Wmax) exercise test and weekly 6-minute walk test. The two groups went through fifteen 30-minute retraining sessions in the overall framework of an identical pulmonary rehabilitation program. RESULTS: There was no significant difference in endurance improvement (Heliox : +52.5 sec, Air:+114sec, median value). FEV1 improvement under heliox exceeding 10% identified a group of 20 patients as "helium responders", who improved their endurance time by a median of 135sec compared to 50sec for the "non-responders" (non-significant difference). CONCLUSION: In patients with severe COPD, use of Heliox in exercise retraining did not produce significantly improved endurance. On the other hand, "helium responders" showed more FEV1 improvement than non-responders. Improved FEV1 under heliox should therefore be used in future studies as an inclusion criterion.
Subject(s)
Helium , Pulmonary Disease, Chronic Obstructive , Exercise Test , Helium/therapeutic use , Humans , Oxygen , Pulmonary Disease, Chronic Obstructive/rehabilitationABSTRACT
Mandibular advancement device provide a therapeutic option for obstructive sleep apnea syndrome (OSAS). Clinical improvement has been proven in the different available studies, mainly on nocturnal respiratory events and quality of sleep. Less snoring have been noted by bed partners and objective studies have demonstrated a decrease in snoring frequency and intensity. The effects of these appliances on upper airways resistance syndrome is not yet well documented. The significant clinical improvement is secondary to the decrease in the occurrence of apneas and hypopneas. Polysomnographic improvement criteria with an apnea hypopnea index less than 10 per hour has been noted in certain cases, although no improvement or even worsening was noted in other cases. Sleep architecture has also changed in these patients, with a decrease in the time spent in stages 1 and 2, and an increase in the time spent in stages 3, 4 and rapid eye movement sleep. Micro-arousals are also reduced in number. Somnolence and loss of attention are improved; these have been evaluated subjectively or by a well known and approved somnolence scale. In some cases a test for vigilance was done. Our results are identical to those published in the different studies concerning respiratory events and sleep architecture.
Subject(s)
Mandibular Advancement/instrumentation , Occlusal Splints , Sleep Apnea, Obstructive/therapy , Airway Resistance , Arousal , Contraindications , Humans , Occlusal Splints/adverse effects , Patient Compliance , Pharynx/pathology , Sleep Stages , Snoring/therapy , Temporomandibular Joint Dysfunction Syndrome/etiology , WakefulnessABSTRACT
Mandibular advancement devices represent a therapeutic option for obstructive sleep apnea syndrome (OSAS). Clinical improvement has been proven in the different available studies, mainly on nocturnal respiratory events and quality of sleep. Less snoring have been noted by bed partners and objective studies have demonstrated decrease in snoring frequency and intensity. The effect of these ortheses on upper airways resistance syndrome is not yet well documented. The significant clinical improvement is secondary to the decrease in the occurrence of apneas and hypopneas. Polysomnographic improvement criteria with an apnea hypopnea index less than 10 per hour has been noted in certain cases. Although no improvement or even worsening was noted in other cases. Sleep architecture has also changed in these patients, with a decrease in the time spent in stages 1 and 2, and an increase in the time spent in stages 3 and 4 and rapid eye movement sleep. Micro-arousals are also decreased in number certainly with the decrease in the occurrence of respiratory events. Somnolence and loss of attention are improved; these have been evaluated subjectively or by a well known and approved somnolence scale. In some cases a test for vigilance was done.
Subject(s)
Mandibular Advancement/instrumentation , Orthotic Devices , Sleep Apnea Syndromes/therapy , Airway Resistance , Arousal , Attention , Equipment Design , Humans , Mandibular Advancement/adverse effects , Patient Selection , Polysomnography , Severity of Illness Index , Sleep Apnea Syndromes/classification , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/physiopathology , Sleep Stages , Treatment OutcomeABSTRACT
Mandibular advancement devices represent a therapeutic option for obstructive sleep apnea syndrome (OSAS). Clinical improvement has been proved in the different available studies, mainly on nocturnal respiratory events and quality of sleep. Less snoring have been noted by bed partners and objective studies have demonstrated decrease in snoring frequency and intensity. The effect of these ortheses on upper airways resistance syndrome is not yet well documented. The significant clinical improvement is secondary to the decrease in the occurrence of apneas and hypopneas. Polysomnographic improvement criteria with an apnea hypopnea index less than 10 per hour has been noted in certain cases. Although no improvement or even worsening was noted in other cases. Sleep architecture has also changed in these patients, with a decrease in the time spent in stages 1 and 2, and an increase in the time spent in stages 3 and 4 and rapid eye movement sleep. Microarousals are also decreased in number certainly with the decrease in the occurrence of respiratory events. Somnolence and loss of attention are improved; these have been evaluated subjectively or by a well known and approved somnolence scale. In some cases a test for vigilance was done.
Subject(s)
Mandibular Advancement/methods , Orthotic Devices , Sleep Apnea, Obstructive/prevention & control , Humans , Snoring , Treatment OutcomeABSTRACT
Problems related with nasal intermittent positive pressure ventilation (NIPPV) are nasal and mouth dryness, soreness on the bridge of the nose, eye irritation and epistaxis. Gastrointestinal distention due to air swallowing has been reported in half of the patients. Acceleration of digestive function with drugs or reduction of the volume delivered to alleviate gastric distension are considered as the conventional treatment. It is also possible that the problem disappears spontaneously after a few weeks of NIPPV. We present a patient in whom conventional treatment was unsuccessful. When we changed to a different ventilator, symptoms disappeared, and the new one was very well tolerated. In our experience, changing ventilators should be included in the management of gastrointestinal distension due to NIPPV, especially if conventional procedures, such as drugs or gas flow modifications, fail.
Subject(s)
Intermittent Positive-Pressure Ventilation/adverse effects , Intermittent Positive-Pressure Ventilation/instrumentation , Vomiting/etiology , Adolescent , Aerophagy/etiology , Aerophagy/prevention & control , Humans , Male , Muscular Dystrophies/complications , Nose , Respiratory Insufficiency/therapyABSTRACT
Noninvasive mechanical ventilation through a nasal mask is a recently introduced therapeutic tool that represents a noteworthy advance in home treatment for patients with respiratory insufficiency secondary to ventilatory pump failure. We present the preliminary results of a program for early detection of respiratory insufficiency in patients with Duchenne's disease. Sixteen patients (mean age 15.8 years) with this disease were evaluated between January 1994 and January 1995. Mean lung function parameters were FVC 1,440 ml (46.7%), PO2 87.3 mmHg, PCO2 40.8 mmHg, PIM 40.1 cmH2O (30.6%), and PEM 41 cmH2O (25%). Two patients had abnormal pulse oximetry readings at night and abnormal gasometric readings during the day and were started on mechanical ventilation through nasal masks. These 2 patients were older, more hypoxemic and hypercapnic, had lower FVC values and showed greater deterioration of inspiratory and expiratory muscle pressures.
Subject(s)
Muscular Dystrophies/complications , Respiratory Insufficiency/diagnosis , Adolescent , Child , Home Care Services , Humans , Male , Masks , Muscular Dystrophies/therapy , Respiration, Artificial , Respiratory Function Tests/statistics & numerical data , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Time FactorsABSTRACT
In most patients with neuromuscular disorders, respiratory insufficiency and problems arising from this are what determine whether or not they survive. Treatment for failure of the respiratory pump by mechanical ventilation in the patient's own home has become more common thanks to the advent of non-invasive methods of treatment such as the nasal mask. Home mechanical ventilation has improved both the survival rate and the quality of life of many of these patients. We review the different types of home ventilation, describing the advantages and disadvantages of each one, with the intention of making information regarding this kind of treatment more easily available.
Subject(s)
Home Care Services , Neuromuscular Diseases/complications , Respiration, Artificial , Respiratory Insufficiency/complications , Respiratory Insufficiency/therapy , Chronic Disease , Humans , Pulmonary VentilationABSTRACT
The clinical course of Duchenne's dystrophy is characterized by respiratory insufficiency secondary to failure of the breathing pump. Up to ten years ago, this respiratory insufficiency was corrected by mechanical ventilation via a tracheostomy. In recent years, nasal mechanical ventilation has been a considerable advance in the treatment of these patients' respiratory problems. We describe a patient with Duchenne's dystrophy who was satisfactorily treated by non-invasive mechanical ventilation.
Subject(s)
Muscular Dystrophies/complications , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Adolescent , Humans , Male , Respiratory Insufficiency/diagnosis , SpirometryABSTRACT
Portable oxygen therapy using liquid oxygen has been available in the Madrid area since 1992 as part of a government program. The prescription of liquid oxygen theoretically requires the careful selection of patients who will benefit from a portable source of oxygen, as well as the performance of a series of treadmill tests with and without supplemental oxygen in order to assess the benefit derived from this expensive means of delivering therapy. As no studies had been done of whether these criteria for prescribing liquid oxygen were being met, we conducted telephone interviews with patients residing in the Madrid area who had portable oxygen sources at their disposal. Of a total of 190 patients, whose names were provided by oxygen supply companies, 145 could be evaluated. Liquid oxygen was not being used by 17%. Stress tests had not been performed before prescription of liquid oxygen in 65%. In conclusion, it can be suspected that a high percentage of patients receive liquid oxygen who do not meet the criteria for prescription and who have not performed the recommended tests, and that compliance is low.
