Pub Date : 2019-02-13DOI: 10.5772/INTECHOPEN.77981
I. Jyothi, K. Prasad, R. Rajalakshmi, RC Satish Kumar, TalatamRamphanindra, T. Vijayakumar, I. Kaliappan
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by complete cessation of upper airflow during sleep, leading to repetitive episodes of desaturations and arousals. The symptoms include excessive daytime somnolence and are associated with a significant cardiovascular morbidity and mortality. The prevalence of OSA is higher in men with an approximate rate of 14 and 5% in women respectively. Typical risk factors for obstructive sleep apnea in the normal adult population are obesity, aging, gender, menopause, ethnicity, genetical predisposition, craniofacial anatomy, smoking, alcohol consumption and some other factors such as REM sleep, surface tension, and impaired sensory processing. Several screening questionnaires can be performed in out - patient settings to identify the patient symptoms. Polysomnography is considered as the gold standard for diagnosis of OSA. Different surgical treatments and devices are readily available for an effective management of this disease. Proper diagnosis and treatment improves not only the quality of life but also relatively decreases patient morbidity and mortality. A multifaceted approach is necessary for an accurate management of the OSA.
{"title":"Obstructive Sleep Apnea: A Pathophysiology and Pharmacotherapy Approach","authors":"I. Jyothi, K. Prasad, R. Rajalakshmi, RC Satish Kumar, TalatamRamphanindra, T. Vijayakumar, I. Kaliappan","doi":"10.5772/INTECHOPEN.77981","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77981","url":null,"abstract":"Obstructive sleep apnea (OSA) is a common sleep disorder characterized by complete cessation of upper airflow during sleep, leading to repetitive episodes of desaturations and arousals. The symptoms include excessive daytime somnolence and are associated with a significant cardiovascular morbidity and mortality. The prevalence of OSA is higher in men with an approximate rate of 14 and 5% in women respectively. Typical risk factors for obstructive sleep apnea in the normal adult population are obesity, aging, gender, menopause, ethnicity, genetical predisposition, craniofacial anatomy, smoking, alcohol consumption and some other factors such as REM sleep, surface tension, and impaired sensory processing. Several screening questionnaires can be performed in out - patient settings to identify the patient symptoms. Polysomnography is considered as the gold standard for diagnosis of OSA. Different surgical treatments and devices are readily available for an effective management of this disease. Proper diagnosis and treatment improves not only the quality of life but also relatively decreases patient morbidity and mortality. A multifaceted approach is necessary for an accurate management of the OSA.","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115666129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-21DOI: 10.5772/intechopen.82663
M. Vats
With the worldwide increasing use of noninvasive ventilation (NIV) and many updated evidences coming under the application of NIV in neuromuscular disease, neonates, and open circuit mouthpiece ventilation apart from the documented success of NIV in OSA, COPD, type 2 respiratory failure and pulmonary edema, it is the time to get more knowledge about its application for various chronic respiratory diseases such as interstitial lung disease and non-respiratory disease characterized by type 1 or type 2 respiratory failure in due course of time, and it is also important to know the potential application of NIV in children and neonates and as a mode for weaning from the mechanical ventilation, NIV is a rapidly changing field; hence, it is very important in clinical practice to have expertise in applying the technique and acquiring problem-solving skills of NIV.
{"title":"Introductory: Non Invasive Ventilation in Medicine","authors":"M. Vats","doi":"10.5772/intechopen.82663","DOIUrl":"https://doi.org/10.5772/intechopen.82663","url":null,"abstract":"With the worldwide increasing use of noninvasive ventilation (NIV) and many updated evidences coming under the application of NIV in neuromuscular disease, neonates, and open circuit mouthpiece ventilation apart from the documented success of NIV in OSA, COPD, type 2 respiratory failure and pulmonary edema, it is the time to get more knowledge about its application for various chronic respiratory diseases such as interstitial lung disease and non-respiratory disease characterized by type 1 or type 2 respiratory failure in due course of time, and it is also important to know the potential application of NIV in children and neonates and as a mode for weaning from the mechanical ventilation, NIV is a rapidly changing field; hence, it is very important in clinical practice to have expertise in applying the technique and acquiring problem-solving skills of NIV.","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125097194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.77173
L. Davidescu, D. Manolescu, R. Ulmeanu, C. Oancea
Respiratory muscle weakness is the main contributor to respiratory imbalance in patients with neuromuscular diseases (NMD). In the advanced stages of the disease, patients develop a chronic respiratory failure due to muscle weakness, which is the principal cause of death among these patients. Respiratory muscle weakness ultimately causes alveolar hypoventilation, initially nocturnal, and later daytime respiratory failure. The signs and symptoms of early respiratory muscle weakness are discrete, namely: dyspnoea on effort, orthopnea, insomnia, frequent nocturnal awakenings, morning headache, loss of appetite, excessive daytime sleepiness, depression, anxiety, and marked fatigue. The management of respiratory failure in neuromuscular diseases requires the use of non - invasive ventilation (NIV) to assist the respiratory muscles in order to correct the alveolar hypoventilation and ameliorate gas exchange. NIV thus slows down the decline of forced vital capacity thereby improving the patient’s quality of life, physical activity and hemodynamics, normalization of blood gases, slight improvement in other physiological measures, and maximal mouth pressures and increases survival. NIV support should be offered to all patients who present with early signs of ventilatory failure as it is probably the most effective among treatments in prolonging life in neuromuscular patients.
{"title":"Noninvasive Ventilation in Neuromuscular Diseases","authors":"L. Davidescu, D. Manolescu, R. Ulmeanu, C. Oancea","doi":"10.5772/INTECHOPEN.77173","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77173","url":null,"abstract":"Respiratory muscle weakness is the main contributor to respiratory imbalance in patients with neuromuscular diseases (NMD). In the advanced stages of the disease, patients develop a chronic respiratory failure due to muscle weakness, which is the principal cause of death among these patients. Respiratory muscle weakness ultimately causes alveolar hypoventilation, initially nocturnal, and later daytime respiratory failure. The signs and symptoms of early respiratory muscle weakness are discrete, namely: dyspnoea on effort, orthopnea, insomnia, frequent nocturnal awakenings, morning headache, loss of appetite, excessive daytime sleepiness, depression, anxiety, and marked fatigue. The management of respiratory failure in neuromuscular diseases requires the use of non - invasive ventilation (NIV) to assist the respiratory muscles in order to correct the alveolar hypoventilation and ameliorate gas exchange. NIV thus slows down the decline of forced vital capacity thereby improving the patient’s quality of life, physical activity and hemodynamics, normalization of blood gases, slight improvement in other physiological measures, and maximal mouth pressures and increases survival. NIV support should be offered to all patients who present with early signs of ventilatory failure as it is probably the most effective among treatments in prolonging life in neuromuscular patients.","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115429956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.73243
M. Agrafiotis, K. Nikolaou, Dimitra Siopi, D. Chloros
Open-circuit mouthpiece ventilation (MPV) is a method of noninvasive ventilation, which can be used to provide full-time support, induce lung volume recruitment, increase cough efficacy, defer tracheostomy and possibly improve survival and quality of life in advanced-stage neuromuscular patients. MPV might also be applicable to other chronic respiratory diseases as well as in acute exacerbations of chronic obstructive pul - monary disease and can also be employed for the extubation of unweanable neuromus cular patients. A candidate for MPV should be able to rotate his neck adequately, grab the mouthpiece with his lips and maintain sufficient control of the upper airway muscles. MPV is usually provided in the volume assisted-controlled mode with a tidal volume between 0.7 and 1.5 L, zero PEEP and backup rate set to the lower allowed value, allow-ing the patient to define his own ventilatory pattern. The “low pressure” and “apnea” alarm should be switched off, if possible, or special setting adjustments should be used to prevent their activation. Comprehensive patient training and dedicated nursing time are important for the application of MPV. MPV is considered a safe method for the majority of the patients, but accidental mouthpiece loss is an important concern.
{"title":"Open-Circuit Mouthpiece Ventilation: Indications, Evidence and Practicalities","authors":"M. Agrafiotis, K. Nikolaou, Dimitra Siopi, D. Chloros","doi":"10.5772/INTECHOPEN.73243","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.73243","url":null,"abstract":"Open-circuit mouthpiece ventilation (MPV) is a method of noninvasive ventilation, which can be used to provide full-time support, induce lung volume recruitment, increase cough efficacy, defer tracheostomy and possibly improve survival and quality of life in advanced-stage neuromuscular patients. MPV might also be applicable to other chronic respiratory diseases as well as in acute exacerbations of chronic obstructive pul - monary disease and can also be employed for the extubation of unweanable neuromus cular patients. A candidate for MPV should be able to rotate his neck adequately, grab the mouthpiece with his lips and maintain sufficient control of the upper airway muscles. MPV is usually provided in the volume assisted-controlled mode with a tidal volume between 0.7 and 1.5 L, zero PEEP and backup rate set to the lower allowed value, allow-ing the patient to define his own ventilatory pattern. The “low pressure” and “apnea” alarm should be switched off, if possible, or special setting adjustments should be used to prevent their activation. Comprehensive patient training and dedicated nursing time are important for the application of MPV. MPV is considered a safe method for the majority of the patients, but accidental mouthpiece loss is an important concern.","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129002827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.77172
A. Elola, E. Alonso, E. Aramendi, U. Irusta
Cardiopulmonary resuscitation (CPR) consisting of chest compressions and assisted ven- tilation is crucial to treat out-of-hospital cardiac arrest (OHCA). It is well reported that quality of manual ventilations, in terms of rate and volume, is suboptimal, with a high incidence of hyperventilation, which is linked to poor outcomes. The lack of a noninvasive technology to monitor ventilations during out-of-hospital CPR precludes feedback on ventilations to the rescuer, and it handicaps the evaluation of the effect of ventilations on the outcome of the patient. This chapter addresses the possibilities and challenges of monitoring the quality of manual ventilations in current defibrillators. Methods are proposed to monitor ventilations based on the thoracic impedance and the capnogram. These methods can be integrated in defibrillators used in both basic and advanced life support. The algorithms are described, and the accuracy of the methods to monitor the ventilation rate and the quality metrics of the ventilations is reported using real OHCA episodes. The accuracy and limitations of the methods as well as the implications of inte- grating them in the treatment of patients in cardiac arrest are discussed.
{"title":"Noninvasive Monitoring of Manual Ventilation during Out-of- Hospital Cardiopulmonary Resuscitation","authors":"A. Elola, E. Alonso, E. Aramendi, U. Irusta","doi":"10.5772/INTECHOPEN.77172","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.77172","url":null,"abstract":"Cardiopulmonary resuscitation (CPR) consisting of chest compressions and assisted ven- tilation is crucial to treat out-of-hospital cardiac arrest (OHCA). It is well reported that quality of manual ventilations, in terms of rate and volume, is suboptimal, with a high incidence of hyperventilation, which is linked to poor outcomes. The lack of a noninvasive technology to monitor ventilations during out-of-hospital CPR precludes feedback on ventilations to the rescuer, and it handicaps the evaluation of the effect of ventilations on the outcome of the patient. This chapter addresses the possibilities and challenges of monitoring the quality of manual ventilations in current defibrillators. Methods are proposed to monitor ventilations based on the thoracic impedance and the capnogram. These methods can be integrated in defibrillators used in both basic and advanced life support. The algorithms are described, and the accuracy of the methods to monitor the ventilation rate and the quality metrics of the ventilations is reported using real OHCA episodes. The accuracy and limitations of the methods as well as the implications of inte- grating them in the treatment of patients in cardiac arrest are discussed.","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"115 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117348924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-12-20DOI: 10.5772/INTECHOPEN.72395
O. Fathi, A. Schlegel, E. Shepherd
The use of mechanical ventilation in the past few decades has greatly contributed to the survival of critically ill neonates, both preterm and term. With this, however, has come an accompanied rise in certain complications and neonatal co-morbidities. Avoiding mechanical ventilation, or at least minimizing the time a neonate is intubated, is considered a critical goal in the care of these patients. Different modes of non-invasive ventila - tion have developed over the course of the time to help address these issues. use of CPAP as the initial mode of
{"title":"Non-Invasive Ventilation of the Neonate","authors":"O. Fathi, A. Schlegel, E. Shepherd","doi":"10.5772/INTECHOPEN.72395","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.72395","url":null,"abstract":"The use of mechanical ventilation in the past few decades has greatly contributed to the survival of critically ill neonates, both preterm and term. With this, however, has come an accompanied rise in certain complications and neonatal co-morbidities. Avoiding mechanical ventilation, or at least minimizing the time a neonate is intubated, is considered a critical goal in the care of these patients. Different modes of non-invasive ventila - tion have developed over the course of the time to help address these issues. use of CPAP as the initial mode of","PeriodicalId":360210,"journal":{"name":"Noninvasive Ventilation in Medicine - Recent Updates","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129799716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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