Unconventional Knowledge About Sleep Ventilator That You Can’t Learn From Books.
Among the greatest areas of progress in respiratory technology in recent years has been in the category of ventilators. Mechanical ventilation is used chiefly to improve gas exchange and attain respiratory muscle relaxation ( 1 ). To attain this aim, it’s important that a patient doesn’t create respiratory attempts out of synchrony with all the cycling of this ventilator ( 2 , 3 ). Since behavioral stimuli are decreased through sleep, respiratory muscle rest may be greater during sleep as compared with wakefulness.
Early bedside physiologic studies in healthy individuals and in patients with respiratory conditions document successful Ventilatory support (ie, decrease in respiratory rate, increase in tidal volume, reduction 睡眠呼吸機 in dyspnea) with decrease in diaphragmatic electromyography (EMG), transdiaphragmatic pressures, work of breathing and development in oxygenation with a reduction in hypercapnia.
The extent of change in end-tidal CO2 was greater during stress support than during assist-control ventilation (p = 0.02; Figure 3 , bottom right). Irregular breathing with abrupt changes in both amplitude and frequency at times interrupted by central apneas lasting 10-30 seconds are noted in Rapid Eye Movement (REM) sleep (These are physiological adjustments and therefore are distinct from abnormal breathing patterns noted in sleep disordered breathing).
While the bulk of the experience lies in patients with chronic respiratory failure, specifically neuromuscular respiratory failure, reports described successful application in patients with severe respiratory failure. In our analysis, the reliability of manual approaches (R&K methodology and sleep-wakefulness organization pattern) for appraising sleep was better at ambulatory patients than in seriously ill patients.
17 It seems unlikely that this sort of deficiency of frontal derivatives would have affected sleep-staging reliability in critically ill patients but not in ambulatory patients. Patients were ventilated through an endotracheal tube or tracheostomy linked into some Puritan-Bennett 7200 ventilator (Mallinckrodt, Hazelwood, MO).
In critically ill patients, when sleep was performed according to R&K methodology with 5 sleep-wakefulness states–stage 1 and 2 NREM sleep, SWS, REM sleep, and wakefulness –that the interobserver reliability was poor (κ = 0.19; 4640 epochs; Table 2 ). By comparison, in control patients, the interobserver reliability was great (κ = 0.74; 7123 epochs; Table 2 ).
The choice of ventilators available to provide non invasive ventilatory support has continued to enlarge. This finding suggests that mechanisms like those found in patients with Cheyne-Stokes respiration could be involved ( 37 ). Occurrence of central apneas during pressure support is not unique to patients with heart failure.