36 results on '"ADEP assistance"'
Search Results
2. Sleep Apnea Treatment During Cardiac Rehabilitation of Congestive Heart Failure Patients (SATELIT-HF)
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ResMed, ResMed Foundation, and Adep Assistance
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- 2015
3. Validation of a Dynamic Evaluation Tool in Respiratory Failure (TELERESP)
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Adep Assistance and david orlikowski, MDPHD
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- 2014
4. Effect of Non Invasive Brain Stimulation on Experimentally Induced Dyspnea (Breathlessness) (tDCS-Dyspnea)
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Adep Assistance
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- 2014
5. Instrumental and Manual Increase of Couch in Neuromuscular Patients (OPTICOUGH)
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Adep Assistance
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- 2013
6. Evaluation of the Impact on Swallowing of Non Invasive Ventilation (OPTIDEG)
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Adep Assistance
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- 2013
7. Comparison of Breathing Pattern During Neurally Adjusted Ventilatory Assist Ventilation and Pressure Support Ventilation
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Adep Assistance and Lofaso, MD-PhD
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- 2013
8. Impact of Patient Controlled Positive End-expiratory Pressure on Speech in Tracheostomized Ventilated Patients (OptiPEP)
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Adep Assistance and PRIGENT, Dr Helene PRIGENT MD
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- 2011
9. Harms of unintentional leaks during volume targeted pressure support ventilation
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Khirani, Sonia, Louis, Bruno, Leroux, Karl, Delord, Vincent, Fauroux, Brigitte, Lofaso, Frédéric, INSERM U955, équipe 13, S2A Santé, S2A Santé-S2A Santé-Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Biomécanique cellulaire et respiratoire (BCR), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), ADEP ASSISTANCE, ADEP assistance, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Role des Cellules Dendritiques Dans la Regulation des Effecteurs de l'Immunite Antitumorale, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Institut Mondor de Recherche Biomédicale (IMRB)
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Pressure support ,Home ventilators ,MESH: Humans ,MESH: Materials Testing ,MESH: Home Care Services ,MESH: Equipment Failure ,Unintentional leaks ,MESH: Ventilators, Mechanical ,MESH: Tidal Volume ,Ventilatory circuit ,MESH: Positive-Pressure Respiration ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,Volume targeted ,MESH: Interactive Ventilatory Support ,Hybrid mode ,MESH: Equipment Design - Abstract
International audience; BACKGROUND: Volume targeted pressure support ventilation (VT-PSV) is a hybrid mode increasingly used to maintain a minimal tidal volume (VT) by automatically adjusting the level of inspiratory pressure. The objective of the study was to determine the ability of home ventilators to maintain the preset minimal VT during unintentional leaks in a VT-PSV mode. METHODS: Seven ventilators were tested on a lung bench with different circuit configurations and with different levels of unintentional leaks. Unintentional leaks were generated using calibrated holes. RESULTS: All the studied ventilators with a single-limb circuit with intentional leak (n = 5) were able to maintain the minimal preset VT during unintentional leaks. One ventilator overcompensated VT during unintentional leaks of high intensity. In contrast, all studied ventilators with a single circuit with an expiratory valve (n = 2) or a double-circuit (n = 3) but one failed to maintain the minimal VT during unintentional leaks. Unintentional leaks generated a decrease in inspiratory pressure, which was responsible for the fall in VT. CONCLUSIONS: Most of the studied ventilators with a single-limb circuit with intentional leak correctly estimate the expiratory VT and therefore successfully maintain the preset minimal VT during unintentional leaks, in contrast to most of the studied ventilators with a double-circuit, which paradoxically are not able to directly measure expiratory VT. Importantly, the VT-PSV mode, when used with most ventilators with expiratory valve or double-circuit, can paradoxically exacerbate the VT drop during unintentional leaks.
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- 2013
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10. Patient-controlled positive end-expiratory pressure with neuromuscular disease: effect on speech in patients with tracheostomy and mechanical ventilation support.: Speech and Mechanical Ventilation
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Garguilo, Marine, Leroux, Karl, Lejaille, Michèle, Pascal, Sophie, Orlikowski, David, Lofaso, Frédéric, Prigent, Hélène, Guellaen, Georges, Groupe de Recherche Clinique et Technologique sur le Handicap (GRCTH), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), ADEP Assistance, ADEP assistance, CIT-IT Garches, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de médecine physique et de réadaptation, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], Service de réanimation médicale[Poincaré], Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], Physiopathologie et Thérapeutiques Respiratoires, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10, and Marine Garguilo received a grant from the Institut Garches and the Axa fund for research. The study was supported by the Association d'Entraide des Polios et Handicapés (ADEP assistance).
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speech ,[SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology ,tracheostomy ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,neuromuscular ,respiratory system ,mechanical ventilation ,respiratory tract diseases ,positive end-expiratory pressure - Abstract
International audience; OBJECTIVE: Communication is a major issue for patients with tracheostomy who are supported by mechanical ventilation. The use of positive end-expiratory pressure (PEEP) may restore speech during expiration; however, the optimal PEEP level for speech may vary individually. We aimed to improve speech quality with an individually adjusted PEEP level delivered under the patient's control to ensure optimal respiratory comfort. METHODS: Optimal PEEP level (PEEPeff), defined as the PEEP level that allows complete expiration through the upper airways, was determined for 12 patients with neuromuscular disease who are supported by mechanical ventilation. Speech and respiratory parameters were studied without PEEP, with PEEPeff, and for an intermediate PEEP level. Flow and airway pressure were measured. Microphone speech recordings were subjected to both quantitative and qualitative assessments of speech, including an intelligibility score, a perceptual score, and an evaluation of prosody determined by two speech therapists blinded to PEEP condition. RESULTS: Text reading time, phonation flow, use of the respiratory cycle for phonation, and speech comfort significantly improved with increasing PEEP, whereas qualitative parameters remained unchanged. This resulted mostly from the increase of the expiratory volume through the upper airways available for speech for all patients combined, with a rise in respiratory rate for nine patients. Respiratory comfort remained stable despite high levels of PEEPeff (median, 10.0 cm H2O; interquartile range, 9.5-12.0 cm H2O). CONCLUSIONS: Patient-controlled PEEP allowed for the use of high levels of PEEP with good respiratory tolerance and significant improvement in speech (enabling phonation during the entire respiratory cycle in most patients). The device studied could be implemented in home ventilators to improve speech and, therefore, autonomy of patients with tracheostomy. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01479959; URL: clinicaltrials.gov.
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- 2013
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11. Continuous positive airway pressure titration in infants with severe upper airway obstruction or bronchopulmonary dysplasia
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Nicolas Leboulanger, Sabrina Aloui, Arnaud Picard, Adriana Ramirez, Brigitte Fauroux, Sonia Khirani, S2A santé Île-de-France, S2A Santé, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Oxygénothérapie, ADEP assistance, INSERM U955, équipe 13, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM), Vaincre la Mucoviscidose (VLM), Assistance Publique-Hôpitaux de Paris, Inserm, Université Pierre et Marie Curie-Paris 6, ADEP Assistance, S2A Santé, and IP Santé Domicile., and BMC, Ed.
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Male ,[SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,medicine.medical_treatment ,Continuous positive airway pressure ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Severity of illness ,Respiratory muscle ,[SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO] ,Humans ,Medicine ,Single-Blind Method ,030212 general & internal medicine ,Bronchopulmonary Dysplasia ,business.industry ,Continuous positive airway pressure titration ,Research ,Oesophageal pressure ,Infant ,Airway obstruction ,medicine.disease ,nervous system diseases ,respiratory tract diseases ,030228 respiratory system ,Bronchopulmonary dysplasia ,Anesthesia ,Breathing ,Female ,Expiratory abdominal activity ,business ,therapeutics ,circulatory and respiratory physiology - Abstract
International audience; INTRODUCTION: Noninvasive continuous positive airway pressure (CPAP) is recognized as an effective treatment for severe airway obstruction in young children. The aim of the present study was to compare a clinical setting with a physiological setting of noninvasive CPAP in infants with nocturnal alveolar hypoventilation due to severe upper airway obstruction (UAO) or bronchopulmonary dysplasia (BPD). METHODS: The breathing pattern and respiratory muscle output of all consecutive infants due to start CPAP in our noninvasive ventilation unit were retrospectively analysed. CPAP set on clinical noninvasive parameters (clinical CPAP) was compared to CPAP set on the normalization or the maximal reduction of the oesophageal pressure (Poes) and transdiaphragmatic pressure (Pdi) swings (physiological CPAP). Expiratory gastric pressure (Pgas) swing was measured. RESULTS: The data of 12 infants (mean age 10 ± 8 mo) with UAO (n = 7) or BPD (n = 5) were gathered. The mean clinical CPAP (8 ± 2 cmH₂O) was associated with a significant decrease in Poes and Pdi swings. Indeed, Poes swing decreased from 31 ± 15 cmH₂O during spontaneous breathing to 21 ± 10 cmH₂O during CPAP (P < 0.05). The mean physiological CPAP level was 2 ± 2 cmH2₂O higher than the mean clinical CPAP level and was associated with a significantly greater improvement in all indices of respiratory effort (Poes swing 11 ± 5 cm H₂O; P < 0.05 compared to clinical CPAP). Expiratory abdominal activity was present during the clinical CPAP and decreased during physiological CPAP. CONCLUSIONS: A physiological setting of noninvasive CPAP, based on the recording of Poes and Pgas, is superior to a clinical setting, based on clinical noninvasive parameters. Expiratory abdominal activity was present during spontaneous breathing and decreased in the physiological CPAP setting.
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- 2013
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12. Value of gas exchange recording at home in children receiving noninvasive ventilation: Gas exchange during noninvasive ventilation
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Osama, Felemban, Karl, Leroux, Guillaume, Aubertin, Fabrice, Miandy, Frédéric, Damagnez, Bruno, Amorim, Adriana, Ramirez, Brigitte, Fauroux, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Pediatric department, Faculty of Medicine, King Abdulaziz University, ADEP Assistance, ADEP assistance, Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM), Assistance Publique-Hôpitaux de Paris, Inserm, ADEP Assistance, and Université Pierre et Marie Curie-Paris 6., CHU Trousseau [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
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Male ,child ,Adolescent ,Pulmonary Gas Exchange ,carbon dioxide ,Neuromuscular Diseases ,gas exchange ,home ,pulse oximetry ,Oxygen ,Positive-Pressure Respiration ,Young Adult ,Child, Preschool ,Humans ,Female ,Oximetry ,noninvasive positive pressure ventilation ,Blood Gas Monitoring, Transcutaneous - Abstract
International audience; Noninvasive positive pressure ventilation (NPPV) is preferentially performed at home. The objectives of the study were to evaluate the feasibility of an overnight gas exchange recording at home and to compare recordings performed in the hospital and at home. Twenty nine pairs of overnight gas exchange recordings during NPPV were performed at home and in the hospital in 11 children with neuromuscular disease and 13 children with other disorders treated with long term NPPV. No technical problem occurred during the recordings performed at home and one pulse oximetry (SpO2) recording failed in the hospital. For the two groups, SpO2 and transcutaneous carbon dioxide (PtcCO2) values did not differ significantly between the hospital and the home. However, correlations between SpO2 and PtcCO2 values obtained in the hospital and at home were better for mean values than for minimal and maximal values, and in patients with other disorders as compared to patients with neuromuscular disease. Overnight gas exchange recordings with NPPV by a combined PtcCO2/SpO2 monitor are feasible at home and show results comparable to hospital recordings. Home PtcCO2/SpO2 recordings may be integrated in the care of children treated with domiciliary NPPV and are associated with less disruption of family life and decreased health care costs.
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- 2011
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13. Value of gas exchange recording at home in children receiving noninvasive ventilation
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Felemban, Osama, Leroux, Karl, Aubertin, Guillaume, Miandy, Fabrice, Damagnez, Frederic, Amorim, Bruno, Ramirez, Adriana, Fauroux, Brigitte, Peer, Hal, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Pediatric department, Faculty of Medicine, King Abdulaziz University, ADEP Assistance, ADEP assistance, Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and The research of Brigitte Fauroux is supported by the Association Française contre les Myopathies (AFM), Assistance Publique-Hôpitaux de Paris, Inserm, ADEP Assistance, and Université Pierre et Marie Curie-Paris 6.
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child ,carbon dioxide ,gas exchange ,home ,noninvasive positive pressure ventilation ,pulse oximetry - Abstract
International audience; Noninvasive positive pressure ventilation (NPPV) is preferentially performed at home. The objectives of the study were to evaluate the feasibility of an overnight gas exchange recording at home and to compare recordings performed in the hospital and at home. Twenty nine pairs of overnight gas exchange recordings during NPPV were performed at home and in the hospital in 11 children with neuromuscular disease and 13 children with other disorders treated with long term NPPV. No technical problem occurred during the recordings performed at home and one pulse oximetry (SpO2) recording failed in the hospital. For the two groups, SpO2 and transcutaneous carbon dioxide (PtcCO2) values did not differ significantly between the hospital and the home. However, correlations between SpO2 and PtcCO2 values obtained in the hospital and at home were better for mean values than for minimal and maximal values, and in patients with other disorders as compared to patients with neuromuscular disease. Overnight gas exchange recordings with NPPV by a combined PtcCO2/SpO2 monitor are feasible at home and show results comparable to hospital recordings. Home PtcCO2/SpO2 recordings may be integrated in the care of children treated with domiciliary NPPV and are associated with less disruption of family life and decreased health care costs.
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- 2011
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14. Evaluation of the trachea and intrathoracic airways by the acoustic reflection method in children with cystic fibrosis
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Redouane Fodil, Bruno Louis, N. Leboulanger, Adriana Ramirez, Harriet Corvol, Frédéric Lofaso, Brigitte Fauroux, Régénération et croissance de l'axone = Axonal Growth and Regeneration (NPS-12), Neuroscience Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), French association against cystic fibrosis (Vaincre la Mucoviscidose, VLM), French Association against Myopathies (Association francaise contre les myopathies, AFM), Assistance Publique-Hopitaux de Paris, INSERM, ADEP Assistance, Universite Pierre et Marie Curie, Societe Francaise d'ORL (SFORL), Neurosciences Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), and Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Physiology ,Bronchi ,030204 cardiovascular system & hematology ,Cystic fibrosis ,03 medical and health sciences ,0302 clinical medicine ,Airway resistance ,Older patients ,medicine ,Airways ,Humans ,Acoustic reflection ,Child ,Tracheomalacia ,business.industry ,General Neuroscience ,Respiration ,Acoustics ,medicine.disease ,Control subjects ,Surgery ,Trachea ,030228 respiratory system ,Case-Control Studies ,Child, Preschool ,Breathing ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Nuclear medicine ,business ,Airway - Abstract
International audience; Tracheomalacia has been observed in older patients with cystic fibrosis (CF). The acoustic reflection method (ARM) allows a noninvasive calculation of the longitudinal cross-sectional area of the trachea (MTAv) and the airway resistance (Raw). ARM measurements were performed in 20 CF children and 20 controls during spontaneous breathing (SB), forced inspiration (FI), and forced expiration (FE). The mean MTAv value was comparable in the CF patients and the control subjects during SB, FI, and FE. The Raw was also comparable during SB and FI. However, the Raw during FE was higher in the CF patients than in the control subjects (7.9 +/- 2.3 vs 5.0 +/- 1.5 cmH(2)Ol(-1) s(-1), respectively, p < 0.001). In the patients with CF, only the Raw during FE correlated with the predicted forced expiratory volume in 1 s (R-2 = 0.37, p = 0.04). The tracheal cross-sectional area measured by the ARM is normal in children with CF but the increase in Raw during FE suggests an increase in intrathoracic airway distensibility.
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- 2012
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15. Effect of manufacturer-inserted mask leaks on ventilator performance
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Karl Leroux, Bruno Louis, Brigitte Fauroux, Frédéric Lofaso, Daniel Isabey, INSERM U955, équipe 13, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), ADEP assistance, CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre d’Investigation Clinique 1429 [Garches] (CIC 1429), Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Association d'Entraide des Polios et Handicapés (ADEP), Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), and Guellaen, Georges
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Pulmonary and Respiratory Medicine ,Adult ,Leak ,medicine.medical_specialty ,Patient-ventilator synchrony ,Pulmonary disease ,MESH: Equipment Failure Analysis ,Mascara ,MESH: Ventilators, Mechanical ,law.invention ,Positive-Pressure Respiration ,03 medical and health sciences ,MESH: Positive-Pressure Respiration ,0302 clinical medicine ,law ,[SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology ,Medicine ,Humans ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,030212 general & internal medicine ,Simulation ,Ventilators, Mechanical ,MESH: Humans ,MESH: Middle Aged ,business.industry ,Masks ,MESH: Adult ,Equipment Design ,Middle Aged ,Leaks ,Interface ,Surgery ,Equipment Failure Analysis ,On ventilator ,Trigger ,030228 respiratory system ,MESH: Masks ,Ventilation (architecture) ,Noninvasive ventilation ,business ,MESH: Equipment Design - Abstract
International audience; Most pressure-support devices use a single circuit with an exhalation port integrated in the mask. The aim of the current study was to compare the effects of masks having different manufacturer-inserted leaks on ventilator performance. We simulated chronic obstructive pulmonary disease and restrictive disease. Four ventilators (VENTImotion (Weinmann, Hamburg, Germany), VPAP III STA (ResMed, Saint Priest, France), Synchrony 2 (Respironics, Nantes, France) and Vivo 40 (Breas, Saint Priest)) were tested with the recommended masks and with the masks having the largest and smallest leaks. Tests were performed with pressure support levels of 10, 15 and 20 cmH(2)O. The in vivo evaluation compared two ventilators using recommended masks opposed in terms of exhaled port resistance. The ventilators were tested with their recommended mask, and after mask exchange. The mask with the largest leak induced auto-triggering and/or increased inspiratory-trigger sensitivity was the VENTImotion under both simulated conditions and VPAP III STA under the simulated obstructive-disease condition. The mask with the smallest leak-increased inspiratory-trigger delay was Synchrony 2 in the simulated obstructive-disease condition and increased rebreathing. The in vivo study confirmed the bench results. When switching to a mask that has a different leak, evaluation is needed to adjust trigger sensitivity and pressurisation level and to check the absence of rebreathing.
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- 2010
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16. Pressure stability with CPAP devices: A bench evaluation
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Frédéric Lofaso, Véronique Grillier-Lanoir, Karl Leroux, Bruno Louis, Brigitte Fauroux, Maud Boucherie, Daniel Isabey, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), ADEP assistance, Respiratory division, Covidien, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d’Investigation Clinique 1429 [Garches] (CIC 1429), Hôpital Raymond Poincaré [AP-HP]-Institut National de la Santé et de la Recherche Médicale (INSERM), Guellaen, Georges, CHU Trousseau [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
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Leak ,MESH: Continuous Positive Airway Pressure ,obstructive sleep apnoea ,medicine.medical_treatment ,MESH: Equipment Failure Analysis ,Pulmonary compliance ,MESH: Pulmonary Ventilation ,leak effects ,Positive-Pressure Respiration ,03 medical and health sciences ,Work of breathing ,MESH: Positive-Pressure Respiration ,0302 clinical medicine ,Airway resistance ,MESH: Computer Simulation ,MESH: Airway Resistance ,work of breathing ,MESH: Humidity ,[SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology ,medicine ,Humans ,Computer Simulation ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,Continuous positive airway pressure ,Lung Compliance ,bench test ,Pressure drop ,MESH: Humans ,business.industry ,Airway Resistance ,Humidity ,General Medicine ,respiratory tract diseases ,Equipment Failure Analysis ,Compliance (physiology) ,MESH: Work of Breathing ,030228 respiratory system ,Constant pressure ,Anesthesia ,Pulmonary Ventilation ,business ,MESH: Lung Compliance ,030217 neurology & neurosurgery ,continuous positive airway pressure - Abstract
International audience; BACKGROUND: Continuous positive airway pressure (CPAP) maintains a constant pressure to reduce the patient's work of breathing (WOB). The aim of this study was to measure the additional WOB imposed by four current CPAP devices during simulation of a difficult but commonly encountered clinical situation. METHOD: Flow contour, respiratory system compliance and total lung-airway resistance of a patient under CPAP were simulated. The devices were tested at a CPAP of 15cm H(2)O with a heated humidifier and a nasal pillow, which increased circuitry resistance and with and without a simulated unintentional leak. RESULTS: With no leak, positive end-expiratory pressure (PEEP) at the interface varied across devices from 14.0 to 15.3cm H(2)O. With a leak of 1L/s, PEEP varied from 11.5 to 17.1cm H(2)O. Imposed inspiratory WOB ranged from less than 0.1J/min to 0.45J/min with no leak, and the range broadened with leaking. Findings were similar for the imposed expiratory WOB. CONCLUSION: The performances of CPAP devices are variable. The device that calibrated for the pressure loss in the circuitry under dynamic conditions and made appropriate pressure adjustments outperformed the other devices.
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- 2010
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17. ventilators for noninvasive ventilation
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Annick Clement, Frédéric Lofaso, Karl Leroux, Bruno Louis, Gilbert Desmarais, Brigitte Fauroux, Daniel Isabey, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Physiologie, biologie des organismes, populations, interactions, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), ADEP assistance, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], The research of BF is supported by the Association Française contre les Myopathies (AFM), Assistance Publique-Hôpitaux de Paris, Inserm, Legs Poix, and Université Pierre et Marie Curie-Paris6., CHU Trousseau [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
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Pulmonary and Respiratory Medicine ,Artificial ventilation ,Adult ,medicine.medical_specialty ,Adolescent ,Home Nursing ,medicine.medical_treatment ,Positive pressure ,law.invention ,Home ventilation ,Positive-Pressure Respiration ,03 medical and health sciences ,0302 clinical medicine ,law ,Medicine ,Humans ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology ,030212 general & internal medicine ,Positive pressure ventilation ,Intensive care medicine ,Tidal volume ,Mechanical ventilation ,Ventilators, Mechanical ,business.industry ,Infant ,Equipment Design ,030228 respiratory system ,Anesthesia ,Child, Preschool ,Ventilation (architecture) ,Equipment Failure ,business ,Airway - Abstract
International audience; The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France. The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles. The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient's inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients. A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.
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- 2008
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18. Performance of ventilators for noninvasive positive-pressure ventilation in children
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Fauroux, Brigitte, Leroux, Karl, Desmarais, Gilbert, Isabey, Daniel, Clément, Annick, Lofaso, Frédéric, Louis, Bruno, Guellaen, Georges, Service de pneumologie [CHU Trousseau], Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Physiologie, biologie des organismes, populations, interactions, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), ADEP assistance, Institut Mondor de recherche biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service de physiologie et d'explorations fonctionnelles [CHU Raymond-Poincaré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], and The research of BF is supported by the Association Française contre les Myopathies (AFM), Assistance Publique-Hôpitaux de Paris, Inserm, Legs Poix, and Université Pierre et Marie Curie-Paris6.
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[SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology ,[SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology - Abstract
International audience; The aim of the present study was to evaluate the performance characteristics of all the ventilators proposed for home noninvasive positive-pressure ventilation in children in France. The ventilators (one volume-targeted, 12 pressure-targeted and four dual) were evaluated on a bench which simulated six different paediatric ventilatory patterns. For each ventilator, the quality of the inspiratory and expiratory trigger and the ability to reach and maintain the preset pressures and volumes were evaluated with the six patient profiles. The performance of the ventilators showed great variability, and depended upon the type of trigger (flow or pressure), type of circuit and patient profile. Differences were observed between the preset and measured airway pressure and between the tidal volume measured by the ventilator and on the bench. Leaks were associated with an inability to detect the patient's inspiratory effort or autotriggering. No single ventilator was able to adequately ventilate the six paediatric profiles. Only a few ventilators were able to ventilate the profiles simulating the youngest patients. A systematic paediatric bench evaluation is recommended for every ventilator proposed for home ventilation, in order to detect any dysfunction and guide the choice of the appropriate ventilator for a specific patient.
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- 2008
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19. Adherence to continuous positive airway pressure therapy in patients with spinal cord injury and obstructive sleep apnea: trajectories and predictors.
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Di Maria J, Hartley S, Levy J, Delord V, Vaugier I, Beghadi J, Ibrahim N, Bensmail D, Prigent H, and Léotard A
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- Humans, Male, Female, Middle Aged, Retrospective Studies, Adult, Polysomnography, Aged, Spinal Cord Injuries therapy, Sleep Apnea, Obstructive therapy, Continuous Positive Airway Pressure, Patient Compliance
- Abstract
Purpose: To identify specific determinants of non-adherence or cessation of continuous positive airway pressure (CPAP) therapy in a population of patients with spinal cord injuries (SCI)., Methods: Retrospective analysis of data from patients with SCI who underwent a full night supervised polysomnography between 2015 and 2021 and presented with moderate to severe obstructive sleep apnea (OSA) and for whom CPAP was indicated. Adherence was studied at 1, 6, and 12 months. Univariate and multivariate analyses were performed to identify factors associated with non-adherence (< 4 h per night or CPAP cessation). Factors studied were demographic and disease-related data and both subjective and objective sleep parameters., Results: A total of 60 patients were included (40% cervical SCI). In univariate analysis, the only predictive parameters of non-adherence observed at 1, 6, and 12 months were the average use of CPAP on the 1st night (p = 0.02) and over the 1st week (p ≤ 0.001). A complete lesion (AIS-A) was predictive of non-adherence at 1 and 6 months (p = 0.02 at 6 months), while mask leakage was associated with non-adherence at 12 months (p = 0.02). Upper limb autonomy and the presence of family caregivers did not appear to be protective. In multivariate analysis, only the average use in the first week remained predictive of adherence (> 4 h) in the short, medium and long term., Conclusion: In patients with SCI and OSA, the 1st week of CPAP treatment seems to be determinant of short-, medium-, and long-term CPAP adherence. Support for SCI patients from the start of treatment is essential and may help avoid treatment failures., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2024
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20. Impact of Interface Type on Noninvasive Ventilation Efficacy in Patients With Neuromuscular Disease: A Randomized Cross-Over Trial.
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Léotard A, Lebret M, Daabek N, Prigent H, Destors M, Saint-Raymond C, Sagniez A, Leroux K, Tamisier R, Lofaso F, Pépin JL, and Borel JC
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- Continuous Positive Airway Pressure, Cross-Over Studies, Humans, Masks, Neuromuscular Diseases therapy, Noninvasive Ventilation
- Abstract
Background and Objective: Around 25% of patients with neuro-muscular diseases (NMD) are treated by home noninvasive ventilation (NIV) through an oronasal mask. However, there is growing evidence that nasal masks require lower NIV pressures and result in fewer residual obstructive events. We hypothesized that nasal masks would improve efficacy and reduce side effects compared to oronasal masks in this population., Methods: open label, cross-over, randomized, study in 2 tertiary care hospitals. Patients with NMD treated by home NIV were randomized for one-week periods to nasal and oronasal interfaces respectively (cross-over). At the end of each period, nocturnal polygraphy (monitoring mouth opening) under NIV, synchronized with transcutaneous partial pressure in CO
2 (tcCO2 ) was performed. Data were collected from the NIV built-in software and NIV side-effects were collected. Intention-to-treat and per protocol analyses were performed. The primary outcome was mean nocturnal SpO2 . The secondary outcomes were: percentage of sleep with SpO2 <90%, oxygen desaturation index (ODI), mean tcCO2 , mean duration of mouth opening during sleep, level of non-intentional leaks and side-effects., Results: Thirty patients with NMD were included. There were no between-group differences for either the primary or secondary outcomes. Post hoc comparisons showed that changing between interfaces reduced NIV efficacy: mean nocturnal SpO2 (p=0.04), ODI (p=0.01), mean tcCO2 (p=0.048), side-effects (p=0.008)., Conclusion: Nasal masks did not improve NIV efficacy or reduce side effects compared to oronasal masks in patients with NMD treated by home NIV. The efficacy of NIV is reduced during the transition to another interface, requiring close monitoring. Registration number: NCT03458507., (Copyright © 2020 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.)- Published
- 2021
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21. Utility of the bispectral index for assessing natural physiological sleep stages in children and young adults.
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Benissa MR, Khirani S, Hartley S, Adala A, Ramirez A, Fernandez-Bolanos M, Quera-Salva MA, and Fauroux B
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- Adolescent, Adult, Anesthesia, General, Child, Diagnosis, Differential, Electroencephalography methods, Electromyography, Electrooculography methods, Female, Humans, Male, ROC Curve, Sensitivity and Specificity, Sleep Apnea Syndromes diagnosis, Sleep Apnea, Obstructive diagnosis, Time Factors, Wakefulness, Young Adult, Polysomnography methods, Sleep Stages
- Abstract
Polysomnography (PSG) is the gold standard for the analysis of sleep architecture but is not always available in routine practice, as it is time consuming and cumbersome for patients. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth. We objectively recorded sleep architecture in young patients using the latest BIS Vista monitor and correlated BIS values with PSG sleep stages in order to determine BIS thresholds. Patients, referred for the screening of sleep apnea/hypopnea syndrome or differential diagnosis of hypersomnia were recruited. Overnight PSG and BIS were performed simultaneously. BIS values were averaged for each sleep stage. Pre-sleep wakefulness (W) and wake after sleep onset (WASO) were also differentiated. BIS values were discarded for a signal quality index <90 %. ROC curves were plotted to discriminate sleep stages from each other. Twelve patients (5.7-29.3 years old) were included. Mean BIS values were 83 ± 8, 76 ± 12, 77 ± 11, 70 ± 10, 43 ± 10, and 75 ± 10 for W, WASO, N1, N2, N3 and R (REM) stages, respectively. BIS failed to distinguish W, WASO, N1 and R stages. BIS threshold that identified stage N2 was <73 (AUC = 0.784, p < 0.001) with low sensitivity (75 %) and poor specificity (64 %). BIS threshold that identified stage N3 was <55 (AUC = 0.964, p < 0.001) with an 87 %-sensitivity and a 93 %-specificity. BIS identified stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep from wake. Further studies combining BIS with chin electromyogram and/or electrooculogram could be of interest.
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- 2016
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22. [Noninvasive ventilation. The 2015 guidelines from the Groupe Assistance Ventilatoire (GAV) of the Société de Pneumologie de Langue Française (SPLF)].
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Rabec C, Cuvelier A, Cheval C, Jaffre S, Janssens JP, Mercy M, Prigent A, Rouault S, Talbi S, Vandenbroeck S, and Gonzalez-Bermejo J
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- Chronic Disease, France, Humans, Monitoring, Physiologic methods, Monitoring, Physiologic standards, Noninvasive Ventilation methods, Pulmonary Disease, Chronic Obstructive therapy, Pulmonary Medicine standards, Respiratory Insufficiency therapy, Societies, Medical standards, Noninvasive Ventilation standards
- Abstract
A task force issued from the Groupe Assistance Ventilatoire (GAV) of the Société de Pneumologie de Langue Française (SPLF) was committed to develop a series of expert advice concerning various practical topics related to long-term non invasive ventilation by applying the Choosing Wisely
® methodology. Three topics were selected: monitoring of noninvasive ventilation, the interpretation of data obtained from built-in devices coupled to home ventilators and the role of hybrid modes (target volume with variable pressure support. For each topic, the experts have developed practical tips based on a comprehensive analysis of recent insights and evidence from the literature and from clinical experience., (Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.)- Published
- 2016
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23. Improvement of the trigger of a ventilator for non-invasive ventilation in children: bench and clinical study.
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Khirani S, Louis B, Leroux K, Ramirez A, Lofaso F, and Fauroux B
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- Adolescent, Child, Child, Preschool, Equipment Design, Humans, Infant, Treatment Outcome, Young Adult, Noninvasive Ventilation instrumentation, Respiratory Insufficiency therapy
- Abstract
Background and Aims: Even though numerous ventilators are licensed for a use in children, very few have been specifically developed for this age range. Therefore, home ventilators may not be able to adequately synchronize with the child's respiratory effort, and the inspiratory triggers (ITs) of assist modes are not always appropriate for children. The aim of the study was to test the improvement of the IT of a ventilator on a pediatric bench and in pediatric patients., Methods: A classical IT (ITc) and an improved IT [non-invasive ventilation (NIV) + IT] were tested on a bench with six pediatric profiles and in six young patients (mean age 14.1 ± 2.7 years old) requiring long-term NIV., Results: On the bench, trigger time delays (ΔT) and trigger pressures (ΔP) were reduced with the NIV + IT as compared with the ITc (ΔT: 0.481 ± 0.332 vs 0.079 ± 0.022 s for ITc and NIV + IT, respectively, P = 0.027; ΔP: -1.40 ± 0.70 vs -0.42 ± 0.28 cmH2 O for ITc and NIV + IT, respectively, P = 0.046). The clinical study confirmed the decrease in ΔT (0.267 ± 0.061 vs 0.178 ± 0.074 s for ITc and NIV + IT, respectively, P = 0.024) and ΔP (-0.68 ± 0.26 vs -0.39 ± 0.11 cmH2 O for ITc and NIV + IT, respectively, P = 0.030)., Conclusions: The sensitivity of the IT of a ventilator can be improved for pediatric use. The improvements observed on the bench study were confirmed in pediatric patients., (© 2014 John Wiley & Sons Ltd.)
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- 2016
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24. Long term continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) in children: Initiation criteria in real life.
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Amaddeo A, Moreau J, Frapin A, Khirani S, Felix O, Fernandez-Bolanos M, Ramirez A, and Fauroux B
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- Adolescent, Carbon Dioxide physiology, Child, Child, Preschool, Female, Humans, Infant, Male, Oximetry, Retrospective Studies, Ventilator Weaning, Continuous Positive Airway Pressure, Noninvasive Ventilation, Polysomnography, Pulmonary Gas Exchange, Respiratory Insufficiency diagnosis, Respiratory Insufficiency therapy
- Abstract
Introduction: Long term noninvasive continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are increasingly used in children but limited information is available on the criteria and conditions leading to the initiation of these treatments. The aim of the study is to describe the objective overnight respiratory parameters and clinical situations that led to the initiation of CPAP/NIV in a pediatric NIV unit., Material and Methods: Retrospective analysis of the data of all the children discharged on home CPAP/NIV over a 1 year period., Results: Seventy-six patients were started on CPAP (n = 64) or NIV (n = 12). CPAP/NIV was initiated because of CPAP/NIV weaning failure (Acute group) in 15 patients. None of these patients had an overnight gas exchange or sleep study before CPAP/NIV initiation. In 18 patients, CPAP/NIV was initiated on abnormal nocturnal gas exchange alone (Subacute group). These patients had a median of three of the following five overnight gas exchange abnormalities: minimal pulse oximetry (SpO2 ) <90%, maximal transcutaneous carbon dioxide (PtcCO2 ) >50 mmHg, time spent with SpO2 <90% or PtcCO2 >50 mmHg ≥2% of recording time, oxygen desaturation index >1.4/hr. In the last 43 patients, CPAP/NIV was initiated after an abnormal sleep study (Chronic group) on a mean of four of the aforementioned criteria and an apnea-hypopnea index >10/hr., Conclusion: In clinical practice, CPAP/NIV was initiated in an acute, subacute and chronic setting with most patients having an association of several abnormal gas exchange or sleep study parameters. Future studies should evaluate the effectiveness and benefits of CPAP/NIV according to the clinical situation and initiation criteria. Pediatr Pulmonol. 2016; 51:968-974. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
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25. Whistle and cough pressures in children with neuromuscular disorders.
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Aloui S, Khirani S, Ramirez A, Colella M, Louis B, Amaddeo A, and Fauroux B
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- Adolescent, Adult, Child, Child, Preschool, Exhalation physiology, Female, Humans, Male, Pressure, Respiratory Function Tests, Retrospective Studies, Vital Capacity, Young Adult, Cough physiopathology, Neuromuscular Diseases physiopathology, Respiratory Muscles physiopathology
- Abstract
Rationale: Expiratory muscle strength is a determinant of cough function. Maximal static expiratory pressure (PEmax) manoeuvres are widely used but are limited by patient motivation and technique. The study hypothesized that whistle mouth (PmW) and cough gastric (PgasCough) pressures might provide additional tests of expiratory muscle strength in children and young adults with neuromuscular disease (NMD)., Methods: We retrospectively reviewed the data of lung function and respiratory muscle tests of all the patients with NMD followed in our centre between November 2001 and December 2013. PmW and PgasCough were compared to other common tests., Results: Three hundred and four respiratory evaluations were performed in 143 patients, aged 3-29 years old. Seventy-two patients had 2 to 8 evaluations. Median [interquartiles] PEmax (38 [28-54] cmH2O) did not differ significantly from PgasCough (45 [30-60] cmH2O) and both were significantly greater than PmW (30 [19-44] cmH2O). Significant good correlations were observed between all the expiratory muscle parameters. The best correlation was observed between PEmax and PmW (r = 0.812, p < 0.001). Moreover, good correlations were found between the percentage of predicted forced vital capacity and PmW (r = 0.619, p < 0.001) and PgasCough (r = 0.568, p < 0.001). Concerning the whistle test, the non-invasive measurement highly correlated with invasive measurements., Conclusions: PmW and PgasCough are simple and valuable tests to assess expiratory muscle strength in children and young adults with NMD. These tests are particularly useful in children having difficulties to perform PEmax manoeuvre. They have the great advantage of their simplicity, but PgasCough is limited by its invasiveness., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
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26. Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study.
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Pavone M, Caldarelli V, Khirani S, Colella M, Ramirez A, Aubertin G, Crinò A, Brioude F, Gastaud F, Beydon N, Boulé M, Giovannini-Chami L, Cutrera R, and Fauroux B
- Subjects
- Adolescent, Age Factors, Body Mass Index, Child, Child, Preschool, Female, Humans, Infant, Male, Oximetry, Oxygen blood, Polysomnography, Retrospective Studies, Severity of Illness Index, Young Adult, Prader-Willi Syndrome complications, Sleep Apnea Syndromes diagnosis
- Abstract
Objectives: Sleep disordered breathing (SDB) is common in patients with Prader-Willi syndrome (PWS) and systematic screening is recommended, especially before growth hormone treatment. The aim of the study was to describe the baseline SDB and therapeutic interventions in a large cohort of patients., Study Design: Retrospective study., Subject Selection: Eighty-eight patients with PWS, median [interquartile range] age of 5.1 [1.0-14.5] years old (range 0.3-44.3), who were followed in three centers (France, Italy)., Methodology: Anthropometrics, polygraphy (PG), and gas exchange data were analyzed., Results: Median body mass index (BMI) was 20 [16-34] kg/m(2), BMI z-score for patients aged 2-20 years old was 2.1 [1.2-2.8] SD, mixed-obstructive apnea-hypopnea index (MOAHI) 1.8 [0.6-5.0] events/hr, and central apnea index (CAI) 0.1 [0.0-0.6] events/hr. Minimum pulse oximetry (SpO2) was 88 [84-91]%, percentage of time with SpO2 <90% 0.1 [0.0-1.0]%, and oxygen desaturation index 2 [1-4]/hr. An apnea-hypopnea index (AHI) ≥ 1.5 and ≥ 5 events/hr was observed in 53% of children and 41% of adults, respectively. No correlations were observed between MOAHI and anthropometrics data (age, BMI, BMI z-score), while MOAHI significantly correlated with SpO2 indexes. Age and BMI only weakly correlated with SpO2 indexes. Growth hormone could be initiated in 48 patients. Regarding post-PG therapy, 9 patients had upper airway surgery, and noninvasive CPAP/bilevel ventilation was started in 16 patients., Conclusions: Patients with PWS exhibit a high prevalence of SDB. The lack of association between obesity and SDB leads to hypothesize that hypotonia and/or facial dysmorphic features may play a major role in the occurrence of SDB., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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27. [Are respiratory muscle testing helpful to prompt sleep studies in children with neuromuscular disease?].
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Khirani S, Ramirez A, Olmo-Arroyo J, Amaddeo A, Quijano-Roy S, Desguerre I, and Fauroux B
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- Adenoids pathology, Adolescent, Airway Resistance, Child, Humans, Hypertrophy, Infant, Muscle Weakness etiology, Muscle Weakness physiopathology, Neuromuscular Diseases complications, Obesity etiology, Obesity physiopathology, Palatine Tonsil pathology, Practice Guidelines as Topic, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes etiology, Work of Breathing, Young Adult, Neuromuscular Diseases physiopathology, Polysomnography methods, Respiratory Function Tests, Respiratory Muscles physiopathology, Sleep Apnea Syndromes physiopathology
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- 2015
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28. Work of breathing in children with diffuse parenchymal lung disease.
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Khirani S, Nathan N, Ramirez A, Aloui S, Delacourt C, Clément A, and Fauroux B
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- Adolescent, Child, Child, Preschool, Female, Humans, Lung pathology, Lung Diseases, Interstitial diagnosis, Male, Respiratory Muscles pathology, Statistics as Topic, Tidal Volume, Vital Capacity, Lung Diseases, Interstitial physiopathology, Respiration, Respiratory Mechanics physiology
- Abstract
Respiratory mechanics have been poorly studied in children with chronic diffuse parenchymal lung disease (DPLD). The aim of the study was to assess the usefulness of respiratory mechanics to monitor lung function alteration in children with DPLD. Respiratory mechanics, total (WOBt), elastic (WOBe) and resistive (WOBr) work of breathing, gas exchange, lung function and respiratory muscle strength were measured in 10 children, aged 1.8-18.4 years old, who were followed in our national reference centre. Mean tidal volume (Vt) was normal (11±4mL/kg) but respiratory rate (fr, 32±19breaths/min), fr/Vt (118±75breaths/min/L) and total lung resistance (10.2±4.8cmH2OL(-1)s) were increased. Mean WOBt was increased mainly due to WOBe. Dynamic lung compliance (Cldyn) was severely reduced (26±24mL/cmH2O). Cldyn and the oesophageal pressure-time product strongly correlated with vital capacity and functional residual capacity. Respiratory muscle strength was within the normal range. In conclusion, lung mechanics may be considered as useful complementary or alternative markers of functional abnormalities in children with DPLD., (Copyright © 2014 Elsevier B.V. All rights reserved.)
- Published
- 2015
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29. Polygraphic respiratory events during sleep in children treated with home continuous positive airway pressure: description and clinical consequences.
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Amaddeo A, Caldarelli V, Fernandez-Bolanos M, Moreau J, Ramirez A, Khirani S, and Fauroux B
- Subjects
- Adolescent, Airway Resistance physiology, Arousal physiology, Child, Child, Preschool, Female, Humans, Infant, Male, Oximetry, Pulmonary Gas Exchange physiology, Respiratory Mechanics physiology, Sleep Apnea, Obstructive therapy, Continuous Positive Airway Pressure, Polysomnography, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive physiopathology
- Abstract
Objective: Data are scarce on respiratory events during sleep for children treated at home with continuous positive airway pressure (CPAP). The present study aimed to characterize the respiratory events with CPAP during sleep and to analyze their clinical consequences., Patients/methods: Consecutive polygraphies (PG) performed on stable children treated with CPAP were analyzed and scored using SomnoNIV Group definitions. For every respiratory event, the presence of a 3% oxygen desaturation and/or an autonomic arousal was systematically searched. Nocturnal gas exchange was assessed using summary data of oximetry and transcutaneous carbon dioxide pressure recordings., Results: Twenty-nine consecutive polygraphies, performed on 26 children (mean age 7.8 ± 6.2 years, mean CPAP use 10.6 ± 14.4 months), were analyzed. The index of total respiratory events was low (median value 1.4/h, range 0-34). The mean number of different types of respiratory events per PG was 2 ± 1 (range 0-4), with always a predominant event. Partial or total upper airway obstruction without a decrease in ventilatory drive was the most frequent event and was the most frequently associated with an oxygen desaturation (in 30% of the events) and an autonomic arousal (in 55% of the events). Weak correlations were observed between nocturnal oximetry and PG results., Conclusions: The index of respiratory events during CPAP treatment for stable children is low. As these events may be associated with an oxygen desaturation or an autonomic arousal, and as nocturnal gas exchange cannot predict PG results, a systematic sleep study seems justified for the routine follow-up of children treated with CPAP., (Copyright © 2014 Elsevier B.V. All rights reserved.)
- Published
- 2015
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30. The value of respiratory muscle testing in a child with congenital muscular dystrophy.
- Author
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Khirani S, Dabaj I, Amaddeo A, Ramirez A, Quijano-Roy S, and Fauroux B
- Abstract
Respiratory muscle testing is often limited to noninvasive volitional tests such as vital capacity and maximal static pressures. We report the case of a 12-year-old boy with congenital muscular dystrophy (CMD) in whom invasive and non-volitional respiratory muscle tests showed an elective diaphragmatic dysfunction with the preservation of expiratory muscle strength. This finding, coupled with a clinical phenotype associating diffuse muscle atrophy with finger hyperlaxity and proximal contractures, strengthened the suspicion of Ullrich CMD. Skin-cultured fibroblasts showed intracellular retention of collagen 6 (COL6), muscle magnetic resonance imaging was typical of COL6 myopathy, and molecular studies identified a COL6 gene mutation (COL6A2 c.954+2T>C). The diagnosis of a diaphragmatic dysfunction led to a sleep study that evidenced periods of hypoxemia which justified nocturnal noninvasive ventilation. This case report highlights the benefit of assessing respiratory muscles, through invasive procedure, to assist in clinical diagnosis and to guide clinical management.
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- 2014
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31. [Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation].
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Gonzalez-Bermejo J, Perrin C, Janssens JP, Pépin JL, Mroue G, Leger P, Langevin B, Rouault S, Rabec C, and Rodenstein D
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Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group, which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators. A systematic description of nocturnal respiratory events, which occur during NIV, is proposed: leaks, obstruction at different levels of the upper airway (glottis and/or pharynx), with or without decrease of respiratory drive and asynchrony., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
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- 2014
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32. Diaphragmatic dysfunction in Collagen VI myopathies.
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Quijano-Roy S, Khirani S, Colella M, Ramirez A, Aloui S, Wehbi S, de Becdelievre A, Carlier RY, Allamand V, Richard P, Azzi V, Estournet B, and Fauroux B
- Subjects
- Adolescent, Adult, Child, Collagen Type VI genetics, Collagen Type VI metabolism, Diagnosis, Differential, Female, Genotyping Techniques, Humans, Immunohistochemistry, Male, Motor Activity physiology, Muscle Strength genetics, Muscle Strength physiology, Muscular Diseases diagnosis, Muscular Diseases genetics, Phenotype, Rest physiology, Severity of Illness Index, Vital Capacity, Young Adult, Diaphragm physiopathology, Muscular Diseases physiopathology
- Abstract
Collagen VI-related myopathies are hereditary disorders causing progressive restrictive respiratory insufficiency. Specific diaphragm involvement has been suggested by a drop in supine volumes. This pilot study aimed at characterizing the respiratory muscle phenotype in patients with COL6A1-3 genes mutations. Lung function, blood gases, muscle strength and respiratory mechanics were measured in 7 patients between 2002 and 2012. Patients were classified as Early-Severe (n = 3), Moderate-Progressive (n = 2) and Mild (n = 2) according to clinical disease presentation. Seven patients (aged 6-28) were evaluated. Forced vital capacity distinguished the Mild group (>60% predicted) from the two other groups (<50% predicted). This distinction was also possible using the motor function measure scale. Diaphragmatic dysfunction at rest was observed in all the Early-Severe and Moderate-Progressive patients. During a voluntary sniff maneuver diaphragmatic dysfunction was observed in all patients, as assessed by a negative gastric pressure. All patients had diaphragmatic fatigue assessed by a tension-time index over the threshold of 0.15. Diaphragmatic dysfunction during a maximal voluntary maneuver and diaphragmatic fatigue are constant features in Collagen VI myopathies. These observations can assist the diagnosis and should be taken in account for the clinical management, with the early detection of sleep-disordered breathing., (Copyright © 2013 Elsevier B.V. All rights reserved.)
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- 2014
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33. Continuous positive airway pressure and noninvasive ventilation adherence in children.
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Ramirez A, Khirani S, Aloui S, Delord V, Borel JC, Pépin JL, and Fauroux B
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- Adolescent, Carbamide Peroxide, Carbon Dioxide blood, Child, Child, Preschool, Continuous Positive Airway Pressure methods, Female, Heart Rate, Humans, Male, Masks, Noninvasive Ventilation methods, Oximetry, Peroxides blood, Treatment Outcome, Urea analogs & derivatives, Urea blood, Continuous Positive Airway Pressure standards, Noninvasive Ventilation standards, Patient Compliance, Sleep Apnea Syndromes therapy
- Abstract
Background: Adherence to continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) is crucial for the successful treatment of sleep-disordered breathing. The aim of our study was to analyze the adherence of children to long-term home CPAP/NIV treatment., Methods: We analyzed data from all consecutive patients older than the age of 2years, in whom CPAP/NIV treatment was initiated in a specialized pediatric NIV and in those who were receiving CPAP/NIV treatment at home for at least 1month. Data of the memory cards of the ventilators and nocturnal gas exchange were analyzed during a routine CPAP/NIV overnight control in the hospital. CPAP/NIV adherence during the previous month was analyzed according to patient's age, ventilatory mode, type of interface, nocturnal gas exchange, and duration of treatment., Results: The data of 62 children (mean age, 10±5years) with obstructive sleep apnea (n=51) treated with CPAP and neuromuscular disease (n=6) or lung diseases (n=5) treated with NIV were analyzed. Mean adherence was 8:17±2:30h:min per night, and the results did not significantly differ between CPAP and NIV adherence. Seventy-two percent of the patients used their device >8h per night. The mean number of nights of CPAP/NIV use during the last month was 26±5 nights per month. Treatment adherence was not correlated to age, the type of underlying disease, the type of interface (nasal, facial mask, or nasal cannula), nocturnal gas exchange, and duration of CPAP/NIV treatment., Conclusion: Long-term CPAP/NIV adherence at home was extremely high in this group of children followed in a pediatric NIV unit. This finding may explain the lack of effect of the interface, nocturnal gas exchange, and duration of CPAP/NIV treatment., (Copyright © 2013 Elsevier B.V. All rights reserved.)
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- 2013
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34. Medical hypnosis as a tool to acclimatize children to noninvasive positive pressure ventilation: a pilot study.
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Delord V, Khirani S, Ramirez A, Joseph EL, Gambier C, Belson M, Gajan F, and Fauroux B
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- Adolescent, Anxiety psychology, Child, Child, Preschool, Dyspnea psychology, Female, Humans, Male, Obesity, Morbid psychology, Pilot Projects, Surgery, Oral psychology, Tracheotomy psychology, Treatment Outcome, Anxiety prevention & control, Hypnosis methods, Patient Compliance psychology, Positive-Pressure Respiration psychology, Respiratory Therapy psychology
- Abstract
Background: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV., Methods: Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated., Results: Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n=2), a history of maxillofacial surgery (n=2), severe dyspnea because of lung disease (n=2), and morbid obesity and depression (n=1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (>6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night., Conclusion: Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.
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- 2013
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35. Assessment of sleep quality by pulse wave amplitude and actigraphy in children with sleep-disordered breathing: evaluation at diagnosis and under non-invasive ventilation.
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Ramirez A, Khirani S, Delord V, Aubertin G, Pépin JL, and Fauroux B
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- Child, Child, Preschool, Female, France, Humans, Male, Mass Screening, Oximetry, Polysomnography, Pulmonary Gas Exchange, Reference Values, Retrospective Studies, Sleep Apnea, Obstructive physiopathology, Treatment Outcome, Actigraphy, Continuous Positive Airway Pressure, Pulse Wave Analysis, Sleep Apnea, Obstructive diagnosis, Sleep Apnea, Obstructive therapy
- Abstract
Purpose: The aims of this study were to assess the interest of pulse wave amplitude (PWA) and actigraphy for characterizing sleep in children with sleep-disordered breathing and to evaluate PWA and actigraphy to assess the efficacy of non-invasive positive pressure ventilation (NPPV)., Methods: We performed a retrospective analysis of children with sleep-disordered breathing. Patients were classified to upper airway obstructive disease (UAO) group or non-obstructive disease (non-UAO) group. Pulse oximetry (SpO2) and PWA were measured by photoplethysmography. Autonomic micro-arousals (AA) and AA related to SpO2 desaturations above 4 % (AA + DS4%) were quantified. The fragmentation index, sleep efficiency, sleep duration, and sleep latency were measured with actigraphy. Transcutaneous carbon dioxide (PtcCO2) was monitored. NPPV was started in case of severe OSA., Results: AA + DS4% were more common in the UAO (n = 15) than the non-UAO group (n = 13) (p < 0.001). All nocturnal gas exchange parameters were worse in the UAO group. Eight children required NPPV. AA + DS4%, maximal PtcCO2, percent of time with PtcCO2 > 50 mmHg, and percent of time with SpO2 < 90 % decreased significantly after 1 month of NPPV., Conclusions: The analysis of AA + DS4% is very informative for the grading of the severity of OSA and for the efficacy of NPPV in children with sleep-disordered breathing.
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- 2013
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36. [Education of the families of patients receiving domiciliary ventilation].
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Rouault S
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- Adult, Allied Health Personnel, Attitude to Health, Child, Emergencies, Equipment Failure, Home Health Aides, Humans, Hygiene, Patient Acceptance of Health Care, Tracheotomy, Caregivers psychology, Family, Health Education, Home Care Services, Home Nursing education, Respiration, Artificial instrumentation, Respiration, Artificial methods
- Abstract
Introduction: Domiciliary ventilation involves the establishment of a network of hospital and community based medical and paramedical carers, together with the technical support of the apparatus. Within this network the family form a pivot and their education should therefore be integrated into the setting up and maintenance of all cases of domiciliary ventilation., Background: Currently this education is neither formalised nor the object of any consensus (with the exception of paediatric departments who, for the most part, provide training for the family, in partnership with the home care provider, in the hospital environment, before a ventilated child is returned home). Most commonly the information packages, medical and technical, are distributed by the various contributors without coordination or validation. The family find themselves in the midst of a network within which they do not understand the role of each member and therefore risk being unable to find the information or knowledge that they may need., Viewpoint: Domiciliary ventilation, particularly non-invasive ventilation, is increasing and the main role of the family, which should be regarded in the broadest sense as everyone involved in the daily activities of the home, is to help the patient accept a treatment that is restricting in the long term. Their education should be integrated, as with the therapeutic education of the patient, into an educational project with objectives, learning tools, and validation of the knowledge acquired. This project should be result of co-operation between all the members of the care network and lead to the production supportive documentation., Conclusions: Better education of families should lead to a reduction, or better still prevention, of the incidents that are inherent in the use of assisted ventilation equipment and improve the quality of life of the patient and his family in a secure environment.
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- 2005
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