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Biomedical subjects

C Monasterio

Publications and source records attributed to C Monasterio.

15 recordsLinked to original sources
PubMed2006

Noninvasive positive pressure ventilation prevents postoperative pulmonary complications in chronic ventilators users.

OBJECTIVE: To evaluate the postoperative pulmonary complications and the long-term impact on pulmonary function of different surgical procedures with general anaesthesia in chronic respiratory failure (CRF) patients who were using noninvasive positive pressure ventilation (NPPV). DESIGN: We retrospectively studied 20 stable patients on NPPV for CRF secondary to: kyphoscoliosis (eight), morbid obesity (six), thoracoplasty (four), neuromuscular diseases (two), who underwent surgical procedures with general anaesthesia, between January 1998 and December 2003. MATERIAL AND METHODS: The variables studied were: type of surgery, hours of orotracheal intubation, hours of stay in the postsurgical reanimation unit (PRU), postoperative pulmonary complications and days of hospital stay. These results were compared with those obtained in patients without respiratory pathology and who were submitted to the same type of surgical interventions during the study period. All patients were tested for: arterial blood gases, forced vital capacity (FVC) and forced expiratory volume in 1s (FVE1). These tests were carried out both prior to surgical intervention and 12 months after this intervention, and the use of medical assistance resources the year prior to and the year after the surgical intervention were also analysed. RESULTS: Sixteen patients were using NPPV at home at the time of the intervention and four patients were adapted to NPPV before surgery. The surgical procedures were: gastroplasty: six; mastectomy: five; septoplasty: three; hip prosthesis: two; cholecystectomy: one; Gasserian ganglion thermocoagulation: one; hysterectomy: one; and endoscopic retrograde cholangiopancreatography (ERCP): one. The mean postoperative intubation time was 3.8+/-3.2h, and only one patient remained intubated for more than 12h. The mean stay in the PRU was 19+/-9h (vs 19+/-6h in the general population, p>0.05). The days of hospital stay for the different pathologies were in the majority of cases greater than in the general population. We did not find significant differences on comparing the arterial blood gases, in pulmonary function or in use of assistance resources between the year previous to and the year following the surgical intervention. CONCLUSIONS: In high-risk patients with chronic respiratory failure as a consequence of a restrictive lung pathology, NPPV can play an important role to confront surgical procedure with general anaesthesia with greater security. To obtain these results, it was fundamental to coordinate between the Pulmonary Services and the Anaesthesia Services as well as to follow up jointly in the PRU.

Anesthesia, General↗
PubMed2001

Effectiveness of continuous positive airway pressure in mild sleep apnea-hypopnea syndrome.

The aim of this trial was to evaluate the effectiveness of continuous positive airway pressure (CPAP) in patients with mild sleep apnea- hypopnea syndrome (SAHS). One hundred forty-two consecutive patients with mild SAHS (apnea-hypopnea index 10-30, without severe sleepiness) were randomly assigned to receive conservative treatment (CT)-sleep hygiene and weight loss-(65 patients) or CT plus CPAP (77 patients), and 125 patients (86% males, age: 54 +/- 9 yr, BMI: 29 +/- 4 kg/m(2), AHI: 20 +/- 6, ESS: 12 +/- 4) completed the follow-up. The following outcomes were assessed at inclusion and after 3 and 6 mo of treatment: sleepiness (Epworth scale, multiple sleep latency test [MSLT]), other symptoms related to SAHS, cognitive function, and perceived health status (Functional Outcomes of Sleep Questionnaire [FOSQ], Nottingham Health profile). The relief of SAHS-related clinical symptoms was significantly greater in the CPAP group than in the CT group; the Epworth scale and FOSQ also showed more improvement in the CPAP group but did not reach significance. There were no significant differences in the other tests performed probably because the baseline values were normal. CPAP compliance was 4.8 +/- 2.2 h and treatment continuation was accepted by 62% of the patients at the end of the study. These results suggest that CPAP can be considered in treating patients with mild SAHS on the basis of an improvement in symptoms.

Chi-Square Distribution↗
PubMed2001

Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. a randomized, controlled trial.

BACKGROUND: The sleep apnea-hypopnea syndrome is defined by a pathologic number of respiratory events during sleep (the apnea-hypopnea index, defined as the number of apnea and hypopnea episodes per hour) and daytime symptoms (mostly, excessive sleepiness). In patients with the sleep apnea syndrome, treatment with continuous positive airway pressure (CPAP) normalizes both the apnea-hypopnea index and diurnal symptoms. However, the effect of CPAP in persons with a pathologic apnea-hypopnea index without daytime sleepiness is unclear. OBJECTIVE: To investigate the short-term effects of CPAP on quality of life, objective sleepiness, cognitive function, and arterial blood pressure in nonsleepy patients with a pathologic apnea-hypopnea index. DESIGN: Multicenter randomized, placebo-controlled, parallel-group study. SETTING: Six teaching hospitals in Spain. PATIENTS: 55 patients with an apnea-hypopnea index of 30 or greater who did not have daytime sleepiness (Epworth Sleepiness Scale score </= 10). INTERVENTION: Patients were randomly assigned to receive optimal (n = 29) or sham (n = 25) CPAP and were observed for 6 weeks. MEASUREMENTS: Quality of life, objective sleepiness (Multiple Sleep Latency Test score), cognitive function, and arterial blood pressure. RESULTS: The intervention and control groups were similar in terms of mean (+/-SE) age (54 +/- 2 vs. 52 +/- 2 years), apnea-hypopnea index (54 +/- 3 vs. 57 +/- 4), Epworth Sleepiness Scale score (7.0 +/- 0.4 vs. 7.0 +/- 0.4) and adherence to CPAP treatment (5.0 +/- 0.4 vs. 4.0 +/- 0.5 hours/d). Other variables, such as quality of life, cognitive function, and arterial blood pressure, were also similar in both groups before treatment. After 6 weeks of CPAP or sham CPAP, none of these variables changed significantly. CONCLUSION: In patients with an apnea-hypopnea index of 30 or greater and no subjective daytime sleepiness, CPAP does not modify quality of life, objective sleepiness, vigilance, attention, memory, information processing, visuomotor coordination, or arterial blood pressure. Treatment with CPAP is therefore not indicated in nonsleepy patients with a pathologic apnea-hypopnea index.

Blood Pressure↗
PubMed1999

[Measurement of the perceived impact of sleep problems: the Spanish version of the functional outcomes sleep questionnaire and the Epworth sleepiness scale].

BACKGROUND: Excessive daytime sleepiness is a frequent symptom and a public health problem due to its association with automobile and work related accidents. The aim of this study was to develop and carry out a preliminary assessment of the Spanish version of the functional outcomes sleep questionnaire and the Epworth sleepiness scale, two instruments designed to evaluate patients with sleep disorders. MATERIAL AND METHODS: For the adaptation, the forward and back-translation method by bilinguals was used with professional and lay panel. Once tested for feasibility and comprehension, 39 patients with obstructive sleep apnea syndrome completed the Spanish version of the FOSQ and the Epworth sleepiness scale, together with a question on self-rated health status. RESULTS: Difficulty of translation was assessed as low and the naturalness of Spanish expressions as high for all the items of the questionnaires except for the response options of the Epworth sleepiness scale. Both questionnaires showed higher reliability than the standard proposed for individual comparisons (Cronbach's alpha > 0.9). The FOSQ vigilance scale showed a high correlation with the Epworth score (r = -0.79), while for the other scales of the FOSQ correlations were moderate (r ranging from -0.52 to -0.68). Patients who reported "regular" or "poor" health had significantly worse scores for most of the FOSQ scales. CONCLUSION: These results suggest that the Spanish versions of both questionnaires are conceptually equivalent to the originals and that they show similar characteristics of reliability and validity. The FOSQ vigilance scale assess daytime sleepiness similarly to Epworth but the others scales of the FOSQ provide additional information for these patients.

Female↗
PubMed1998

Long-term mechanical ventilation in amyotrophic lateral sclerosis.

BACKGROUND: Acute respiratory insufficiency (ARI) with alveolar hypoventilation or incapacitating dyspnoea but without peripheral muscle involvement can be an early manifestation of respiratory involvement in amyotrophic lateral sclerosis (ALS). Some of these patients benefit from assisted ventilation. The object of this study was to analyse the results of long-term mechanical ventilation (LTMV) in ten patients with ALS. METHODS: A retrospective analysis of intensive care unit (ICU) or ambulant patients with ALS who underwent LTMV in a conventional hospital ward was performed. Erect and supine spirometry, blood gas analysis and pulse oximetry were performed before the start and during the course of ventilation. RESULTS: Ten patients on LTMV were included. Four from the ICU were ventilated via tracheostomy, and six ambulant patients had non-invasive (nasal) ventilation. In all cases, ventilation was performed in a conventional hospital ward. The ambulant patients improved symptomatically during ventilation, confirmed by measurement of gas exchange and of SaO2 by continuous pulse oximetry. Three of the ten patients survive in long-term care--two with nasal and one with tracheostomy ventilation. CONCLUSIONS: LTMV outside ICU was possible in ten patients, seven of whom returned home. Returning home is very difficult for patients dependent on a ventilator who lack family support.

Amyotrophic Lateral Sclerosis↗
PubMed1992

[The evaluation of the oxygen-conserving valve during exertion].

BACKGROUND: The oxygen-conserving valve (OCV) permits reduction in oxygen consumption upon the release of oxygen only during inhalation thereby increasing the autonomy of portable sources. METHODS: In order to confirm its efficacy during exercise, 15 patients with chronic limitation of air flow and gasometric criteria of domiciliary oxygen therapy were selected. The patients underwent three walking tests (WT) of 6 minutes during which the continuous form of transcutaneous hemoglobin saturation (SaO2) and the distance covered were registered. The first was carried out breathing synthetic air at a flow of 2 liters per minute; the second with continuous oxygen released by a portable source at 2 liters per minute and the third with the OCV coupled to a portable source at the same flow. RESULTS: SaO2 reached with the continuous oxygen is significantly higher to that of synthetic air while there was no difference between the SaO2 with continuous oxygen and with valve. Improvement in SaO2 upon use the valve was not obtained in only 2 of the 15 patients. A significant increase was observed in the distance covered upon oxygen administration not only in the continuous form but also with OCV with respect to synthetic air. CONCLUSIONS: OCV is as effective as continuous oxygen in the correction of desaturation during exercise, however its indications must be individualized by exercise tests (WT) in each patients in order to ensure its correct functioning.

Adult↗
PubMed1990

[The introduction of liquid oxygen as a portable source in continuous home oxygen therapy].

The most widespread types of oxygen delivery at home in our area are bottles where the gas is stored under pressure and concentrators. Both devices can only be used at rest. We have assessed a new system for the delivery of liquid oxygen to be used at home, provided with a portable unit which permits that the patients receive oxygen also outside their homes. Seven such devices have been implemented in the Barcelona area, with an excellent acceptance and without technical problems. To verify the clinical indication, exercise tests were carried out both in baseline conditions and receiving oxygen from the portable source. Oxyhemoglobin saturation and the walked distance were continuously measured. In all patients important drops in the saturation of oxyhemoglobin were recorded during walking, which was corrected with oxygen administration. Liquid oxygen with a portable source is a good delivery system for oxygen therapy at home, permitting to receive oxygen throughout the day, particularly during exercise. Although the availability of liquid oxygen is limited, it should be recommended to the patients in whom exercise hypoxemia is shown to be corrected and who desire an active social life.

Drug Storage↗
PubMedDate not supplied

[Effectiveness of a mandibular advancement prosthesis in the treatment of obstructive sleep apnea syndrome].

OBJECTIVE: To assess the efficacy of a mandibular advancement prosthesis for treating obstructive sleep apnea syndrome (OSAS). METHOD: Mandibular advancement appliances were prescribed for 21 patients (20 men) with OSAS diagnosed by polysomnography. Mean age was 51 (8) years, BMI was 30 (4) kg/m2, and the apnea-hypopnea index (AHI) per hour was 48 (17). If the device was well tolerated, regardless of clinical response, polysomnography was repeated between 1 to 3 months after start of treatment. The device was considered effective if the AHI decreased to < 15/h and symptoms related to OSAS disappeared. RESULTS: Seven patients withdrew from treatment after only a few days. The remaining 14 (66%) tolerated treatment well and the second polysomnogram was performed. In six of the 14 (43%), the device proved effective for correcting OSAS. In six more patients, the AHI decreased but failed to become normal. In the remaining two patients, no improvement was observed. Improvement in the AHI was unrelated to severity of OSAS. CONCLUSION: The mandibular advancement prosthesis is effective for some patients with OSAS, including those in whom the AHI is high. Larger studies are needed to allow us to define the type of patients that might benefit.

Female↗