MULTIDISCIPLINARIETÀ E GESTIONEUNITARIA NEL PAZIENTE PNEUMOLOGICO:CORSO DI AGGIORNAMENTO SU OSAS E BPCO   Come avviare all...
CPAPcontinuous positive airway pressure
CPAPVENTILATORE   CIRCUITO:        INTERFACCIA:              TUBO CORRUGATO   MASCHERA
CPAP
CPAP (Continuous positive airway pressure)        Il paziente respira      spontaneamente      su un livello di pressione...
Basale
CPAP
BasaleCPAP
BasaleCPAP
BasaleCPAP
Sospensione Temporanea
CPAP reduces blood pressureArch Intern Med. 2007;167:757
Less recurrent atrial fibrillation with    CPAP in OSA    prospektiv all (n=118) pat. with atrial fibrillation and      ca...
Cardiovascular mortality increased in OSA   and reduced by CPAPn>1500 !From sleepclinic andpopulation-basedsampleFullyadju...
Trattamento   Evitare pasti serali ad alto contenuto    calorico   Svolgere attività fisica   Dormire in decubito later...
Titolazione con autoCPAP
Titolazione con autoCPAP
Obesity- Hypoventilation syndrome(OHS)Quadro clinicoObesitàQuadro disfunzionale restrittivo (Vc,FRC,WOB) SpO2< 90% per + ...
Effetti collaterali più comuni•Lesioni della cute del naso•Rinite•Secchezza delle fauci•Congiuntivite•Otalgia•Aerofagia•An...
Umidificatore a caldo
OLIVE NASALI
Maschera oro-nasale
MASCHERA TOTAL FACE
Farmaci sedativiAnalgesiciAnesteticiIpoventilazione
Costi sanitariCosti•Acquisto/noleggio CPAP•Materiale di                               Beneficiconsumo                     ...
Grazie dell’attenzione
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011
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Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011

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  • Methods: We identified randomized controlled trials of CPAP vs placebo in patients with OSAS specifically reporting 24-hour ambulatory mean blood pressure (MBP). Results: We included a total of 572 patients from 12 randomized controlled trials. According to a randomeffects model, the pooled estimate of the effect of the CPAP intervention was a net decrease of 1.69 mm Hg in 24- hour MBP (95% confidence interval, −2.69 to −0.69). Statistical heterogeneity was moderate (I2=41%). Predefined metaregression analyses estimated that 24-hour MBP would decrease by 0.89 mm Hg per 10-point increase in apnea-hypopnea index at entry ( P =.006), by 0.74 mm Hg for each increase of 10 arousal events per hour slept ( P =.008), and by 1.39mmHg for each 1-hour increase in effective nightly use of the CPAP device ( P =.01). Conclusions: Among patients with OSAS, CPAP reduces 24-hour ambulatory MBP, with greater treatmentrelated reductions in ambulatory MBP among patients with a more severe degree of OSAS and a better effective nightly use of the CPAP device. These reductions in blood pressure are likely to contribute to a better prognosis in terms of adverse cardiovascular events.
  • Fully adjusted: arterial hypertension Methods We recruited men with obstructive sleep apnoea-hypopnoea or simple snorers from a sleep clinic, and a population-based sample of healthy men, matched for age and body-mass index with the patients with untreated severe obstructive sleep apnoea-hypopnoea. The presence and severity of the disorder was determined with full polysomnography, and the apnoea-hypopnoea index (AHI) was calculated as the average number of apnoeas and hypopnoeas per hour of sleep. Participants were followed-up at least once per year for a mean of 10·1 years (SD 1·6) and CPAP compliance was checked with the built-in meter. Endpoints were fatal cardiovascular events (death from myocardial infarction or stroke) and non-fatal cardiovascular events (non-fatal myocardial infarction, non-fatal stroke, coronary artery bypass surgery, and percutaneous transluminal coronary angiography). Findings 264 healthy men, 377 simple snorers, 403 with untreated mild-moderate obstructive sleep apnoea-hypopnoea, 235 with untreated severe disease, and 372 with the disease and treated with CPAP were included in the analysis. Patients with untreated severe disease had a higher incidence of fatal cardiovascular events (1·06 per 100 person-years) and non-fatal cardiovascular events (2·13 per 100 person-years) than did untreated patients with mild-moderate disease (0·55, p=0·02 and 0·89, p0·0001), simple snorers (0·34, p=0·0006 and 0·58, p0·0001), patients treated with CPAP (0·35, p=0·0008 and 0·64, p0·0001), and healthy participants (0·3, p=0·0012 and 0·45, p0·0001). Multivariate analysis, adjusted for potential confounders, showed that untreated severe obstructive sleep apnoea-hypopnoea significantly increased the risk of fatal (odds ratio 2·87, 95%CI 1·17–7·51) and non-fatal (3·17, 1·12–7·51) cardiovascular events compared with healthy participants. Interpretation In men, severe obstructive sleep apnoea-hypopnoea significantly increases the risk of fatal and non-fatal cardiovascular events. CPAP treatment reduces this risk
  • Ciuffreda Marcello. Multidisciplinarietà e gestione unitaria nel paziente pneumologico. ASMaD 2011

    1. 1. MULTIDISCIPLINARIETÀ E GESTIONEUNITARIA NEL PAZIENTE PNEUMOLOGICO:CORSO DI AGGIORNAMENTO SU OSAS E BPCO Come avviare alla terapia con dispositivi a pressione positiva Marcello Ciuffreda UOC Pneumologia Ospedale SM Goretti Azienda USL Latina
    2. 2. CPAPcontinuous positive airway pressure
    3. 3. CPAPVENTILATORE CIRCUITO: INTERFACCIA: TUBO CORRUGATO MASCHERA
    4. 4. CPAP
    5. 5. CPAP (Continuous positive airway pressure) Il paziente respira spontaneamente su un livello di pressione fisso durante tutte e due le fasi del ciclo respiratorio La ventilazione è affidata totalmente al paziente. Occorre regolare soltanto il livello di pressione stabilita e la rampa (tempo necessario per raggiungerla).
    6. 6. Basale
    7. 7. CPAP
    8. 8. BasaleCPAP
    9. 9. BasaleCPAP
    10. 10. BasaleCPAP
    11. 11. Sospensione Temporanea
    12. 12. CPAP reduces blood pressureArch Intern Med. 2007;167:757
    13. 13. Less recurrent atrial fibrillation with CPAP in OSA prospektiv all (n=118) pat. with atrial fibrillation and cardioversion Recurrent atrial fibrillation after 12 month: 82% OSA without CPAP 42% OSA with CPAP 53% in pat. without polysomnographyKanagala Circulation 2003; 107: 2589
    14. 14. Cardiovascular mortality increased in OSA and reduced by CPAPn>1500 !From sleepclinic andpopulation-basedsampleFullyadjusted OR2.5; p=0.005 Marin J et al. Lancet. 2005; 365: 1046-1053
    15. 15. Trattamento Evitare pasti serali ad alto contenuto calorico Svolgere attività fisica Dormire in decubito laterale Ottimizzare la respirazione nasale Evitare farmaci sedativo/ipnotici Evitare fumo Evitare alcool Normalizzare la funzionalità tiroidea
    16. 16. Titolazione con autoCPAP
    17. 17. Titolazione con autoCPAP
    18. 18. Obesity- Hypoventilation syndrome(OHS)Quadro clinicoObesitàQuadro disfunzionale restrittivo (Vc,FRC,WOB) SpO2< 90% per + del 30% del tempo totale PaCO2>45 mmHg PaO2<70 mmHg BMI>30
    19. 19. Effetti collaterali più comuni•Lesioni della cute del naso•Rinite•Secchezza delle fauci•Congiuntivite•Otalgia•Aerofagia•Ansietà
    20. 20. Umidificatore a caldo
    21. 21. OLIVE NASALI
    22. 22. Maschera oro-nasale
    23. 23. MASCHERA TOTAL FACE
    24. 24. Farmaci sedativiAnalgesiciAnesteticiIpoventilazione
    25. 25. Costi sanitariCosti•Acquisto/noleggio CPAP•Materiale di Beneficiconsumo •Riduzione utilizzo•Manutenzione servizi sanitari(350-500 euro (farmaci,ricoveri)anno) •Incidenti stradaliControlli clinici •Giornate lavorative
    26. 26. Grazie dell’attenzione

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