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Attila Somfay

Respiratory Insufficiency Sleep Apnoe-Hypopnoe Syndrome (SAHS). Attila Somfay. SZTE Tüdőgyógyászati Tanszék, Deszk. Classification of respiratory insufficiency. Progression in time – acute (pH!) - chronic Pathophysiolog y - type I (hypoxemia = PaO2 <60 Hgmm)

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Attila Somfay

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  1. Respiratory InsufficiencySleep Apnoe-Hypopnoe Syndrome (SAHS) Attila Somfay SZTE Tüdőgyógyászati Tanszék, Deszk

  2. Classification of respiratory insufficiency • Progression in time – acute (pH!) • - chronic • Pathophysiology-type I (hypoxemia=PaO2<60 Hgmm) • -type II (hypoxemia + hypercapnia=PaCO2>50 Hgmm) • Pathomechanism - V/Q mismatch • - hypoventilation • - limited diffusion • - right-left shunt • Etiology - airway • - lung parenchyma • - lung vasculature • - chest wall and pleura • - neuromuscular

  3. Alveolar gas equation: PA (mmHg)=(PB-47) x FIO2 – 1.2 x PaCO2 102 = 150 - 48

  4. VCO2 PCO2= VA

  5. The causes of hypoventilation

  6. Diminished diffusion • Transit (contact)time: 0.75 s • Equilibration: 0.25 s • Exercise+ diminished diffusion: PaO2<60 Hgmm • PaCO2 : no change or decreases • Causes: alveolitis fibrotisans, sarcoidosis, pneumoconiosis, connective tissue diseases, drugs, irradiation, alveolar cell cc, Goodpasture-sy, CHF

  7. Mechanism of exercise induced hypoxaemia

  8. Right-left shunt • Anatomic: lung (a-v malformation), heart (ASD, VSD, Eisenmenger-sy) • Functional: V/Q=0; ARDS, atelectasia, oedema, haemorrhagia • Hypercapnia: no or rarely • Hypoxemia: cannot be corrected by 100% O2

  9. Ventilation-perfusion mismatch • “Functional shunt”, most frequent cause of hypoxemia • COPD, ILD, pulmonary embolism • Regional differences in airway resistance and lung compliance • Hypercapnia: only in severe cases (e.g.blue bloater COPD) • Hypoxemia: correctable with small incraese in FIO2

  10. Symptoms of hypoxemia és hypercapnia

  11. Diseases leading to resp. insuff.

  12. Oxigen supplementation in chronic resp. insuff. only way to prolong survival in case of chronic resp.insuff. NOTT: Ann Intern Med, 1980 BMC: Lancet, 1981 • Indication: (stable condition) • PaO2 < 55 mmHg or SAT < 88% • 55 mmHg < PaO2 < 60 mmHg with pulmonary hypertension, polyglobuliaor right heart failure • Aim: PaO2 ≈ 60 mmHg vagy SAT ≈ 90 % • CAVE: CO2 retention in COPD (max.1-2 L/min)! • Dosage: > 15 h/day

  13. PaO2 < 55 Hgmm PaO2 > 55 Hgmm

  14. ARDS

  15. The causes of ARDS

  16. Diagnosis of ARDS • Acuteonset (1-3 days) • One or more risk factors • Chest X-ray: new, bilateral, snow flake – like infiltrates • Exclusion: heart failure, fluid overdose, chronic lung disease • Hypoxemia not corrected with O2: - mild: PaO2/FIO2200-300 mmHg - moderate: 100-200 mmHg - severe: < 100 mmHg

  17. Non-invasive ventilation (NIV) in global respiratory insufficiency - BiPAP

  18. Sleep apnoe-hypopnoe syndrome (SAHS) • Dg: apnoe >5/h , >30/sleep period, SAT decrease:minimum 4% • Apnoe: > 10 s • Arousal (EEG) defraction of sleep • Apnoe index: Number of apnoe/h:<5 - mild: 5-15 - moderate: 15-30 - severe: >30

  19. Types of SAHS • Central (kb. 5%) • Obstructive (site:pharyngeal level) • Mixed Risk factors: - obesity - alcohol - sedatives

  20. Symptoms of SAS • Daytime sleepiness • Morning headache, tenebrosity • Change in personality • Strong hoarsness • Movements during sleep • Enuresis nocturna • Impotency • Hypertonia, arrhythmias • Right heart failure

  21. Score: 0 – 24 Upper limit of normal: 9 Normal : 5.9 ± 2.2 SAS: 16 ± 4.4

  22. Diagnosis of SAS (poliszomnográfia) • EEG • EOG • EMG • EKG • ABG, pulzoximetry • Detection of airflow • Detection of breathing movements, leg movements • Voice recording • Video

  23. Therapy of SAS • Change in life style • nCPAP, BiPAP • Medroxiprogesteron (Provera) • Surgery • Acetazolamid (Diamox, Fonurit) • Almitrin • Protryptilin

  24. cPAP with nasal mask

  25. Effect of cPAP on SpO2

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