Sono e VNI Flashcards
Diagnóstico de SAOS
Diagnóstico de SAOS: RDI>=5ev/h com sintomas típicos ou
RDI>=15ev/h
We recommend that clinical tools, questionnaires and prediction algorithms not be used to diagnose OSA in adults, in the absence of polysomnography or home sleep apnea testing.
We recommend that polysomnography, or home sleep apnea testing with a technically adequate device, be used for the diagnosis of OSA in uncomplicated adult patients presenting with signs and symptoms that indicate an increased risk of moderate to severe OSA (presence excessive daytime sleepiness and at least two: snoring, witnessed apnea, gasping or choking, hypertension).
We recommend that if a single home sleep apnea test is negative, inconclusive, or technically inadequate, polysomnography be performed for the diagnosis of OSA.
We recommend that polysomnography, rather than home sleep apnea testing, be used for the diagnosis of OSA in patients with significant cardiorespiratory disease, potential respiratory muscle weakness due to neuromuscular condition, awake hypoventilation or suspicion of sleep related hypoventilation, chronic opioid medication use, history of stroke or severe insomnia.
We suggest that, if clinically appropriate, a split-night diagnostic protocol, rather than a full-night diagnostic protocol for polysomnography be used for the diagnosis of OSA. (Initiates CP titration only: moderate to severe degree of OSA for a minimum of 2 hours; at least 3 hours available for titration)
We suggest that when the initial polysomnogram is negative and clinical suspicion for OSA remains, a second polysomnogram be considered for the diagnosis of OSA.
Tratamento da SAOS
- We recommend that clinicians use PAP, compared to no therapy, to treat OSA in adults with excessive sleepiness.
- We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with impaired sleep-related quality of life. (snoring, sleep-related choking, insomnia, disruption of bedpartner’s sleep, morning headaches, nocturia, impairments in productivity or social functioning, and daytime fatigue)
- We suggest that clinicians use PAP, compared to no therapy, to treat OSA in adults with comorbid hypertension.
- We recommend that PAP therapy be initiated using either APAP at home or in-laboratory PAP titration in adults with OSA and no significant comorbidities.
- We recommend that clinicians use either CPAP or APAP for ongoing treatment of OSA in adults.
- We suggest that clinicians use CPAP or APAP over BPAP in the routine treatment of OSA in adults.
- We recommend that educational interventions be given with initiation of PAP therapy in adults with OSA.
- We suggest that behavioral (cognitive behavioral therapy or motivational enhancement) and/or troubleshooting interventions (identify PAP-related problems and initiate potential solutions) be given during the initial period of PAP therapy in adults with OSA.
- We suggest that clinicians use telemonitoring-guided interventions during the initial period of PAP therapy in adults with OSA.
Distúrbios do sono centrais
Apneia e hipopneia central: redução do fluxo oro-nasal e do esforço respiratório. Cânula melhor para deteção de hipopneia. Termistor melhor para deteção de apneia.
Servoventilacao adaptativa:
-na ACS associada aos opioides (ou binivel)
-na ACS e IC com FÉ preservada >45%
-na ACS em acromegalia, diabetes e DRCT (ou CPAP)
-melhor na ACS persistente ao tratamento (que desenvolvem ACS de novo sob tratamento com CPAP ou BPAP e que persistem sob tratamento)
-considerar em doentes sintomáticos com ACS idiopatica
Acetazolamida:
-em conjunto com APAP nas ACS/respiração periódica em alta altitude
-melhora as oxigenação na ACS em HP precapilar (com O2 noturno)
-em doentes sintomáticos com ACS idiopatica (ou zolpidem)
Síndrome de hipoventilacao obesidade
SHO definição: combinação de obesidade (IMC>=30), distúrbio do sono e hipercapnia diurna (PaCO2>=45).
Prevalência: 8-20% em obesos
90% tem SAOS coexistente
Restantes 10% tem hipoventilacao no sono não obstrutiva
For obese patients with SDB who are STRONGLY SUSPECTED (obeso grave com sintomas típicos) of having OHS, we suggest measuring PaCO2 rather than serum bicarbonate or SpO2 to diagnose OHS.
-For patients with LOW TO MODERATE probability of having OHS (pretest probability,20%), we suggest using serum bicarbonate level to decide whether to measure PaCO2 :in patients with serum bicarbonate ,27 mmol/L, clinicians might forego measuring PaCO2 , as the diagnosis of OHS is very unlikely; in patients with serum bicarbonate >27 mmol/L, clinicians might need to measure PaCO2 to confirm or rule out the diagnosis of OHS
-We suggest that clinicians do not use SpO2 to decide when to measure PaCO2
For stable ambulatory patients diagnosed with OHS, we suggest treatment with PAP during sleep.
we suggest CPAP rather than NIV be used as the initial treatment of stable ambulatory adult patients with OHS and concurrent severe OSA (AHI>30 events/h) presenting with chronic stable respiratory failure.
Importantly, >70% of patients with OHS have severe OSA.
We suggest that hospitalized patients suspected of having OHS be started on NIV therapy before being discharged from the hospital and continued on NIV therapy until they undergo outpatient workup and titration of PAP therapy in the sleep laboratory, ideally during the first 3 months after hospital discharge.
For patients with OHS we suggest using weight-loss interventions that produce sustained weight loss of 25% to 30% of actual body weight. This level of weight loss is most likely required to achieve resolution or clinically meaningful reduction of hypoventilation
VNI na DPOC
Suggests LTH-NIV be used for patients with chronic stable hypercapnic COPD.
Suggests LTH-NIV be used in patients with COPD following a life-threatening episode of acute hypercapnic respiratory failure requiring acute NIV, if hypercapnia persists following the episode.
Suggests titrating LTH-NIV to normalise or reduce PaCO2 levels in patients with COPD.
Suggests using fixed pressure support mode as first-choice ventilator mode in patients with COPD using LTH-NIV.
VNI na Insuficiência respiratória aguda
COPD exacerbation:
-We suggest NIV NOT be used in patients with hypercapnia who are not acidotic in the setting of a COPD exacerbation.
-We recommend BILEVEL NIV for patients with ARF leading to acute or acute-on-chronic respiratory acidosis (pH ⩽7.35) due to COPD exacerbation.
-We recommend a TRIAL of BILEVEL NIV in patients considered to require endotracheal intubation and mechanical ventilation, unless the patient is immediately deteriorating.
Cardiogenic pulmonary oedema
-We recommend either BILEVEL NIV or CPAP for patients with ARF due to cardiogenic pulmonary oedema.
- We suggest that CPAP or BILEVEL NIV be used for patients with ARF due to cardiogenic pulmonary oedema in the pre-hospital setting.
Immunocompromised
-We suggest early NIV for immunocompromised patients with ARF.
Post-operative
-We suggest NIV for patients with post-operative ARF.
Palliative care
-We suggest offering NIV to dyspnoeic patients for palliation in the setting of terminal cancer or other terminal conditions.
Chest trauma
-We suggest NIV for chest trauma patients with ARF.
ARF following extubation from invasive mechanical ventilation
-We suggest that NIV be used to prevent post-extubation respiratory failure in HIGH-risk patients post-extubation (>65a ou comorbilidades cardíacas ou respiratórias)
-We suggest that NIV should NOT be used to prevent post-extubation respiratory failure in non-high-risk patients.
-We suggest that NIV should NOT be used in the treatment of patients with established post-extubation respiratory failure.
Facilitate weaning patients from invasive mechanical ventilation
-We suggest NIV be used to facilitate weaning from mechanical ventilation in patients with HYPERCAPNIC respiratory failure.
Given the uncertainty of evidence we are unable to offer a recommendation
-Acute asthma
-De novo respiratory failure (without prior chronic respiratory disease)
-ARF due to pandemic viral illness
-Hypoxaemic patients weaning from invasive mechanical ventilation
ONAF na insuficiência respiratória aguda
Suggests the use of HFNC (over COT and over NIV) in patients with acute
hypoxaemic respiratory failure
Suggests the use of HFNC (over COT) during breaks from NIV in
patients with acute hypoxaemic respiratory failure
Suggests the use of either COT or HFNC in post-operative
patients at LOW risk of respiratory complications.
Suggests the use of either HFNC or NIV in post-operative
patients at HIGH risk of respiratory complications
Suggests the use of HFNC (over COT) in nonsurgical patients
after extubation
Suggests the use of NIV (over HFNC) for patients at high risk of
extubation failure, unless there are absolute or relative contraindications to NIV
Suggests a trial of NIV prior to use of HFNC in patients with
COPD and acute hypercapnic respiratory failure
