Continuous nasal positive airway pressure with a mouth leak: effect on nasal mucosal blood flux and nasal geometry.

Nasal symptoms associated with the use of nasal continuous positive airway pressure (nCPAP) in obstructive sleep apnoea (OSA) can adversely impact on patients' tolerance, acceptance and adherence to nCPAP therapy. Regular use of heated humidification is effective in alleviating these symptoms and improve patient comfort.In a randomised, parallel, double-blinded, controlled study, the present authors examined the use of heated humidification during a single night laboratory nCPAP titration in untreated OSA patients and its effect on nasal symptoms, nasal airway resistance (NAR), effective pressure and treatment tolerability and acceptance.Baseline characteristics of subjects (n570) receiving placebo and humidification were (mean¡SEM): age 51.2¡2.2 versus 50.6¡1.6 yrs; body mass index 33.6¡0.9 versus 35.2¡0.9 kg?m significantly different between the groups. No difference was found in the frequency and severity of nasopharyngeal symptoms, therapeutic pressure and subjective response to nCPAP.In conclusion, heated humidification during the initial nasal continuous positive airway pressure titration offers no additional benefit in nasal physiology, symptoms or subjective response to nasal continuous positive airway pressure, and, therefore, should not be routinely recommended.

Section: Discussionmentioning

confidence: 57%

Use of heated humidification during nasal CPAP titration in obstructive sleep apnoea syndrome

Duong

Jayaram

Camfferman³

et al. 2005

“…Previous studies have assessed the role of CPAP on nasal airway of healthy volunteers [8][9][10]16] and in a rodent model [11], and have also evaluated the effect of different forms of humidification on nasal symptoms and adherence in OSA patients [13][14][15]22]. However, the effect of CPAP (with and without humidification) on nasal airway pathophysiology of OSA patients remains unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Among the side effects caused by CPAP, undesirable nasal symptoms such as congestion, dryness or rhinorrhea are particularly prevalent and can significantly compromise compliance [7]. Several mechanisms may be potentially involved in the development of nasal discomfort with CPAP but they have been described only in healthy volunteers [8][9][10] and in a rodent model [11]. Indeed, deliberate mouth leaks while normal subjects were using CPAP can cause high unidirectional nasal airflow with increased nasal airway resistance [8] as well as enhance nasal mucosal blood flux [9].…”

mentioning

confidence: 99%

“…Several mechanisms may be potentially involved in the development of nasal discomfort with CPAP but they have been described only in healthy volunteers [8][9][10] and in a rodent model [11]. Indeed, deliberate mouth leaks while normal subjects were using CPAP can cause high unidirectional nasal airflow with increased nasal airway resistance [8] as well as enhance nasal mucosal blood flux [9]. Similarly, TOGIAS et al [10] documented a release of inflammatory mediators in nasal-wash fluids when compressed cold and dry air was delivered through the nose.…”

mentioning

confidence: 99%

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Nasal inflammation in sleep apnoea patients using CPAP and effect of heated humidification

Koutsourelakis¹,

Vagiakis²,

Perraki³

et al. 2010

Nasal continuous positive airway pressure (CPAP) can cause undesirable nasal symptoms, such as congestion to obstructive sleep apnoea (OSA) patients, whose symptoms can be attenuated by the addition of heated humidification. However, neither the nature of nasal symptoms nor the effect of heated humidification on nasal pathophysiology and pathology are convincingly known.20 patients with OSA on nasal CPAP who exhibited symptomatic nasal obstruction were randomised to receive either 3 weeks of CPAP treatment with heated humidification or 3 weeks of CPAP treatment with sham-heated humidification, followed by 3 weeks of the opposite treatment, respectively. Nasal symptom score, nasal resistance, nasal lavage interleukin-6, interleukin-12 and tumour necrosis factor-a and nasal mucosa histopathology were assessed at baseline and after each treatment arm.Heated humidification in comparison with sham-heated humidification was associated with decrease in nasal symptomatology, resistance and lavage cytokines, and attenuation of inflammatory cell infiltration and fibrosis of the nasal mucosa.In conclusion, nasal obstruction of OSA patients on CPAP treatment is inflammatory in origin and the addition of heated humidification decreases nasal resistance and mucosal inflammation.

“…Humidification and warming of the inspired gas by specific devices may be needed to prevent the effects due to cool, dry gases on the trachea-bronchial epithelium during NIV [27,28]. It is, therefore, rather surprising that humidification is employed in a relatively small percentage of patients (,55%).…”

Section: Humidificationmentioning

confidence: 99%

A European survey of noninvasive ventilation practices

Crimi¹,

Noto²,

Princi³

et al. 2010

183

136

Although noninvasive ventilation (NIV) is becoming very popular, little is known about its pattern of clinical and technical utilisation in different environments.We conducted a web-based survey in Europe to identify the perceived pattern of NIV utilisation and the reason for choosing a specific ventilator and interface type in four common clinical scenarios: acute hypercapnic respiratory failure (AHRF), cardiogenic pulmonary oedema (CPE), de novo hypoxic respiratory failure and weaning/post-extubation failure (W/PE).A response was obtained from 272 (51.3%) out of 530 selected European physicians involved in NIV practice. The NIV utilisation rate was higher for pulmonologists than intensivists/ anesthesiologists (p,0.05). The most common indication for all the physicians was AHRF (48%). Physicians were more likely to use NIV dedicated ventilator in AHRF and CPE and an intensive care unit (ICU) ventilator with NIV module in de novo hypoxic respiratory failure and W/ PE, mainly because of the possibility of using the double circuit and inspiratory oxygen fraction control. Overall, the oro-nasal mask was the most frequently used interface, irrespective of clinical scenarios.The use of NIV in Europe is generally relatively high, especially among pulmonologists and in AHRF. Dedicated NIV ventilators and ICU ventilators with NIV modules are preferably in AHRF and in de novo hypoxic respiratory failure, respectively, together with oro-nasal masks.