scholarly journals Ventilation Strategies in Obese Patients

2021 ◽  
Author(s):  
Pavol Pobeha
Keyword(s):  
Obese Patient ◽  
Chronic Obstructive ◽  
Obese Patients ◽  
Upper Airways ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Prevalent Disease ◽  
Ventilation Modes ◽  
Ventilatory Mechanics ◽  
Hypoventilation Syndrome

Obesity is an increasingly prevalent disease and is a root and complication of conditions necessitating mechanical ventilation. Obese patients require a careful approach due to the particular manner of how ventilatory mechanics is affected, if obstructive sleep apnea (OSA) is present. The two main diagnoses we may encounter while ventilating these patients are obesity hypoventilation syndrome (OHS) and chronic obstructive pulmonary disease (COPD) in an obese patient, which has been recently proposed as a novel phenotype of COPD. The excessive amount of fat in the abdomen, chest wall, and around upper airways warrants the use of special ventilation modes and settings. This chapter provides insight into which issues should be considered when ventilating an obese patient, either in acute or chronic conditions. We stress the importance of acknowledging the high risk of OSA and how OSA affects the ventilation algorithms.

scholarly journals Prevalence of obstructive sleep apnea among patients with chronic obstructive pulmonary disease

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Osama Ibrahim Mohammad ◽  
Ahmed Gouda Elgazzar ◽  
Shymaa Mohammad Mahfouz ◽  
Marwa Elsayed Elnaggar
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obese Patients ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Obstructive Sleep ◽  
Severe Copd

Abstract Background The conjunction of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome (OS). The coexistence of these diseases has cardiovascular morbidity and mortality. The aim of this study is to assess the prevalence of OSA in COPD patients. One hundred COPD patients (obese and non-obese) performed sleep questionnaires and polysomnograms. Results OSA prevalence in COPD was 50% and it increases with increasing disease severity (P < 0.001). The highest prevalence of OSA was found in obese patients with severe COPD; 90.5% of these patients have OSA. In the OSA group, obese patients were found to have significantly higher STOP-Bang Questionnaire (SBQ), Epworth Sleep Scale (ESS), modified medical research council (mMRC) dyspnea scale, apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI). Both obese and non-obese COPD patients showed significant positive correlations between AHI and smoking index (SI), SBQ, ESS, mMRC, ODI, and neck circumference (NC). Conclusions From this study, it can be concluded that moderate and severe COPD patients had a higher diagnosis of sleep-disordered breathing. Also, obese-COPD patients are more susceptible to develop OSA. Trial registration Name of the registry: Benha University Protocol Record Benha U123, Obstructive Sleep Apnea Prevalence in Patients With Chronic Obstructive Pulmonary Diseases. Trial registration number: NCT04903639. Date of registry: 5/22/2021 (retrospective study).

scholarly journals Average volume-assured pressure support

2018 ◽  
Vol 6 (22) ◽  
pp. 29-37
Author(s):  
Abdurahim Aloud
Keyword(s):  
Pressure Support ◽  
Neuromuscular Disorders ◽  
Small Sample ◽  
Chronic Obstructive ◽  
Average Volume ◽  
Obstructive Pulmonary Disease ◽  
Bilevel Positive Airway Pressure ◽  
Obstructive Sleep ◽  
Small Sample Sizes ◽  
Hypoventilation Syndrome

Average volume-assured pressure support (AVAPS) is a relatively new mode of noninvasivepositive pressure ventilation (NiPPV); only a few studies have been done tocompare its effectiveness and safety to bilevel positive airway pressure (BiPAP) in chronicrespiratory failure secondary to obesity hypoventilation syndrome, obstructive sleep apnea,chronic obstructive pulmonary disease, and neuromuscular disorders with respiratory muscleweakness. Only six studies were found in PubMed, and these studies had many limitations,especially small sample sizes. This review provides detailed summaries of these studies.These devices require more investigation.

scholarly journals Awakening efficacy of a vibrotactile device in patients on home nocturnal ventilatory assistance and healthy subjects as family caregiver proxies

2020 ◽  
Vol 17 ◽  
pp. 147997312098333
Author(s):  
Valerie Attali ◽  
Sophie Lavault ◽  
Antoine Guerder ◽  
Saba Al-Youssef ◽  
Benjamin Dudoignon ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Vibrotactile Stimulus ◽  
Chronic Obstructive ◽  
Vibrotactile Stimulation ◽  
Obstructive Pulmonary Disease ◽  
Copd Patients ◽  
Random Intervals ◽  
Healthy Family ◽  
Central Hypoventilation ◽  
Hypoventilation Syndrome

The objective of this study was to test the capacity of vibrotactile stimulation transmitted to the wrist bones by a vibrating wristband to awaken healthy individuals and patients requiring home mechanical ventilation during sleep. Healthy subjects (n = 20) and patients with central hypoventilation (CH) (Congenital Central Hypoventilation syndrome n = 7; non-genetic form of CH n = 1) or chronic obstructive pulmonary disease (COPD) (n = 9), underwent a full-night polysomnography while wearing the wristband. Vibrotactile alarms were triggered five times during the night at random intervals. Electroencephalographic (EEG), clinical (trunk lift) and cognitive (record the time on a sheet of paper) arousals were recorded. Cognitive arousals were observed for 94% of the alarms in the healthy group and for 66% and 63% of subjects in the CH and COPD groups, respectively (p < 0.01). The percentage of participants experiencing cognitive arousals for all alarms, was 72% for healthy subjects, 37.5% for CH patients and 33% for COPD patients (ns) (94%, 50% and 44% for clinical arousals (p < 0.01) and 100%, 63% and 44% for EEG arousals (p < 0.01)). Device acceptance was good in the majority of cases, with the exception of one CH patient and eight healthy participants. In summary this study shows that a vibrotactile stimulus is effective to induce awakenings in healthy subjects, but is less effective in patients, supporting the notion that a vibrotactile stimulus could be an effective backup to a home mechanical ventilator audio alarm for healthy family caregivers.

Postoperative Management for the Obese Patient

2021 ◽  
Author(s):  
Shiliang Alice Cao ◽  
Maurice Frankie Joyce
Keyword(s):  
Obese Patient ◽  
Preoperative Evaluation ◽  
Postoperative Management ◽  
Impaired Wound Healing ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Postoperative Cognitive Decline ◽  
Complete Reversal ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Obesity results in physiologic changes that effect nearly every organ system, including respiratory, cardiovascular, gastrointestinal, endocrine, genitourinary, and neuropsychiatric. These changes are associated with complications in the postoperative period that the anesthesia provider must take into account when planning the anesthetic of the obese patient. Obesity is associated with obstructive sleep apnea, obesity hypoventilation syndrome, and restrictive-type changes in lung volumes that decrease the obese patient’s ability to compensate for the changes that take place with anesthesia. The anesthetic provider should conduct a thorough preoperative evaluation, ensure complete reversal of neuromuscular blockade prior to extubation to prevent obstruction, ensure adequate pain control without compromising respiratory function, and consider use of Continuous positive airway pressure (CPAP) machines for patients on home CPAP. Obesity is also associated with an increased risk of perioperative arrhythmias, thrombotic events, impaired wound healing, decreased kidney function, and postoperative cognitive decline. Anesthetic providers should make every effort to take steps in order to prevent these complications and be knowledgeable about their management should they occur. This review contains 3 figures, 2 tables, 37 references  

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