Formation DPC indication de la VNI -...

FormationDPCindicationdelaVNI

Elastance Resistance

FormationDPCindicationdelaVNILarynx

Nasopharynx

Oropharynx

Hypopharynx

Pression Pulmonaire

Physiologiedelamécaniqueventilatoire

VS PPC Ventil VOL

Ventil PRES

Pression bouche

Débit

Volume

RESPIRATIONENVENTILATIONSPONTANEENORMALE

HartN,MandalS,ManuelA,MokhlesiB,PépinJL,PiperA,StradlingJ.Thorax2013/08/28.

ALTÉRATIONVENTILATIONPERFUSION

HYPOVENTILATIONALVÉOLAIRE

Diminutiondel’endurancedudiaphragme

Diminutiondelacompliancedelacagethoracique

Augmentationdesrésistancesdespetitesbronches

Dégradationdesrapportsventilation/perfusionauxbases

Diminutiondelaréponseàl’hypercapnieet/ouàl’hypoxémie

Résistanceàlaleptine

Augmentationdelaventilationminute

Augmentationdelaforcedudiaphragme

PaCO236 4245

RÔLEDUSAS:Obstructionsdelavoieaériennesupérieure

ChangingPatternsinLong-termNoninvasiveVentilation*A7-YearProspectiveStudyintheGenevaLakeArea(CHEST2003;123:67–79)

GustafsonT.CHEST2006;130:1828-33

VNIetcyphoscoliose

SurvieSurvie

VNIsansCM

VNIavecCM

O2sansCM

O2avecCM

CM:Comorbidités

JagerL.CHEST2008;133:156-60

(18%concomitantO2)

OxygenothérapielongtermeversusVNIdanslesséquellesmutilantes

deTuberculose

BourkeLancetNeurol.2006Feb;5(2):140-7.FormationDPCindicationdelaVNI

SLAtoutesformes

Formesnonbulbaires

Formesbulbaires

PLoSOne.2015Feb11;10(2)2015.Obesity-HypoventilationSyndrome:IncreasedRiskofDeathoverSleepApneaSyndrome.Castro-AñónO1

Tempsjusqu’aupremieraccidentcardiovasculaire

SAOSnormocapnique

ObesityHypoventilationSyndrome*HypoxemiaDuringContinuousPositiveAirwayPressureDevBanerjee,(CHEST2007;131:1678–1684)

%tempsdesommeiltotalavecSaO2<90%

Message1:

CertainsSOHsontnonrepondeursàlaCPAP

PaCO236 4245

FormationSOHphilipsJuin2016

AmandaPiperCHEST2016;149(3):856-868

(BMI,46.8kg/m2;PaCO2,49mmHgPoids126kgs

3moisplustard

PaCO240mmHgPoids113Kgs

EfficacyofDifferentTreatmentAlternativesforObesityHypoventilationSyndromePickwickStudyJuanF.Masa1,2,AmericanJournalofRespiratoryandCriticalCareMedicineVolume192Number1|July12015

Controle

Symptômes

PaCO236 4245

FormationDPCindicationdelaVNICrummythorax2008

22ans156cm228Kgs

Pertede110Kgsen18moisparrégimeseul

Nocturnalnon-invasivenasalventilationinstablehypercapnicCOPD:arandomisedcontrolledtrialRDMcEvoy,Thorax2009;64:561–566.

Pasdedifférencesignificative

Mortalité12%

Mortalité33%

ThomasKöhnlein,LancetRespirMed2014July25,2014

Qualitédevie

Hospitalisations

Struik,Thorax2014FormationDPCindicationdelaVNI

Survie

Qualitédevie P=0.054

SleepdisordersinCOPD:theforgottendimensionWalterT.McNicholas1,EurRespirRev2013;22:365–375FormationDPCindicationdelaVNI

JCBorelRespirology(2014)19,857–865

MessageBPCOobèse:meilleurpronostic

BPCOObèse BPCOnonObèse

Risquededécèsoud’hospitalisation

Lerisqued’hospitalisationestsupérieurdanslegroupeVNInonobèse/groupeVNIobèse

Formation DPC indication de la VNI -...

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Presentación del VNI Argentina - Febrero 2016

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