• 【CPAP治疗老年阻塞性睡眠呼吸暂停患者。】 复制标题 收藏 收藏
    DOI:10.3390/jcm9020546 复制DOI
    作者列表:Posadas T,Oscullo G,Zaldívar E,Garcia-Ortega A,Gómez-Olivas JD,Monteagudo M,Martínez-García MA
    BACKGROUND & AIMS: :The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%-20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter's form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.
    背景与目标: : 由于预期寿命的不断延长,人口金字塔正在发生变化,这使得深入了解最常影响老年人的疾病至关重要。阻塞性睡眠呼吸暂停 (OSA) 影响65岁以上人群的15%-20%。尽管这种流行,但在这一年龄组中很少有关于OSA管理的具体研究,尽管超过60% 的65-70岁以上患有OSA怀疑的睡眠单位的患者接受持续气道正压通气 (CPAP) 治疗,根据CPAP在涉及中年男性的临床试验中取得的积极结果进行外推。然而,与OSA相比,后者的表现形式,进化形式以及预后可能与老年患者不同。最近对一系列老年患者进行的临床试验揭示了CPAP治疗在老年OSA患者中的可能作用,但仍有许多问题需要回答。随着时间的流逝,与睡眠有关的疾病数量的生理增加,以及该年龄段缺乏经过验证的诊断和治疗工具,可能是定义,诊断和治疗老年人OSA的最大障碍。
  • 【CPAP失败患者在进行CPAP治疗时药物诱导的睡眠内窥镜检查。】 复制标题 收藏 收藏
    DOI:10.1007/s11325-020-02098-x 复制DOI
    作者列表:Dieleman E,Veugen CCAFM,Hardeman JA,Copper MP
    BACKGROUND & AIMS: STUDY OBJECTIVES:To study the pattern of upper airway collapse in patients with CPAP failure by performing DISE while administering CPAP therapy and to determine the reason for CPAP failure accordingly. METHODS:This observational retrospective study comprised 30 patients diagnosed with OSA and CPAP failure, who underwent DISE while administering CPAP therapy. During DISE, the upper airway was assessed with and without CPAP therapy using the VOTE classification. Additionally, a jaw thrust maneuver was performed, in order to mimic the effect of an additional mandibular advancement device (MAD) in combination with CPAP therapy. Consequently, the outcome of DISE was translated into a clinically relevant categorization. RESULTS:Eleven patients (37%) had a persistent anteroposterior (AP) collapse, including a collapse at velum, tongue base, or epiglottis level and multilevel collapse. Eight patients (27%) had a floppy epiglottis. Five patients (17%) had a persistent complete concentric collapse (CCC) and three patients had a persistent laryngeal collapse (10%). In three patients (10%), no airway collapse was found after CPAP administration. CONCLUSIONS:Based on the results of the reported study, in most cases, the potential cause of CPAP failure can be determined by this new diagnostic method. Consequently, suggestions can be made for additional therapy.
    背景与目标:
  • 【微创手术或CPAP治疗的OSAHS患者生活质量的变化: 一项为期2年的回顾性,单中心平行组研究。】 复制标题 收藏 收藏
    DOI:10.2174/1566524019666191009150734 复制DOI
    作者列表:Zhang XQ,Zhao X,Hong PW,Zhou J,Zeng P,Liu C,Li XY,Zhao Y,Jiang LQ
    BACKGROUND & AIMS: BACKGROUND:By including untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) patients as the control group, this study explores the influence of minimally invasive surgical treatment and continuous positive airway pressure (CPAP) therapy on OSAHS patients, with the subjective and objective performance. The study also discusses their relationship, determines the effect factor, and provides a simple and practical method for evaluation of clinical efficacy. METHODS:A total of 90 OSAHS patients, who were diagnosed in the Sleep Disorders Diagnosis and Treatment Center of Sichuan Province from May 2014 to May 2016, were selected for the present study. These patients were divided into three groups: surgery group, CPAP group, and untreated group. These patients were followed up at six months, one year, and two years, respectively. The physiological indicators, clinical symptoms, degree of daytime sleepiness and quality of life were compared among these three groups. The daytime sleepiness and the quality of life before and after minimally invasive surgery and CPAP treatment were evaluated, and the subjective and objective efficacy of surgery and CPAP treatment was explored. RESULTS:Among these 90 patients, 11 (12.2%) patients had hypertension, while two (2.2%) patients had diabetes. The average AHI score was 50.53±23.39 per hour, and the mean minimum oxygen saturation and mean oxygen saturation was 71.25±14.16% and 90.13±5.90%, respectively. There were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness in the group having received surgery at 0.5 year and one year. In the CPAP group, there were statistically significant differences in mouth breathing, morning sore throat and daytime sleepiness at 0.5 year, one year and two years. Moreover, there were statistically significant differences in memory loss at one year and two years, and there were statistically significant differences in frequent nocturia at one year. The ESS value in the surgery group decreased at 0.5 year and one year, but increased at two years. The situation was the same in terms of the total points and in each dimension of the SF-36 paramter. The delta values of ESS among the three groups had statistical significance at 0.5 year, one year and two years, in which the CPAP group experienced the most changes, followed by the surgery group and the group received health education. CONCLUSION:For minimally invasive surgery, CPAP therapy and health education can improve daytime sleepiness and quality of life. CPAP therapy was found to be the most effective, followed by minimally invasive surgery and provision of health education. However, the treatment of OSAHS should be comprehensive.
    背景与目标:
  • 【在阻塞性睡眠呼吸暂停的高预检概率患者中,无睡眠研究的CPAP指征。】 复制标题 收藏 收藏
    DOI:10.1007/s11325-019-01949-6 复制DOI
    作者列表:Nigro CA,Borsini E,Dibur E,Larrateguy L,Cazaux A,Elias C,de la Vega M,Berrozpe C,Maggi S,Grandval S,Cambursano H,Visentini D,Blanco M,Ernst G,Bledel I,Nogueira F
    BACKGROUND & AIMS: OBJECTIVE:To evaluate the performance of clinical criteria (CC) for diagnosis and initiation of empirical treatment with continuous positive airway pressure (CPAP) in patients with suspected obstructive sleep apnea (OSA) compared with the treatment decision based on sleep studies (polysomnography or respiratory polygraphy), guidelines, and experience of participating physicians. METHODS:This was a simulated intention-to-treat study in a retrospective (G1) and prospective (G2) cohort. Four observers (two per group) called CC1 and CC2 reviewed the sleep questionnaires and indicated CPAP if the patients presented snoring, frequent apneas (≥ 3-4/week), body mass index (BMI) > 25 kg/m2, sleepiness (Epworth > 11), or tiredness (at least 3-4 times per week) and some comorbidity (hypertension, coronary/cerebrovascular event, diabetes). Ten independent observers formed two groups of five (FD1 and FD2) and were blinded to each other's opinion. These observers in FD1 and FD2 decided CPAP treatment based on guidelines of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) or guidelines of the American Academy of Sleep Medicine (AASM) and factored in their own opinion. Sensitivity (S), specificity (Sp), and positive/negative likelihood ratios (LR+/-) were calculated with the test method: CC1/2, and the reference method: majority decision of FD1/2. RESULTS:A total of 653 patients (264 women, 40%) were studied. Median age was 54 years, BMI 28 kg/m2, and apnea hypopnea index (AHI) 16.5 events/h. S ranged from 21 to 25% (p 0.60), Sp 96.1 to 97.6% (p 0.39), and LR+ of clinical criteria 6.4 to 8.9 (p 0.52). CONCLUSION:CPAP indication without a previous sleep study showed a low sensitivity (≅ 22%) but a specificity greater than 95% in patients with high pretest probability for OSA (snoring, report of frequent apneas, BMI > 25 kg/m2 and sleepiness or tiredness plus comorbidity).
    背景与目标:
  • 【影响患者接受CPAP治疗睡眠呼吸暂停综合症的心理因素初步研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.sleep.2005.10.005 复制DOI
    作者列表:Tyrrell J,Poulet C,Pe Pin JL,Veale D
    BACKGROUND & AIMS: BACKGROUND:Many patients abandon continuous positive airway pressure (CPAP) treatment after initial acceptance. This may be for physical or psychological reasons. METHODS:We have carried out semi-structured interviews, constructed from the Health Belief Model (HBM) with a convenience sample of patients who had recently abandoned CPAP treatment after at least 6 months of use. We explored their understanding and experiences of their OSA and of the CPAP therapy and their reasons for stopping treatment. RESULTS:Nine patients were interviewed (age 32-70 years; 8 males). Four patients were not clear about the nature, severity, or consequences of sleep apnoea syndrome (SAS) and did not consider themselves to be ill. Three expected to be cured by the machine. Only one patient spoke of life-threatening risk. Eight of the nine patients had other health disorders. Seven stopped CPAP because of negative experiences, including problems with the mask and noise from the machine. Two patients felt 'liberated' on stopping treatment. CONCLUSIONS:Studies at the initiation stage of CPAP treatment are needed in order to identify factors impeding acceptance, which can be addressed early. The Health Belief Model, which emphasises subjective health experience and patients' beliefs about treatment, may be a useful tool for such investigations.
    背景与目标:
  • 【吸湿性冷凝器加湿器作为一种解决因鼻CPAP治疗阻塞性睡眠呼吸暂停综合征而导致的鼻干燥的方法。】 复制标题 收藏 收藏
    DOI:10.1093/sleep/14.2.166 复制DOI
    作者列表:Parra O,Klamburg J,Xirgu J,Abad J,Sala H,Tomasa A,Morera J
    BACKGROUND & AIMS: :We report an apparent solution to nasal dryness for patients with obstructive sleep apnea syndrome treated with nasal continuous positive airway pressure (CPAP) when a hygroscopic condenser humidifier is introduced into the CPAP circuit. Six patients underwent a 5-h test period of nasal CPAP therapy with a mask containing a hygroscopic humidifier. The water vapor showed a statistically significant increase in both inspired and expired gases. The relative humidity of the inspired gases increased significantly. The levels of O2 and CO2 in the respired gases did not change. When patients were asked about nasal dryness at the end of the test, all of them reported marked improvement.
    背景与目标: : 我们报告了将吸湿冷凝器加湿器引入CPAP回路时,经鼻持续气道正压通气 (CPAP) 治疗的阻塞性睡眠呼吸暂停综合征患者的鼻干燥的明显解决方案。六名患者使用装有吸湿机的面罩进行了5小时的鼻CPAP治疗测试期。水蒸气在吸入和呼出气体中均显示出统计学上的显着增加。吸入气体的相对湿度显着增加。呼吸气体中O2和CO2的含量没有变化。当患者在测试结束时被问及鼻干燥时,所有患者均报告有明显改善。
  • 【持续气道正压通气 (CPAP) 对肾血管阻力的影响: 肾失神经支配的影响。】 复制标题 收藏 收藏
    DOI:10.1186/cc304 复制DOI
    作者列表:Sharkey RA,Mulloy EM,Long M,O'Neill SJ
    BACKGROUND & AIMS: :OBJECTIVE: To non-invasively study the effects of continuous positive airway pressure breathing (CPAP) on renal vascular resistance in normal subjects and renal allograft recipients, in other words those with with denervated kidneys. We could then ascertain the influence of renal innervation on any resulting changes in renal haemodynamics. METHODS: Ten healthy volunteers and six renal transplant patients were studied. Using Doppler ultrasonography, the pulsatility index (PI), an index of renovascular resistance, was measured at incremental levels of CPAP (0, 2.5, 5.0 and 7.5 cmH2O). RESULTS: In both groups, the PI increased significantly between 0 and5.0 cmH2O CPAP, with a further increase at 7.5 cmH2O CPAP. CONCLUSIONS: We found that CPAP at 5.0 and 7.5 cmH2O caused a significant increase in renovascular resistance in both normal and renal transplant patients. There was no difference in the degree of rise in renovascular resistance between both groups, indicating that the renal nerves do not play a role in altering renal vascular resistance with the application of CPAP.
    背景与目标: 目的: 非侵入性地研究持续气道正压呼吸 (CPAP) 对正常受试者和同种异体肾移植受者,即失神经肾受者的肾血管阻力的影响。然后,我们可以确定肾脏神经支配对肾脏血流动力学任何变化的影响。方法: 对10名健康志愿者和6名肾移植患者进行研究。使用多普勒超声检查,在CPAP (0、2.5、5.0和7.5 cmH2O) 的增量水平下测量搏动指数 (PI),即肾血管阻力指数。结果: 在两组中,PI在0至5.0 cmH2O CPAP之间显着增加,在7.5 cmH2O CPAP时进一步增加。结论: 我们发现5.0和7.5 cmH2O的CPAP导致正常和肾移植患者的肾血管阻力显着增加。两组之间的肾血管阻力上升程度没有差异,表明使用CPAP时,肾神经在改变肾血管阻力方面不起作用。
  • 【CPAP对阻塞性睡眠呼吸暂停患者动脉僵硬度的影响: 一项随机试验的荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1007/s11325-020-02226-7 复制DOI
    作者列表:Chalegre ST,Lins-Filho OL,Lustosa TC,França MV,Couto TLG,Drager LF,Lorenzi-Filho G,Bittencourt MS,Pedrosa RP
    BACKGROUND & AIMS: PURPOSE:This study aimed to perform a systematic review and meta-analysis of randomized trials investigating the effect of continuous positive airway pressure (CPAP) on non-invasive markers of arterial stiffness in patients with OSA. METHODS:The purpose of the study was to evaluate the effect of CPAP on markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix)) in patients with OSA. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically reviewed MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, and LILACS databases for randomized trials (RT) evaluating the changes in markers of arterial stiffness (pulse wave velocity (PWV) and augmentation index (Aix) comparing CPAP vs. controls in patients with OSA. Reviewer Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used to perform meta-analysis. Risk of bias analysis was performed using the Cochrane tool. RESULTS:Of the 464 studies initially retrieved, 9 relevant studies with 685 participants were included in the analysis. The studies presented moderate risk of bias. CPAP did not significantly reduce Aix (mean difference, - 1.96 (95% confidence interval (CI) - 5.25 to 1.33), p = 0.24), whereas it significantly changed PWV (mean difference, - 0.44 (95% confidence interval (CI) - 0.76 to - 0.12), p = 0.00). CONCLUSION:CPAP treatment was effective in improving arterial stiffness by reducing PWV in patients with OSA. Additional randomized trials, however, should be performed to confirm these findings.
    背景与目标:
  • 【CPAP随机干预冠状动脉疾病和睡眠呼吸暂停的原理和设计 -- RICCADSA试验。】 复制标题 收藏 收藏
    DOI:10.1080/14017430802276106 复制DOI
    作者列表:Peker Y,Glantz H,Thunström E,Kallryd A,Herlitz J,Ejdebäck J
    BACKGROUND & AIMS: RATIONALE:Obstructive sleep apnoea (OSA) is common in coronary artery disease (CAD) and a possible cause of increased mortality. To date, there is a lack of randomized controlled trials to draw the conclusion that all CAD patients should be investigated for OSA and subsequently be treated with continuous positive airway pressure (CPAP). OBJECTIVE:The Randomized Intervention with CPAP in CAD and OSA (RICCADSA) trial is designed to address if CPAP treatment reduces the combined rate of new revascularization, myocardial infarction, stroke and cardiovascular mortality over a 3-year period in CAD patients with OSA. Secondary outcomes include cardiovascular biomarkers, cardiac function and maximal exercise capacity at 3-month- and 1-year follow-ups. PATIENTS AND METHODS:A sample of 400 CAD patients (100 non-sleepy OSA patients randomized to CPAP, 100 to non-CPAP; 100 sleepy OSA patients on CPAP, and 100 CAD patients without OSA) will be included. So far, 240 patients have been enrolled in the trial since December 31, 2005. CONCLUSION:The RICCADSA trial will contribute to defining the impact of CPAP on prognosis of CAD patients with OSA.
    背景与目标:
  • 【使用术前心理评估来确定减肥手术候选人中CPAP不依从性的心理社会危险因素。】 复制标题 收藏 收藏
    DOI:10.1016/j.soard.2019.07.012 复制DOI
    作者列表:Martin-Fernandez KW,Heinberg LJ,Ben-Porath YS
    BACKGROUND & AIMS: BACKGROUND:Obstructive sleep apnea (OSA) is prevalent among bariatric surgery candidates and is associated with numerous adverse health conditions, both pre- and postoperatively. Continuous positive airway pressure therapy (CPAP) is the first-line treatment for OSA, but it requires significant behavioral changes. As such, CPAP adherence is a significant problem in OSA treatment. Information from the preoperative psychological evaluation may be used to identify psychosocial risk factors associated with CPAP nonadherence and inform the implementation of more specific and appropriate interventions. OBJECTIVES:Examine the utility of Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) behavioral/externalizing dysfunction scale scores to determine personality and psychopathology associations with, and risk for, CPAP nonadherence. SETTING:Academic medical center. METHODS:Patients who underwent a preoperative psychological evaluation and were diagnosed with OSA (n = 358) were divided into 2 groups: CPAP adherent (n = 271) and CPAP nonadherent (n = 87). Independent samples t tests were computed to examine differences in average MMPI-2-RF scale scores between these groups. Relative risk ratios were computed using multiple MMPI-2-RF substantive scale score cut-offs to determine which MMPI-2-RF scales were associated with increased risk of CPAP nonadherence. RESULTS:Higher scores on scales measuring behavioral/externalizing dysfunction and family problems were associated with and indicative of risk for CPAP nonadherence. CONCLUSIONS:CPAP nonadherence is related to and may be affected by generally higher levels of behavioral/externalizing dysfunction. Using a broadband measure of personality and psychopathology, like the MMPI-2-RF, during the preoperative evaluation can provide important information about co-morbid symptoms that may interfere with CPAP adherence. Considering this information during preoperative treatment planning could increase the likelihood of preoperative CPAP adherence and reduce the likelihood of adverse postoperative outcomes.
    背景与目标:
  • 【CPAP期间夜间呼吸频率升高可能是阻塞性睡眠呼吸暂停患者新型冠状病毒肺炎的早期迹象。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Nakano H,Kadowaki M,Furukawa T,Yoshida M
    BACKGROUND & AIMS: None:A middle-aged man with obstructive sleep apnea who had been treated with continuous positive airway pressure (CPAP) developed COVID-19. An analysis of airflow records from the CPAP machine revealed a rise in his respiratory rate on the night before the onset of COVID-19-related symptoms, while his nocturnal respiratory rate had been stable during the 18-month period prior to the presently reported episode. The present case suggests that a rise in respiratory rate detected using CPAP machine data could be an important sign of impending acute illness, such as COVID-19. Studies to elucidate the usefulness of this method are warranted.
    背景与目标: 无: 一名患有阻塞性睡眠呼吸暂停的中年男子,接受持续气道正压通气 (CPAP) 治疗,并发新型冠状病毒肺炎。对CPAP机器的气流记录进行的分析显示,在COVID-19-related症状发作前的晚上,他的呼吸频率有所上升,而在目前报道的发作之前的18个月内,他的夜间呼吸频率一直稳定。目前的病例表明,使用CPAP机器数据检测到的呼吸频率上升可能是即将发生的急性疾病 (新型冠状病毒肺炎) 的重要迹象。有必要进行研究以阐明该方法的有用性。
  • 【在马拉维的一家教学医院中引入泡沫CPAP。】 复制标题 收藏 收藏
    DOI:10.1179/1465328110Y.0000000001 复制DOI
    作者列表:van den Heuvel M,Blencowe H,Mittermayer K,Rylance S,Couperus A,Heikens GT,Bandsma RH
    BACKGROUND & AIMS: BACKGROUND:Continuous positive airway pressure (CPAP) is relatively inexpensive and can be easily taught; it therefore has the potential to be the optimal respiratory support device for neonates in developing countries. OBJECTIVE:The possibility of implementing bubble CPAP in a teaching hospital with a large neonatology unit but very limited resources was investigated. METHODS:A CPAP system was developed consisting of a compressor, oxygen concentrator, water bottle to control the pressure and binasal prongs. Neonates with birthweights between 1 and 2·5 kg with persistent respiratory distress 4 hours after birth were eligible for bubble CPAP. RESULTS:In the 7-week introduction period from 11 March until 27 April 2008, 11 neonates were treated with CPAP. Five of these neonates met the inclusion criteria and six neonates did not meet these criteria. Of the five neonates who received CPAP and met the inclusion criteria, three survived. The six infants who did not meet the inclusion criteria included three preterm infants with apnoea (all died), two with birthweights <1 kg (both died) and a firstborn twin (1.2 kg) who survived. No major complications of CPAP occurred. Bubble CPAP could be used independently by nurses after a short training period. CONCLUSION:Successful long-term implementation of CPAP depends on the availability of sufficient trained nursing staff.
    背景与目标:
  • 【在资源有限的环境中用于婴儿和儿童的气泡CPAP设备: 文献综述。】 复制标题 收藏 收藏
    DOI:10.1080/20469047.2018.1534389 复制DOI
    作者列表:Won A,Suarez-Rebling D,Baker AL,Burke TF,Nelson BD
    BACKGROUND & AIMS: :Background: Early management of respiratory distress is critical to reducing mortality in infants and children in resource-limited settings. Bubble continuous positive airway pressure (bCPAP) can offer effective and affordable non-invasive respiratory support. Objective: To determine the best physical components of bubble CPAP circuits for respiratory support of children in low-resource settings. Methods: Using PubMed, CINAHL and LILACS, studies of any design in any language published before June 2017 which examined the physical components of bCPAP circuits were identified and reviewed. Results: After screening, the review included 45 articles: 17 clinical trials, 11 literature reviews, 10 technical assessments of bCPAP components, three reports of real-world implementation in low-resource settings, three cost analyses and one case report. There is no ideal bCPAP circuit for all settings and patients, but some choices are generally better than others in designing a circuit for low-resource settings. Oxygen concentrators are usually the best source of oxygen. As yet, there is no affordable and accurate oxygen blender. Nasal prongs are the simplest patient interface to use with the fewest complications but are not the cheapest option. Expiratory limbs should be at least 1 cm in diameter. Home-made pressure generators are effective, safe and affordable. Conclusion: This narrative review found many studies which evaluated the real clinical outcomes with bCPAP in the target population as well as technical comparison of bCPAP components. However, many studies were not blinded or randomised and there was significant heterogeneity in design and outcome measures. Abbreviations: bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; FiO2, fractional oxygen concentration; HFNC, high-flow nasal cannula; HIC, high-income countries; LMIC, low- and middle-income countries; NP, nasopharyngeal; O2, oxygen; PEEP, positive end-expiratory pressure; PICO, Population, Intervention, Comparison and Outcome.
    背景与目标: 背景: 在资源有限的环境中,呼吸窘迫的早期管理对于降低婴儿和儿童的死亡率至关重要。气泡持续气道正压通气 (bCPAP) 可以提供有效且负担得起的无创呼吸支持。目的: 确定低资源环境下儿童呼吸支持的气泡CPAP回路的最佳物理成分。方法: 使用PubMed,CINAHL和LILACS,对2017年6月前发表的任何语言的任何设计进行了研究,这些研究检查了bCPAP电路的物理成分。结果: 筛选后,该综述包括45篇文章: 17篇临床试验,11篇文献综述,10篇bCPAP组件的技术评估,3篇在低资源环境中实际实施的报告,3篇成本分析和1篇病例报告。对于所有设置和患者,没有理想的bCPAP电路,但是在为低资源设置设计电路时,某些选择通常比其他选择更好。氧气浓缩器通常是氧气的最佳来源。到目前为止,还没有负担得起的精确氧气搅拌机。鼻插脚是最简单的患者界面,并发症最少,但不是最便宜的选择。呼气肢体的直径应至少1厘米。自制压力发生器是有效、安全和负担得起的。结论: 本叙述性综述发现许多研究评估了bCPAP在目标人群中的真实临床结果以及bCPAP成分的技术比较。然而,许多研究不是盲法或随机化的,在设计和结果测量方面存在显著的异质性。缩写: bCPAP,气泡持续气道正压; CPAP,持续气道正压; FiO2,氧浓度分数; HFNC,高流量鼻插管; HIC,高收入国家; LMIC,中低收入国家; NP,鼻咽; O2,氧气; PEEP,呼气末正压; PICO,人群,干预,比较和结果。
  • 【术后使用CPAP对减肥手术后吻合口和钉线渗漏的影响。】 复制标题 收藏 收藏
    DOI:10.1007/s11325-020-02199-7 复制DOI
    作者列表:Reijers SNH,Nijland LMG,Bosschieter PFN,de Raaff CAL,Ravesloot MJL,van Veen RN,de Castro SMM,de Vries N
    BACKGROUND & AIMS: PURPOSE:Almost two-thirds of the population undergoing bariatric surgery (BS) suffers from obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the standard treatment for moderate to severe OSA and is recommended in patients undergoing BS perioperatively. A severe and dreaded complication after BS is anastomotic leakage. There is theoretical concern that perioperative CPAP use may result in increased distension of the gastrointestinal tract and increase the risk of developing an anastomotic leakage. The aim of this study was to evaluate the effect of postoperative CPAP use on the risk of developing anastomotic leakages after BS. METHODS:Retrospectively, all patients from a single bariatric center who underwent BS from November 2007 to August 2019 were included. Presence and severity of OSA were determined using poly(somno)graphy. To evaluate the effect of postoperative CPAP use on anastomotic leakage, a multivariable logistic regression analysis was performed. RESULTS:A total of 4052 patients were included, with OSA being diagnosed in 62%. Overall, 970 patients (24%) used CPAP after BS. Anastomotic leakage occurred in 64 (1.6%) patients after BS. Leakage rate was 1.3% in non-CPAP group versus 2.5% in CPAP group (p = 0.01). CPAP use was associated with anastomotic leakage; however, after adjustment, CPAP use was not an independent predictor (OR = 1.40, 95% CI 0.60-3.28, p = 0.44). CONCLUSION:There is no independent relation between postoperative CPAP use and anastomotic leakage after BS. Only revision surgery was an independent predictor of anastomotic leakage.
    背景与目标:
  • 【在标准标准下停止Cpap (蝉): 实施改善新生儿结局。】 复制标题 收藏 收藏
    DOI:10.1111/jpc.13087 复制DOI
    作者列表:Heath Jeffery RC,Broom M,Shadbolt B,Todd DA
    BACKGROUND & AIMS: BACKGROUND:A previous randomised controlled trial (RCT) in babies born < 30 weeks gestation found the so-called CICADA method (ceasing continuous positive airways pressure (CPAP) with a view to remain off rather than slow weaning) significantly reduced CPAP time. Post-RCT we introduced the CICADA method and evaluated whether the improved outcomes of the CICADA method during the RCT were replicated in clinical practice. AIM:The aim of the study is to compare cardio-respiratory outcomes in PBs < 30 weeks GA over three epochs: (i) pre RCT, (ii) during RCT and (iii) post RCT implementation. METHODS:The study used prospective data to compare baseline characteristics and cardio-respiratory outcomes over the three epochs. RESULTS:There were 270/393(69%) PBs < 30 weeks GA who fulfilled the inclusion criteria over the three epochs. No significant differences were found in GA or birthweight between the three epochs (27.9 ± 1.3, 27.7 ± 1.4, 28.0 ± 1.3 (weeks ± 1 standard deviation); and 1100 ± 252, 1086 ± 251, 1094 ± 320 (grams ± 1 standard deviation)). There were significant decreases in CPAP days and corrected GA to cease CPAP post implementation (20.5 ± 2.1, 21.1 ± 2.1, 16.5 ± 1.8 (days ± SE); P = 0.006 and 33.3 ± 0.4, 33.5 ± 0.4, 32.6 ± 0.4 (weeks ± SE); P = 0.01). Compared with the pre RCT epoch, there were significant reductions in patent ductus arteriosus (36/78 (46%), 33/87 (37%), 18/103 (17%); P < 0.001) and chronic lung disease (40/78 (51%), 19/87 (21%), 30/103 (29%); P < 0.001). CONCLUSIONS:CPAP time, corrected GA to cease CPAP, patent ductus arteriosus and chronic lung disease significantly reduced following the introduction of the CICADA method. Early cessation of CPAP expedites the transition from neonatal intensive care to special care.
    背景与目标:

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