06/05/2014. Respiratory Medicine Professor Colin Sullivan

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2 Respiratory Medicine Professor Colin Sullivan 2

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4 Modalidade utilizada em 90% dos casos. Thorax : Lancet : AJRCCM : AJRCCM 161: , 2000 Chest 2005; 128: Arch Intern Med. 2003;163:41-45 Urology, 2006; 67(5): Sleep Med 2005;6(4):

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6 NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author NIH-PA Manuscript Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 06/05/2014 Dev Banerjee, MD et al 2007; 131: NIH Public Access Author Manuscript Respir Care. Author manuscript; available in PMC 2011 June 22. Published in final edited form as: Respir Care September ; 55(9): CPAP and Bi-level PAP Therapy: New and Established Roles NIH Public Access Andreea Antonescu-Turcu, MD and Clement J Zablocki Veterans Affairs Medical Center and the University of Wisconsin Milwaukee, Pulmonary and Critical Care Medicine, Department of Medicine, Milwaukee, Wisconsin Author Manuscript Respir Care. Author manuscript; available in PMC 2011 June 22. Sairam Parthasarathy, MD Research and Development, Southern Arizona Veterans Administration Healthcare System, and Published the Department in final of Medicine, edited University form as: of Arizona, Tucson, Arizona Respir Antonescu-Turcu Care. and Parthasarathy 2010 September ; 55(9): Page 18 Abstract Over the past few decades, continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea has evolved Ação into de more and more sophisticated modes of therapy for various forms of sleep-disordered breathing. While the principles of splinting the airway and delivering assisted ventilation underpin CPAP/BiPAP CPAP and Bi-level the basics of this PAP therapy, the Therapy: introduction of newer New technologies and Established Roles miniaturization are revolutionizing the former conventions of the field. The purpose of this review is to improve our understanding of various forms of PAP therapy by providing the rationale for Andreea such modalities, Antonescu-Turcu, gaining a basic working MD knowledge and of device technology, and critically assessing the clinical research evidence while identifying barriers to implementation. Dissemination of such Clement information J Zablocki is vital in order Veterans to prevent Affairs knowledge Medical gaps in healthcare Center providers and and the systems. University of Wisconsin Milwaukee, Pulmonary and Critical Care Medicine, Department of Medicine, Milwaukee, Wisconsin Sairam KeywordsParthasarathy, MD obstructive sleep apnea; continuous positive airway pressure; adherence; adult; pediatric; Research and Development, Southern Arizona Veterans Administration Healthcare System, and compliance; sleep apnea; artificial respiration; central sleep apnea; servo ventilation; obesity the Department of Medicine, University of Arizona, Tucson, Arizona Introduction Abstract Historically, the administration of positive airway pressure (PAP) to help assist respiration Fig. 2. goes Physiological back very effects far of in positive time. In airway the pressure ancient (PAP) Middle therapy. East, PAP midwives therapy splints used the bellows with modified Over the past few decades, continuous positive airway pressure (CPAP) therapy for obstructive nasal upper adaptors airway (black to resuscitate crosses and arrows), newborns. achieves Moreover, positive intrathoracic the bible pressure contains (whitereferences to mouth-tomouth has NIH sleep apnea Public crosses), decreases administration evolved Access venous return, of into increases breaths more lung as a means and volume, more decreases of resuscitation. sophisticated after- load, and can In the 17th modes century, of Robert therapy for various forms of increase cardiac output. The bidirectional vertical arrows signify the traction on the upper Author sleep-disordered Manuscript Hooke airways elegantly affected breathing. by demonstrated the increase in While end-expiratory that small the lung animals principles volume. could Such a be of traction kept splinting effect alive can during the vivisection airway by and delivering assisted the assist administration the splinting of open positive of the upper pressure airway. Respir Care. Author manuscript; available in PMC breaths 2011 using June bellows 22. connected to the trachea by a ventilation small underpin tube. However, the the basics introduction of this of positive-pressure therapy, the ventilation introduction into modern of newer medicine technologies and Published final did edited not occur form until as: miniaturization are revolutionizing the disastrous polio the epidemic former in the conventions middle of last century. of the In field. 1953, Bjorn The purpose of this review Respir Care Ibsen, September an anesthesiologist, ; 55(9): used bag ventilation connected to a tracheotomy to resuscitate a is to improve teenage girl our suffering understanding from respiratory of various failure due forms to bulbar of poliomyelitis, PAP therapy and thereby by providing gave the rationale for such modalities, rise to the concept gaining of the a modern basic intensive working care knowledge unit. However, of the device noninvasive technology, application and critically assessing CPAP of positive airway pressure to treat obstructive sleep apnea (OSA) had to await the nifty the clinical and Bi-level research PAP evidence Therapy: while identifying New and barriers Established to implementation. Roles Dissemination of such NIH information is vital in order to prevent knowledge gaps in healthcare providers and systems. Andreea Antonescu-Turcu, Public MD Access and Clement 2010 Daedalus J Zablocki Enterprises Veterans Affairs Medical Center and the University of Wisconsin Milwaukee, Author Correspondence: Pulmonary and Sairam Manuscript Critical Parthasarathy Care MD, Medicine, Department Department of Medicine, University of Medicine, of Arizona, Milwaukee, 3601 S Sixth Wisconsin Avenue, Mail Stop 0-151, Tucson, AZ spartha@arc.arizona.edu. Keywords Respir Dr Sairam Parthasarathy Parthasarathy, Care. presented Author a version MDof manuscript; this paper at the 45th Respiratory available Care Journal in PMC Conference, 2011 Sleep Disorders: June Diagnosis 22. and Treatment Research held and December Development, 10-12, 2009, Southern in San Antonio, Arizona Texas. Veterans Administration Healthcare System, and Published Dr the Antonescu-Turcu Department obstructive in final has of disclosed sleep Medicine, edited no apnea; conflicts University form of continuous interest. as: of Arizona, Dr Parthasarathy positive Tucson, has disclosed airway Arizona a relationship pressure; with Rcspironics. adherence; adult; pediatric; Antonescu-Turcu Respir compliance; and Parthasarathy Care sleep September apnea; artificial ; 55(9): respiration; central sleep apnea; Page 17 servo ventilation; obesity Abstract Over the past few decades, continuous positive airway pressure (CPAP) therapy for obstructive Respir Care. Author manuscript; available in PMC 2011 June 22. sleep apnea has evolved into more and more sophisticated modes of therapy for various forms of Introduction sleep-disordered breathing. While the principles of splinting the airway and delivering assisted CPAP ventilation and underpin Bi-level the basics of this PAP therapy, the Therapy: introduction of newer New technologies and Established Roles miniaturization are revolutionizing the former conventions of the field. The purpose of this review is to improve our Historically, understanding the of various administration forms of PAP therapy positive by providing airway the rationale pressure for (PAP) to help assist respiration Andreea such modalities, Antonescu-Turcu, goes gaining back a basic very working far MD in knowledge time. and In of the device ancient technology, Middle and critically East, assessing midwives used bellows with modified the clinical research evidence while identifying barriers to implementation. Dissemination of such Clement nasal adaptors to resuscitate newborns. Moreover, the bible contains references to mouth-tomouth Critical administration Care Medicine, of breaths Department as a means of of Medicine, resuscitation. Milwaukee, In the 17th Wisconsin century, Robert information J Zablocki is vital in order Veterans to prevent Affairs knowledge Medical gaps in healthcare Center providers and and the systems. University of Wisconsin Milwaukee, Pulmonary and Hooke elegantly demonstrated that small animals could be kept alive during vivisection by Sairam KeywordsParthasarathy, the administration MD of positive pressure breaths using bellows connected to the trachea by a obstructive sleep apnea; continuous positive airway pressure; adherence; adult; pediatric; Research and small Development, tube. However, Southern introduction Arizona Veterans of positive-pressure Administration ventilation Healthcare into modern System, medicine and compliance; sleep apnea; artificial respiration; central sleep apnea; servo ventilation; obesity the Department did of not Medicine, occur until University the disastrous of Arizona, polio epidemic Tucson, in Arizona the middle of last century. In 1953, Bjorn Introduction Ibsen, an anesthesiologist, used bag ventilation connected to a tracheotomy to resuscitate a Abstract teenage girl suffering from respiratory failure due to bulbar poliomyelitis, and thereby gave Fig. 1. Historically, the administration of positive airway pressure (PAP) to help assist respiration goes rise back to very the far concept in time. In of the the ancient modern Middle East, intensive midwives care used unit. bellows However, with modified Over Representative the past few tracings decades, of flow, tidal continuous volume, and airway positive pressure airway (P aw) during pressure (CPAP) therapy noninvasive for obstructive application administration nasal adaptors of continuous to resuscitate positive newborns. airway pressure Moreover, (CPAP) the bible and bi-level contains PAP. references In the left to mouth-tomouth that has administration there evolved are small of into undulations breaths more as a in means and the CPAP more of resuscitation. level sophisticated that are In generated the 17th modes by century, the of Robert therapy for various forms of sleep of positive airway pressure to treat obstructive sleep apnea (OSA) had to await the nifty panel apnea note sleep-disordered patient s Hooke inspiratory elegantly breathing. and demonstrated expiratory While effort, that and small the animals principles consequent could displacement be of kept splinting alive of during inspiratory the vivisection airway by and delivering assisted and expiratory the administration tidal volume. of positive Such inflections pressure are breaths usually using negligible bellows in connected a responsive to CPAP the trachea by a ventilation device. small In this underpin tube. instance However, the the CPAP the basics introduction is set of at 14 this cm of Hpositive-pressure therapy, 2O. In right the panel ventilation introduction there are into large modern of newer medicine technologies and 2010 miniaturization decrements Daedalus did Enterprises not occur the are pressure until revolutionizing the during disastrous exhalation polio (expiratory the epidemic former in positive the conventions middle airway of pressure last century. of [EPAP], the In field. 1953, Bjorn The purpose of this review which Ibsen, is set at an 4 anesthesiologist, cm H2O), whereas used during bag inspiration ventilation the connected inspiratory a positive tracheotomy airwayto resuscitate a Correspondence: is to pressure improve teenage Sairam (IPAP) girl our is Parthasarathy set suffering understanding at 14 cm from H?O, MD, respiratory which Department of would various failure conceivably due of forms Medicine, to bulbar provide of poliomyelitis, University PAP the same therapy level of and Arizona, of thereby by providing 3601 gave S Sixth the Avenue, rationale Mail for Stop 0-151, Tucson, such AZ airway modalities, rise splinting to spartha@arc.arizona.edu. the as concept gaining a CPAP of of the a 14 modern basic cm H2O. intensive working Note the care larger knowledge unit. tidal However, volumes of the and device noninvasive flow patterns technology, application and critically assessing consequent Dr Parthasarathy of presented positive to the airway pressure a version pressure assist provided this to treat by paper obstructive the bi-level at the 45th sleep PAP Respiratory apnea device. (OSA) In this Care had instance, Journal to await a Conference, the nifty the pressure clinical support research or assist evidence level of 10 cm while H identifying barriers to implementation. Sleep Dissemination Disorders: Diagnosis of such and 2O (IPAP minus EPAP) is being administered, Treatment information with held consequently December is vital greater 10-12, in tidal order 2009, volume to in San prevent and Antonio, inspiratory knowledge Texas. flow. gaps in healthcare providers and systems. 6

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11 RESEARCH ARTICLE Automatic CPAP Performance in Patients with Sleep Apnea Plus COPD Arnoldo Guerrero1,6, J. M. Montserrat1,5, Ramon Farre2,5, Fernando Masa3,5, Joaquín Duran4,5, Cristina Embid1,5 COPD, 9:1 8, 2012 RESEARCH ARTICLE Automatic CPAP Performance in Patients with Sleep Apnea Plus COPD Arnoldo Guerrero1,6, J. M. Montserrat1,5, Ramon Farre2,5, Fernando Masa3,5, Joaquín Duran4,5, Cristina Embid1,5 COPD, 9:1 8,

12 RESEARCH ARTICLE Automatic CPAP Performance in Patients with Sleep Apnea Plus COPD Arnoldo Guerrero1,6, J. M. Montserrat1,5, Ramon Farre2,5, Fernando Masa3,5, Joaquín Duran4,5, Cristina Embid1,5 COPD, 9:1 8,

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