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ΜΗ ΕΠΕΜΒΑΤΙΚΟΣ ΜΗΧΑΝΙΚΟΣ ΑΕΡΙΣΜΟΣ (ΜΕΜΑ) PowerPoint PPT Presentation


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ΜΗ ΕΠΕΜΒΑΤΙΚΟΣ ΜΗΧΑΝΙΚΟΣ ΑΕΡΙΣΜΟΣ (ΜΕΜΑ) ΣΤΗ ΣΤΑΘΕΡΟΠΟΙΗΜΕΝΗ ΧΡΟΝΙΑ ΑΠΟΦΡΑΚΤΙΚΗ ΠΝΕΥΜΟΝΟΠΑΘΕΙΑ (ΧΑΠ) Δρ ΠΡΟΚΟΠΗΣ Κ. ΚΥΘΡΕΩΤΗΣ ΠΝΕΥΜΟΝΟΛΟΓΟΣ – ΕΝΤΑΤΙΚΟΛΟΓΟΣ Δ/ΝΤΗΣ Ε.Σ.Υ. ΚΕΝΤΡΟ ΑΝΑΠΝΕΥΣΤΙΚΗΣ ΑΝΕΠΑΡΚΕΙΑΣ Γ.Ν.Ν.ΘΩΡΑΚΟΣ ΑΘΗΝΩΝ « Η ΣΩΤΗΡΙΑ».

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ΜΗ ΕΠΕΜΒΑΤΙΚΟΣ ΜΗΧΑΝΙΚΟΣ ΑΕΡΙΣΜΟΣ (ΜΕΜΑ)

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Copd is the only major cause of death that has increased significantly in recent years

COPD is the only major cause of death that has increased significantly in recent years

Proportion of 1965 rate

3.0

Coronaryheart

Stroke

OtherCVD

COPD

All othercauses

2.5

2.0

1.5

1.0

0.5

59%

64%

35%

+ 163%

7%

0.0

Percent change in age-adjusted death rates in US from 1965 to 1998

CVD = cerebrovascular disease

www.goldcopd.com


Copd is projected to be the third biggest killer by 2020

COPD is projected to be the third biggest killer by 2020

1990

2020

Ischemic heart disease

CVD disease

Lower respiratory infection

Diarrhoeal disease

Perinatal disorders

COPD

Tuberculosis

Measles

Road traffic accident

Lung cancer

3rd

6th

Stomach cancer

HIV

Suicide

Murray & Lopez 1997


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  • ( 2 ~ 30-40%) Foucher P et al. Chest 1998; 113: 1580-7


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:

1. 2. 3.

4.

5.

6. GOLD, 2008


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H Medical Research Council Working Party, Lancet 1981;1:681-86

;


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  • -E


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  • -

  • :

  • Shapiro SH et al: Lancet 1992; 340:1425-1429

  • Celli B. et al: Am Rev Respir Dis 1989;140:1251-1256

  • Zibrak JD et al: Am Rev Respir Dis 1988; 138:1515-1518

  • Mehta S. Am J respir Crit Care Med 2001;163: 540-577


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  • , ,


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,, , (2 ) NPPV + LTOT:1.

2.

3. ( HRQOL)

LTOT ,

** LTOT > 6


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:-

- -

- ( NPPV + LTOT)

- PaCO2

-

- HRQOL

>15h/d

>5h.night-1

. V+ LTOT 45% LTOT 27 %.

V+ LTOTvs LTOT.

H


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: NPPV : 27 NPPV(IPAP 18 2 cmH2O EPAP = 2 cmH2O)

15 sham-NPPV (CPAP 2 cm H2O) 3 h .day-1 , 5 days / week x 3 weeks


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: NPPV , :

PaCO2 , FEV1, FVC. P0.1

6MWD . 76m

DI 3

6MWD DI


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  • NPPV

  • : , , , , , , , HRQOL, .

  • 15 ,6 RCTs - 9 non- RCTs.


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  • RCTs NPPV non RCTs

  • non RCTs NPPV

  • H HRQOL NPPV : , NPPV .


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  • ( 1997- 2003)

  • 34

  • PaCO2, PaO2, FEV1 2 NPPV

  • Mean inspiratory pressures 28 cmH2O (17-40 cmH2O)

  • : 86%


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P = 0.001

87.7%

71.8%

56.7%

6.4 2.6 h.d-1

42%

IPAP =21 4 cmH2O

EPAP= 4.5 1.4 cmH2O


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, , .

: V , ,

.

72 NIV + LTOT . IPAP = 12.9 ( 12. 5 13.4), EPAP = 5.1 ( 4.8 5.3)

72 LTOT

~ 2


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  • +LTOT

  • [ (adjusted)Cox model]

  • * 2.21 (0.01-5.59)

  • FEV1 PaC2 (6 12 )

  • +LTOT


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: NPPV , . 40 NPPV 40

NPPV : 7.9 0.5 h.d-1 , IPAP = 17.5 1.4 cmH2O EPAP = 4.5 0.9 cmH2O


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82

50

89

51


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OVERLAP SYNDROME

  • > 40 10%

  • 5-10%

  • 0,5-1 %


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pH

< 7.35

>7.35

( 1 )

( shock )

Pa CO2

+/- 2

> 50 mmHg

< 50 mmHg

.

+/ - 2

CPAP

SaO2 PSG

pH

( 1 )

( 1 )

SaO2

SaO2

.

PCO2

CPAP

IPAP

2

Veale D.et al. Breathe, 2008; vol :4 No 3: 211


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  • NPPV ,

  • NPPV

  • . ..


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  • . (, )

  • 2. , ,

  • : - PaCO2 > 55mmHg

  • - PaCO2 = 50 54 mmHg

  • (SaO2 < 88% 5 2 l/min)

  • - PaCO2 = 50 54 mmHg 2 12

  • .

  • A consensus Conference Report , Chest 1999


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