211 research outputs found

    Uso da ventilação não invasiva no tratamento de pacientes com edema agudo de pulmão cardiogênico

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    Current literature was searched by using the MEDLINE database to find consistent evidence regarding the use of noninvasive mechanical ventilation in patients with acute cardiogenic pulmonary edema. 18 studies demonstrating that noninvasive ventilation applied by continuous positive airway pressure (CPAP) or bilevel positive airway pressure (bilevel-PAP) is safe, and that the two approaches have similar effects and are effective in preventing endotracheal intubation in patients with respiratory distress of cardiac origin, were found. The results support the concept that positive intrathoracic positive pressure must be seen as a nonpharmacological form of treatment of acute pulmonary edema rather than only a supportive measure.Pesquisamos a literatura atual usando a base de dados MEDLINE para encontrar evidências consistentes sobre o uso da ventilação não invasiva em pacientes com edema agudo de pulmão cardiogênico. Foram encontrados 18 estudos demonstrando que a ventilação não invasiva aplicada por CPAP ou bilevel-PAP é segura, tem efeitos similares e é efetiva em reduzir a necessidade de intubação traqueal em pacientes com desconforto respiratório de origem cardíaca. Os resultados reforçam o conceito que a pressão positiva intratorácica deve ser considerada um forma não farmacológica de tratamento do edema agudo de pulmão cardiogênico e não simplesmente uma medida de suporte

    12 Dicas sobre a import√Ęncia do sono para estudantes de Medicina

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    O espírito do Jornal de Pneumologia

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    Dimens√Ķes da faringe em homens e mulheres saud√°veis

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    INTRODUCTION: Epidemiological studies reveal a high male prevalence of obstructive sleep apnea syndrome. A possible explanation for this male predominance is the existence of anatomical differences in the upper airway between men and women. METHODS: The upper airways of 10 male and 10 female healthy volunteers were prospectively evaluated by magnetic resonance imaging. Anatomical pharyngeal and column cross-sectional linear measurements were made in sagittal T1 and axial T1 and T2 weighted fast spin-echo images. RESULTS: Men had significantly greater mean sagittal pharyngeal structural dimensions compared to women for all structures with the exception of the craniocaudal length of the soft palate and the thickness of the submentonian fat. In contrast, cross-sectional linear dimensions were similar in men and women with the exception of the laterolateral tongue length, which was greater in men. All mean linear measurements of the pharyngeal air column were similar in men and women at all studied levels. CONCLUSIONS: Men and women present pharyngeal air columns with similar dimensions, but in women this column is surrounded by smaller structures, which might imply a smaller effort to keep its patency. Our data suggest the existence of an anatomical protective factor in women against the upper airway collapse.INTRODU√á√ÉO: Estudos epidemiol√≥gicos demonstram alta preval√™ncia da s√≠ndrome da apn√©ia obstrutiva do sono no sexo masculino. Uma explica√ß√£o plaus√≠vel para esta predomin√Ęncia masculina √© a exist√™ncia de diferen√ßas anat√īmicas nas vias a√©reas superiores entre homens e mulheres. M√ČTODOS: As vias a√©reas superiores de 10 homens e 10 mulheres, volunt√°rios saud√°veis, foram avaliados prospectivamente atrav√©s do exame de resson√Ęncia magn√©tica. Foram realizadas medidas lineares das vias a√©reas superiores e das estruturas da faringe atrav√©s de imagens sagitais pesadas em T1 e imagens axiais pesadas em T1 e T2 com a t√©cnica de fast spin-echo. RESULTADOS: Os homens mostraram dimens√Ķes significativamente maiores das estruturas da faringe em rela√ß√£o √†s mulheres em todas as medidas realizadas nas imagens sagitais, com exce√ß√£o do di√Ęmetro cr√Ęnio-caudal do palato mole e da espessura da gordura submentoniana. Em contraste, as imagens axiais mostraram medidas similares entre os sexos, exceto o di√Ęmetro l√°tero-lateral da l√≠ngua que foi maior nos homens. Todas as medidas da coluna a√©rea das vias a√©reas superiores foram semelhantes nos dois sexos. CONCLUS√ēES: Embora homens e mulheres apresentem vias a√©reas superiores com dimens√Ķes similares, nas mulheres as estruturas anat√īmicas ao seu redor s√£o menores, sugerindo um menor esfor√ßo para manter as vias a√©reas superiores patentes no sexo feminino. Nossos resultados sugerem a exist√™ncia de um fator de prote√ß√£o anat√īmico contra o colapso das vias a√©reas superiores nas mulheres

    A respira√ß√£o de Cheyne-Stokes em pacientes com insufici√™ncia card√≠aca congestiva: causas e conseq√ľ√™ncias

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    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.A respira√ß√£o de Cheyne-Stokes √© uma forma de respira√ß√£o peri√≥dica na qual apn√©ias e hipopn√©ias se alternam com per√≠odos de hiperpn√©ias que apresentam um padr√£o crescendo e decrescendo de volume corrente. Esta revis√£o enfoca as causa e conseq√ľ√™ncias da respira√ß√£o de Cheyne- Stokes em pacientes com insufici√™ncia card√≠aca congestiva na qual a preval√™ncia √© extremamente alta e varia entre 30 a 50%. V√°rios fatores foram implicados na g√™nese da respira√ß√£o de Cheyne-Stokes, incluindo baixo debito card√≠aco e hipoxia recorrente. Hiperventilac√£o e baixos n√≠veis de CO2 arterial (PaCO2), que quando abaixo do limiar de apn√©ia desencadeiam apn√©ia central s√£o os mecanismos fisiopatol√≥gicos chave na g√™nese da respira√ß√£o de Cheyne-Stokes. Hiperventila√ß√£o est√° associada com congest√£o pulmonar, e a respira√ß√£o de Cheyne-Stokes tem uma tend√™ncia maior de ocorrer durante o sono, quando o centro respirat√≥rio √© dependente principalmente do controle qu√≠mico. A respira√ß√£o de Cheyne-Stokes est√° associada a quedas recorrentes da satura√ß√£o de oxig√™nio e ao despertar do sono, com oscila√ß√Ķes recorrentes na freq√ľ√™ncia card√≠aca, press√£o arterial, aumento da atividade simp√°tica e risco aumentado de taquicardia ventricular. A respira√ß√£o de Cheyne-Stokes √© um marcador independente de mau prognostico e provavelmente participa de um ciclo vicioso que contribui para a deteriora√ß√£o card√≠aca

    Obstructive Sleep Apnea A Cardiometabolic Risk in Obesity and the Metabolic Syndrome

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    Obstructive sleep apnea (OSA) is an underdiagnosed condition characterized by recurrent episodes of obstruction of the upper airway leading to sleep fragmentation and intermittent hypoxia during sleep. Obesity predisposes to OSA, and the prevalence of OSA is increasing worldwide because of the ongoing epidemic of obesity. Recent evidence has shown that surrogate markers of cardiovascular risk, including sympathetic activation, systemic inflammation, and endothelial dysfunction, are significantly increased in obese patients with OSA versus those without OSA, suggesting that OSA is not simply an epiphenomenon of obesity. Moreover, findings from animal models and patients with OSA show that intermittent hypoxia exacerbates the metabolic dysfunction of obesity, augmenting insulin resistance and nonalcoholic fatty liver disease. in patients with the metabolic syndrome, the prevalence of moderate to severe OSA is very high (similar to 60%). in this population, OSA is independently associated with increased glucose and triglyceride levels as well as markers of inflammation, arterial stiffness, and atherosclerosis. A recent randomized, controlled, crossover study showed that effective treatment of OSA with continuous positive airway pressure for 3 months significantly reduced several components of the metabolic syndrome, including blood pressure, triglyceride levels, and visceral fat. Finally, several cohort studies have consistently shown that OSA is associated with increased cardiovascular mortality, independent of obesity. Taken together, these results support the concept that OSA exacerbates the cardiometabolic risk attributed to obesity and the metabolic syndrome. Recognition and treatment of OSA may decrease the cardiovascular risk in obese patients. (C) 2013 by the American College of Cardiology FoundationUniv S√£o Paulo, Sch Med, Heart Inst InCor, S√£o Paulo, BrazilUniversidade Federal de S√£o Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, S√£o Paulo, BrazilJohns Hopkins Univ, Sch Med, Dept Med, Div Pulm & Crit Care Med, Baltimore, MD 21205 USAUniversidade Federal de S√£o Paulo, Dept Psicobiol, Disciplina Med & Biol Sono, S√£o Paulo, BrazilWeb of Scienc

    Dynamics of Snoring Sounds and Its Connection with Obstructive Sleep Apnea

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    Snoring is extremely common in the general population and when irregular may indicate the presence of obstructive sleep apnea. We analyze the overnight sequence of wave packets --- the snore sound --- recorded during full polysomnography in patients referred to the sleep laboratory due to suspected obstructive sleep apnea. We hypothesize that irregular snore, with duration in the range between 10 and 100 seconds, correlates with respiratory obstructive events. We find that the number of irregular snores --- easily accessible, and quantified by what we call the snore time interval index (STII) --- is in good agreement with the well-known apnea-hypopnea index, which expresses the severity of obstructive sleep apnea and is extracted only from polysomnography. In addition, the Hurst analysis of the snore sound itself, which calculates the fluctuations in the signal as a function of time interval, is used to build a classifier that is able to distinguish between patients with no or mild apnea and patients with moderate or severe apnea

    Sleep in Infants with Congenital Heart Disease

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    OBJECTIVES: To investigate hypoxia and sleep disordered breathing in infants with congenital heart disease. METHODS: Prospective study. In-hospital full polysomnography was performed on 14 infants with congenital heart disease, age 7 ¬Ī1 months, and in 7 normal infants, age 10 ¬Ī2 months. Congenital heart disease infants were classified as acyanotic (n=7) or cyanotic (n=7). RESULTS: Nutritional status, assessed by the Gomez classification and expressed as % weight for age, was 70 ¬Ī7, 59 ¬Ī11 and 94 ¬Ī16 in the acyanotic, cyanotic congenital heart disease and control infants, respectively (p<0.001). The respiratory disturbance index (AHI, events per hour) was [median (25-75%)]: 2.5 (1.0-3.4), 2.4 (1.5-3.1) and 0.7 (0.7-0.9) in acyanotic, cyanotic CHD infants and controls, respectively (p=0.013). Almost all congenital heart disease infants (11 out of 14) and only one control infant had an AHI >1 event/hour. The minimum oxygen saturation was 79% (74-82), 73% (57-74) and 90% (90-91) in the acyanotic, cyanotic congenital heart disease infants and controls, respectively (p <0.001). The arousal index (events/hour) was similar among the three groups at 8.4 ¬Ī2.4, 10.3 ¬Ī8.7 and 6.5 ¬Ī3, respectively (p=0.451). CONCLUSIONS: Infants with congenital heart disease frequently present with sleep-disordered breathing associated with oxygen desaturations but not arousals. Therefore, sleep may represent a significant burden to infants with congenital heart disease
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