Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is the most effective treatment in obstructive sleep apnea syndrome (OSAS) although it is known that adherence to therapy is limited. The aims of this study were to evaluate the effect of visual education on CPAP adherence and to identify the factors affecting adherence. METHODS: Out of 133 consecutive newly diagnosed moderate-to-severe OSAS patients, 66 were informed about OSAS and CPAP therapy and received visual education by videotape (video group), whereas only information was given to 67 of them (control group). The patients were followed up in the 1st, 3rd, and 6th months. RESULTS: After 6-month follow-up, adherence rate to CPAP therapy was 71.2% in the video group and 56.7% in the control group (p = 0.08). OSAS symptoms, such as witnessed apnea, morning headache, night sweating, dry mouth, and Epworth sleepiness score (ESS), were ameliorated more significantly in the video group (p < 0.05). In order to assess predictors of adherence, 85 patients using CPAP effectively were compared to 48 nonadherent patients; significant improvement in OSAS symptoms and ESS was observed in the adherent patients (p < 0.05). ESS was negatively correlated with the duration of CPAP use (r = -0.524, p < 0.0001). Adverse effects such as mask intolerance, choking, noise, and nasal congestion were related to poorer adherence (p < 0.01). CONCLUSIONS: It is shown that adherence rate to CPAP therapy might be improved by visual education although the difference was not significant. Besides, patients with better adherence to CPAP treatment report the greatest improvement in OSAS symptoms and daytime sleepiness, and adverse effects are significantly related to poorer adherence.

[Colistin use in ventilator-associated pneumonia due to panresistant Pseudomonas aeruginosa and Acinetobacter baumannii]. / Panrezistan Pseudomonas aeruginosa ve Acinetobacter baumannii ile gelisen ventilatörle iliskili pnömonilerde kolistin kullanimi.

Nosocomial infections by resistant gram-negative microorganisms are important causes of mortality in intensive care unit (ICU)'s. The treatment choices are limited in infections due to Acinetobacter baumannii and Pseudomonas aeruginosa, especially if they are panresistant. In these type of resistant infections, colistin--an old antibiotic--has become a current issue. The aim of this study was to evaluate the efficacy of colistin in 9 cases (6 males, mean age 75.8 +/- 9.4 years), with ventilator associated pneumonia (VAP) caused by panresistant A. baumannii and P. aeruginosa in respiratory ICU. All cases were referred to ICU from other hospitals or clinics. It was detected that 7 of 9 cases were treated with anti-pseudomonal antibiotics before the development of VAP. Panresistant A. baumannii was isolated in 5 cases and P. aeruginosa in 4 cases. VAP by these microorganisms was detected on the 26.6 +/- 12.4th days of invasive mechanical ventilation and the cases were followed up for 54.2 +/- 25.7 days in ICU. During colistin treatment, dermatitis (one case) and nephrotoxicity (one case) were observed as side effects. Microbiological response to colistin was obtained in 6 cases. Three cases died due to non-eradication of panresistant microorganisms and three cases died due to other infections during ICU follow-up. The data presented in this study demonstrates that colistin can be considered as a safe and effective antibiotic in the treatment of panresistant A. baumannii and P. aeruginosa infections.