Is CPAP therapy in COVID-19 associated with an increased rate of pulmonary barotrauma?

Pulmonary barotrauma such as pneumothorax (PTX) is a known complication of invasive mechanical ventilation. However, it is uncommonly reported with the use of noninvasive positive pressure ventilation (NPPV) and CPAP (continuous positive airway pressure) therapy. We present a case of a 66-year-old female who presented with chronic dyspnea on exertion secondary to right-sided diaphragmatic hernia. The patient also underwent a home sleep study which suggested obstructive sleep apnea (OSA) for which she was initiated on CPAP. She then underwent surgical repair of her right diaphragmatic hernia. The patient developed pneumothorax three times over the course of the following several months, once on the right side and twice on the left side. The patient’s incidences of PTX had a temporal association with the CPAP initiation. Her CPAP therapy was discontinued permanently after the third occurrence of PTX. With this case report, we highlight the risk of barotrauma with the use of CPAP for OSA. There are very few reported cases of PTX in association with NPPV therapy for OSA. The lung-protective ventilation strategies and limiting the positive airway pressures can help reduce the risk of pulmonary barotrauma with CPAP.

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Continuous Positive Airway Pressure (CPAP) Therapy for the Treatment of Hypernasality: A Single Case Study

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod24.2.48 ◽

2014 ◽

Vol 24 (2) ◽

pp. 48-58 ◽

Cited By ~ 3

Author(s):

Lakshmi Kollara ◽

Graham Schenck ◽

Jamie Perry

Keyword(s):

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Single Case ◽

Treatment Method ◽

Post Treatment ◽

Subjective Perception ◽

Cpap Therapy ◽

Long Term Follow Up

Studies have investigated the applications of Continuous Positive Airway Pressure (CPAP) therapy in the treatment of hypernasality due to velopharyngeal dysfunction (VPD; Cahill et al., 2004; Kuehn, 1991; Kuehn, Moon, & Folkins, 1993; Kuehn et al., 2002). The purpose of this study was to examine the effectiveness of CPAP therapy to reduce hypernasality in a female subject, post-traumatic brain injury (TBI) and pharyngeal flap, who presented with signs of VPD including persistent hypernasality. Improvements in mean velopharyngeal orifice size, subjective perception of hypernasality, and overall intelligibility were observed from the baseline to 8-week post-treatment assessment intervals. Additional long-term assessments completed at 2, 3, and 4 months post-treatment indicated decreases in immediate post-treatment improvements. Results from the present study suggest that CPAP is a safe, non-invasive, and relatively conservative treatment method for reduction of hypernasality in selected patients with TBI. More stringent long-term follow up may indicate the need for repeated CPAP treatment to maintain results.

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Intensive care of a complicated form of asthmatic status (clinical case)

Medical alphabet ◽

10.33667/2078-5631-2019-2-31(406)-46-51 ◽

2019 ◽

Vol 2 (31) ◽

pp. 46-51

Author(s):

D. A. Temerov ◽

L. V. Vorobyova ◽

S. V. Vyzhevsky ◽

S. B. Savchenkov ◽

Yu. V. Marchenkov

Keyword(s):

Clinical Case ◽

Mixture Distribution ◽

Severe Pneumonia ◽

Control Mode ◽

Respiratory Support ◽

Oxygen Mixture ◽

Bronchial Obstruction ◽

Optimal Regime ◽

Pulmonary Barotrauma ◽

Airway Patency

The article presents a clinical case of successful treatment of a patient with prolonged asthmatic status. The pathogenesis of purulent-septic and other life-threatening complications developing as a result of the above critical condition is described. The positive effect of a differentiated approach in conducting respiratory support depending on the stage of the disease is justified: at the beginning, when airway obstruction is in the foreground, and in the future, when restrictive respiratory disorders develop. When conducting respiratory support, the most reasonable methods for ensuring airway patency were selected. The necessity of neurovegetative blockade and myoplegia for the prevention of pulmonary barotrauma during respiratory support by aggressive ventilation modes and with the goal of antihypoxic protection of the brain is emphasized. During the treatment of the patient, it was confirmed that the optimal regime for obstruction of the bronchi is forced volume-cyclic ventilation of the lungs to provide the necessary minute volume of breathing, and in severe pneumonia, in the case of relief of bronchial obstruction, respiratory support is carried out in pressure control mode for better air-oxygen mixture distribution in the airways. The need for early tracheostomy and daily therapeutic fibrobronchoscopy to ensure airway patency and treat pneumonia has been confirmed.

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Obstructive sleep apnea and CPAP therapy in different clinical scenarios

Kreativnaya kardiologiya ◽

10.24022/1997-3187-2018-12-4-353-365 ◽

2018 ◽

Vol 12 (4) ◽

pp. 353-365

Author(s):

N.M. Magomedova ◽

S.N. Kazanovskaya

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Clinical Scenarios

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Type D Personality and the Compliance for CPAP Therapy and Cardiovascular Complications in OSA.

Case Medical Research ◽

10.31525/ct1-nct04114409 ◽

2019 ◽

Author(s):

Keyword(s):

Cardiovascular Complications ◽

Type D Personality ◽

Cpap Therapy ◽

Type D

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Prediction of signs/symptoms of decompression sickness following submarine tower escape

Undersea and Hyperbaric Medicine ◽

10.22462/01.03.2019.3 ◽

2019 ◽

pp. 17-33

Author(s):

Joel Edney ◽

Geoffrey Loveman ◽

Fiona Seddon ◽

Julian Thacker ◽

Karen Jurd ◽

...

Keyword(s):

Body Mass ◽

Marked Effect ◽

Decompression Sickness ◽

Outcome Data ◽

Calibration Data ◽

Limb Pain ◽

Pulmonary Barotrauma ◽

Escape Depth ◽

Different Types ◽

Risk Curves

Crew survival in a distressed submarine (DISSUB) scenario may be enhanced by the knowledge of the risks of different types of decompression sickness (DCS) should the crew attempt tower escape. Four models were generated through calibration against DCS outcome data from 3,919 pressure exposures, each for the prediction of one of four categories of DCS: neurological, limb pain, respiratory and cutaneous. The calibration data contained details of human, goat, sheep and pig exposures to raised pressure while breathing air or oxygen/nitrogen mixtures. No exposures had substantial staged decompression or cases of suspected pulmonary barotrauma. DCS risk was scaled between species and with body mass. A parameter was introduced to account for the possibility of the occurrence of some symptom types masking others. The calibrated models were used to estimate likelihood of DCS occurrence for each symptom category following submarine tower escape. Escape depth was found to have a marked effect only on predicted rates of neurological DCS. Saturation at raised internal DISSUB pressure prior to escape was found to affect predicted rates of all symptom types. The iso-risk curves presented are offered as guidance to submarine crews and rescue forces in preparation for, or in the event of, a DISSUB scenario.

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0543 Computational Phenotyping In CPAP Therapy: Using Interpretable Physiology-Based Machine Learning Models To Predict Therapeutic CPAP Pressures

SLEEP ◽

10.1093/sleep/zsz067.541 ◽

2019 ◽

Vol 42 (Supplement_1) ◽

pp. A217-A217

Author(s):

Dominic Munafo ◽

Bretton Hevener ◽

William Hevener ◽

Sam Clark ◽

Jeff Goe ◽

...

Keyword(s):

Machine Learning ◽

Cpap Therapy ◽

Learning Models ◽

Machine Learning Models

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The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension

International Journal of Molecular Sciences ◽

10.3390/ijms22052300 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2300

Author(s):

Ronni Baran ◽

Daniela Grimm ◽

Manfred Infanger ◽

Markus Wehland

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Common Disease ◽

Cpap Therapy ◽

Pressure Therapy ◽

Airway Patency ◽

Obstructive Sleep

Obstructive sleep apnea (OSA) is a common disease, with approximately 3–7% of men and 2–5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.

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Rationale and design of remotely-supervised cardiac rehabilitation study in patients with obstructive sleep apnea

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.207 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

J Hnatiak ◽

O Ludka ◽

L Batalik ◽

P Winnige ◽

F Dosbaba

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cardiac Rehabilitation ◽

Public Institution ◽

Moderate Intensity ◽

Newly Diagnosed ◽

Cpap Therapy ◽

Phone Calls ◽

Obstructive Sleep ◽

Home Conditions

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ministry of Health Czech Republic; identification of organization 65269705 Background Although continuous positive airway pressure (CPAP) is currently still the gold standard for therapy of moderate to severe obstructive sleep apnea (OSA), another alternative or adjunct effective therapeutic options exist. Lifestyle intervention focused on nutrition and weight reduction, regular exercise, sleep hygiene, smoking and alcohol restriction represents a recommended therapeutic strategy for OSA. Though this intervention represents an effective tool for improving objective and subjective parameters of OSA, it’s effectivity depends on components of the intervention, OSA severity and gender. Comprehensive remotely-supervised cardiac rehabilitation (CR) represents possible training intervention in home conditions using elements of telemedicine. Purpose This prospective study aims to investigate the feasibility and effect of a remotely-supervised CR in patients with newly diagnosed OSA with Apnea-Hypopnea Index greater than 15 episodes per hour. Methods This monocentric study is designed as a prospective, parallel, randomised, controlled trial of remotely-supervised 12-week CR in male patients between 40-60 years old with newly diagnosed OSA indicated to CPAP therapy. The sample size is calculated by 0,05 level of significance and 80% statistical power on 25 participants in each group. The Intervention group will undergo comprehensive remotely-supervised CR in home conditions with teleconsultation (contains telecoaching, telemonitoring) via regular phone calls and e-mails at least 1-2 times a week. The intervention will include nutrition, health-related lifestyle and behavioral changes recommendations, and at least 5 times a week 30 minutes of moderate-intensity aerobic training, 10 minutes of inspiratory and expiratory muscle training with breathing device and 10 minutes of oropharyngeal exercise along with individually titrated CPAP therapy. The control group will undergo individually titrated CPAP therapy only. The participants in both groups will go through the following assessments before and after this study: polysomnography, spirometry, anthropometry and body composition examination, laboratory values examination, quality of life questionnaires, Epworth sleepiness scale, 6-min walking test. Conclusions: Comprehensive remotely-supervised CR, as mentioned in this study, may represent an adjunct therapy with a promising future in patients with OSA. The study is occupied with a current issue and can also bring new possibilities and experiences in remote rehabilitation.

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