Podcasts about hypoventilation

This week Dr Darren Reed, a respiratory consultant from Northampton General Hospital discussed both OSA and OHS with us. We cover the mechanisms for both conditions, looking at the overlap and teasing apart the differences, before covering how to diagnose and treat these patients. This is definitely an episode you don't want to sleep on!

Obesity hypoventilation syndrome can be challenging to manage. Obtaining the appropriate device for each patient is often complicated by insurance requirements and endless red tape. Previous guidelines have indicated that CPAP may be as effective as bi-level PAP; however, this doesn't apply to all patients. How can we identify patients who may require more advanced treatment modalities while also ensuring that those treatments do not cause undue financial burden for them? Here to help us understand this better is Dr. Babak Mokhlesi. 

Thanks to LMNT for sponsoring this video! Visit https://drinklmnt.com/FLO to get your free LMNT sample pack with any purchase.   Kasper van der Meulen is a renowned author, speaker, and expert in the fields of human performance, mindfulness, and breathwork. He has worked with many elite athletes, special operators and other high performers.    Watch this full interview on YouTube: https://youtu.be/sY46A5AIhzs   CHAPTERS 00:00 Breathing techniques to improve your running 03:45 The power of the breath. Kasper's journey to getting the word out 08:04 State regulation through breathwork, minimal effective dose 11:56 Breathing strategies for athletes, Hypoventilation (under breathing) 17:16 The less you ventilate, the more you respirate 19:28 Balancing training load with breathwork as an aid to health and performance 21:47 Breathing practice for endurance running and recovery 31:07 Functional and dysfunctional breathing, hyperventilation and trauma 40:46 Posture and breath, desk athletes' hips and glutes 51:07 How to coordinate movement and breath 1:01:31 Breathwork Masterclass with Kasper 1:06:09 Ways to become a strong, healthier and happier athlete 1:10:32 Outro and enter to win contest   Affiliate Disclosure: I may earn commissions if you purchase items via my affiliate links. "As an Amazon Associate I earn from qualifying purchases.” Affiliate links do not increase cost to you. Also, you do not need to use these links. You can also search for these same items in Amazon or on any search engine/shopping site of your choice and buy/research them that way.   FIND KASPER VAN DER MEULEN HERE Kasper is also the founder of Breathwork Masterclass, to become a Certified Masterful BreathCoach.  ► Website: https://breathworkmasterclass.com/ ► Instagram: (kaspersfocus) https://www.instagram.com/kaspersfocus/     LINKS & TOOLS MENTIONED ► My Berlin Marathon Race Video: https://www.youtube.com/watch?v=1ZIUBaAXIoo ► Mindlift (book) by Kasper Van Der Meulen https://amzn.to/469DVoC ► Scott Jurek books https://amzn.to/3ZEg4Ls ► Lawrence Van Lingen – YouTube https://bit.ly/46wNv4v ► Breathing for Warriors (book) by Belisa Vranich https://amzn.to/3LIfqXs   EXTRAMILEST SHOWS MENTIONED: ► Dr. Phil Maffetone on Training Your Brain #68 - https://www.youtube.com/watch?v=QfUCQ-LQeYo ► Kilian Jornet's Advice to Race Faster, For Non-Elites #51 - https://www.youtube.com/watch?v=OJZO-t6O5Bk ► Shut Your Mouth for Running and Health, with Patrick McKeown #30 - https://www.youtube.com/watch?v=D1JMP_-zoEY   YOU CAN FIND ME, FLORIS GIERMAN HERE: ► Podcast: https://extramilest.com/podcast/ ► Personal Best Program: https://www.pbprogram.com/ ► Strava: https://www.strava.com/athletes/1329785 ► Instagram: https://www.instagram.com/florisgierman ► Website: https://extramilest.com ► Website: https://pathprojects.com   MORE ABOUT KASPER VAN DER MEULEN: Kasper van der Meulen is a highly respected figure in the realms of human performance, mindfulness, and breathwork. With a strong academic foundation in neuroscience and an unwavering commitment to exploring the boundless capacities of the human psyche and physiology, Kasper has devoted his professional journey to assisting individuals in realizing their fullest potential and cultivating healthier, more enriching existences. Through an array of mediums such as authored works, educational seminars, and keynote addresses, Kasper disseminates practical methodologies and profound insights, which originate from his extensive research endeavors and personal encounters. His primary focus frequently revolves around harnessing the transformative capabilities of breathwork and mindfulness techniques to optimize mental and physical well-being, bolster concentration and efficiency, and nurture resilience in the face of life's formidable trials. Kasper van der Meulen's comprehensive strategy for enhancing human potential has solidified his status as a leading authority within the sphere of personal development. His enduring mission is to motivate and empower individuals across the globe, encouraging them to tap into their innate potential and embark on more conscious, purpose-driven paths in life.   ABOUT THE EXTRAMILEST SHOW: A podcast and YouTube channel where host Floris Gierman interviews world class athletes, coaches and health experts on the topic of how to become a stronger, healthier and happier athlete.   More info about our running coaching program can be found at https://www.pbprogram.com .   Subscribe and hit the bell to see new videos: https://bit.ly/Flo-YT   

Join the fellas as they dive into an extraordinary conversation with the fabulous Shannon. Shannon shares her experience in living with Congenital Central Hypoventilation Syndrome, a disorder that affects normal breathing. People with this disorder take shallow breaths (hypoventilate), especially during sleep, resulting in a shortage of oxygen and a buildup of carbon dioxide in the blood. Basically, if you nap, you die. They explore the wild world of technology transitions, from going trach to vent to becoming a full-blown bionic wonder. Shannon thrives independently and manages to conquer parenting challenges while raising a kid with the same diagnosis. Hold your breath—literally—as they navigate the comorbidities of CCHS and the complexities of pediatric care. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN

Join the fellas as they dive into an extraordinary conversation with the fabulous Shannon. Shannon shares her experience in living with Congenital Central Hypoventilation Syndrome, a disorder that affects normal breathing. People with this disorder take shallow breaths (hypoventilate), especially during sleep, resulting in a shortage of oxygen and a buildup of carbon dioxide in the blood. Basically, if you nap, you die. They explore the wild world of technology transitions, from going trach to vent to becoming a full-blown bionic wonder. Shannon thrives independently and manages to conquer parenting challenges while raising a kid with the same diagnosis. Hold your breath—literally—as they navigate the comorbidities of CCHS and the complexities of pediatric care. Join the post-episode conversation over on Discord! https://discord.gg/expeUDN

Den BOHR-EFFEKT zu verstehen ist eine Grundvoraussetzung um Breathwork zu unterrichten. Daher erkläre ich dir in dieser Folge was es mit dem Bohr-Effekt auf sich hat und welche Effekte wir damit gezielt über die Atmung erreichen können. Jeder RB® Breathwork Coach bekommt dieses Wissen von Anfang an vermittelt und lernt es direkt einzusetzen. In dieser Folge kläre ich dafür die folgenden Punkte:

2.17 Pickwickian Syndrome Pulmonary system review for the USMLE Step 1 Exam Pickwickian Syndrome is also called obesity hypoventilation syndrome Characterized by daytime hypoventilation leading to hypercapnia Often occurs in individuals with a BMI over 30 Excess fat puts pressure on lungs and reduces ability to fully inflate Reduction in ventilatory drive may also cause hypercapnia Typical patient presents with obesity, daytime sleepiness, and symptoms consistent with obstructive sleep apnea Diagnosis confirmed by arterial blood gas Short term treatment with positive airway pressure therapy Long term treatment involves lifestyle changes to lose weight CPAP machine supplies positive pressure to reduce CO2 build up Weight loss relieves symptoms by reducing excess weight on lungs.

Tasha McNerney is a Veterinary Technician Specialist in anesthesia, and she's sharing all the details on what your dog's veterinary care team does to keep your dog safe, the things that can go wrong while under anesthesia, and what you can do to prepare your dog beforehand. One of her best tips for dog lovers feeling anxious about an anesthetic event? Talk to your dog's veterinary team. Ask about what training and credentials your state requires for someone to do anesthesia, as well as how the staff monitor dogs while under anesthesia and during recovery. Vets and vet techs all understand that you love and are worried about your dog, and hearing the protocols in place can help to ease your mind. Listen in to learn about the different types of anesthesia and some of the different drugs that your vet will use to keep your dog calm and pain-free. Links Mentioned in Today's Show: How ASA scores help make anesthesia safer for your pet patients https://www.veterinarypracticenews.com/how-asa-scores-help-make-anesthesia-safer-for-your-pet-patients/ Related Links: Preparing Your Dog for Surgery podcast episode What to Expect the Day of Your Dog's Surgery podcast episode Caring for Your Dog After Surgery podcast episode Chapters: 0:00 Start 2:32 Anesthesia Risks 9:53 Hypotension, Hypoventilation, Hypothermia 12:50 Before Your Dog Goes Under Anesthesia 17:17 Techs Who Do Anesthesia 21:13 Types of Anesthesia 23:47 Pain Control and Unaware 27:03 Reversible Anesthesia 29:06 Injectable Anesthetics 30:50 Recovery 36:50 Home Care 40:14 No Breakfast Before Surgery 42:14 Dogs Who Struggle with Anesthesia 44:17 Dog Cancer Anesthesia 47:00 Tasha's #1 Tip About Today's Guest, Tasha McNerney VTS: Tasha is a Certified Veterinary Technician from Glenside, PA. She is also a Certified Veterinary Pain Practitioner and works closely with the IVAPM to educate the public about animal pain awareness. Tasha became a Veterinary Technician Specialist in anesthesia in 2015. Tasha loves to lecture on various anesthesia and pain management topics around the globe and was recently named the VMX 2020 Speaker of the Year for veterinary technicians. Tasha travels across the U.S. to consult with veterinary hospitals on best anesthesia practices. Tasha has authored numerous articles on anesthesia and analgesia topics for veterinary professionals and pet parents. In her spare time Tasha enjoys reading, spending time with her husband and son, and recording the Veterinary Anesthesia Nerds Podcast. LinkedIn TikTok Other Links: To join the private Facebook group for readers of Dr. Dressler's book “The Dog Cancer Survival Guide,” go to https://www.facebook.com/groups/dogcancersupport/ Dog Cancer Answers is a Maui Media production in association with Dog Podcast Network This episode is sponsored by the best-selling animal health book The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity by Dr. Demian Dressler and Dr. Susan Ettinger. Available everywhere fine books are sold. Have a guest you think would be great for our show? Contact our producers at DogCancerAnswers.com Have an inspiring True Tail about your own dog's cancer journey you think would help other dog lovers? Share your true tail with our producers. If you would like to ask a dog cancer related question for one of our expert veterinarians to answer on a future Q&A episode, call our Listener Line at 808-868-3200 Dog Cancer News is a free weekly newsletter that contains useful information designed to help your dog with cancer. To sign up, please visit: www.dogcancernews.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr Glenn McConell chats with Professor Grégoire Millet from the University of Lausanne in Switzerland. He is an absolute world leader in research into altitude training and hypoxic conditioning. This area has progressed greatly from Live High-Train High (LHTH) to Live High-Train Low (LHTL), LLTH and LHTL (and High). The type of attitude training/hypoxic conditioning one would undertake depends on if training for endurance or team sports. We also discussed using low oxygen (hypoxia) and high oxygen (hyperoxia) for health benefits. 0:00. Introduction and Grégoire's background 4:58. History of altitude training 6:52. Many combinations of altitude training LHTH, Live High-Train Low (LHTL), LLTH, LHTL (and High) 9:45. Altitude and oxygen availability 12:45. Altitude vs breathing low oxygen: not the same 14:32. Immediate responses to hypoxia 20:12. Lower VO2 max at altitude 24:39. Absolute vs relative exercise intensity 25:46. Placebo effect? 28:45. Long-term responses to altitude 32:24. Need to exercise for optimal adaptations in muscle 33:34. LHTL 36:19. LLTH 41:34. Health effects of LLTH 43:04. Repeated sprints in hypoxia (RSH) 45:29. LLTH and improved blood vessel function 47:54. Health effects of low and high oxygen 54:50. Hypoventilation at low lung volume (VHL) to cause hypoxia 59:00. VO2 max training at altitude 1:00:55. Use more carbohydrate during exercise at altitude 1:02:30. Greater sympathetic activation (adrenaline etc) at altitude 1:04:52. Oxidative stress/ Reactive oxygen species 1:08:42. What doesn't kill you makes you stronger 1:10:12. Manipulating repeated sprints duration to alter aerobic/anaerobic contributions 1:13:20. Specificity of training to achieve required outcomes 1:13:51. LHTL (and High) in Rugby players 1:17:40. LHTL and LHTL (and High) for endurance 1:19:09. Ultramarathon star Killian Jornet and altitude training 1:21:15. Controversies in the area 1:24:47. Health benefits the most exciting for him 1:25:37. Outro (9 secs) Inside Exercise brings to you the who's who of exercise metabolism, exercise physiology and exercise's effects on health. With scientific rigor, these researchers discuss popular exercise topics while providing practical strategies for all. The interviewer, Emeritus Professor Glenn McConell, has an international research profile following 30 years of Exercise Metabolism research experience while at The University of Melbourne, Ball State University, Monash University, the University of Copenhagen and Victoria University. He has published over 120 peer reviewed journal articles and recently edited an Exercise Metabolism eBook written by world experts on 17 different topics (https://link.springer.com/book/10.1007/978-3-030-94305-9). Connect with Inside Exercise and Glenn McConell at: Twitter: @Inside_exercise and @GlennMcConell1 Instagram: insideexercise Facebook: Glenn McConell LinkedIn: Glenn McConell https://www.linkedin.com/in/glenn-mcconell-83475460 ResearchGate: Glenn McConell Email: glenn.mcconell@gmail.com Subscribe to Inside exercise: Apple Podcasts: https://podcastsconnect.apple.com/my-podcasts/show/inside-exercise/03a07373-888a-472b-bf7e-a0ff155209b2 YouTube https://www.youtube.com/channel/UChQpsAQVEsizOxnWWGPKeag Spotify Google Podcasts Anchor Podcast Addict Etc

Episode 105: Antidotes to toxidromes. Some poisonings share common signs and symptoms and may be treated with antidotes without laboratory confirmation of the offending agent. Dr. Francis discussed with Dr. Arreaza some of those toxidromes and how to treat them. Written by Aida Francis, MD. Participation by Hector Arreaza, MD. Definitions: • Antidotes are substances given as a remedy that inhibit the effects of another drug of abuse or poison. Most are not 100% effective and fatality is still possible after administration. • Toxidrome is a constellation of signs and symptoms caused by an overdose or exposure to chemicals or drugs that interact with neuroreceptors. Toxidrome is the combination of the word “toxin” and “syndrome”. Management strategies of toxidromes are determined by the signs and symptoms even when the causative agent has not been identified. A little bit of Background: The World Health Organization reported that 13% of deaths caused by poisonings are children and young adults. Intentional poisoning attempts are more frequent among adolescent women than men. It is difficult to evaluate poisoned patients because they are too altered to provide history and there is often not enough time to perform a physical exam or obtain serum studies prior to life-saving interventions. To diagnose a toxidrome clinically, you need three elements: pupil size, temperature, and bowel sounds. For example: Pinpoint pupils with hyperactive bowel sounds point to cholinergic toxidrome, and dilated pupils with high temperature, and hypoactive bowel sounds point to anticholinergic (see details below). Pinpoint pupils -> Bowel sounds -> Hyperactive: CHOLINERGIC -> Hypoactive: OPIOIDS Normal or dilated pupils -> Temperature -> High -> Bowel sounds -> Hyperactive: SYMPATHOMIMETIC -> Hypoactive: ANTICHOLINERGIC -> Normal or Low -> Bowel sounds -> Hyperactive: HALLOCUNOGENIC -> Hypoactive: SEDATIVE-HYPNOTICS Anticholinergic Toxidrome and the Physostigmine antidote: • Anticholinergics inhibit the binding of acetylcholine to the muscarinic receptors in the central nervous system and the parasympathetic nervous system. Examples of anticholinergics include atropine and tiotropium. Other substances that may cause anticholinergic toxidrome include antihistamines (especially first-generation: diphenhydramine), antipsychotics (quetiapine), antidepressants (TCAs, paroxetine), and antiparkinsonian drugs (benztropine). Symptoms of toxicity include tachycardia, non-reactive mydriasis, anhidrosis, dry mucous membranes, skin flushing, decreased bowel sounds, and urinary retention. Neurological symptoms include delirium, confusion, anxiety, agitation, mumbling, visual hallucination, and strange behavior. Neurological symptoms last longer because of the anticholinergic lipophilic properties which cause them to distribute into fatty organs and tissues like the brain. “Mad as a hatter, red as a beet, blind as a bat, hot as a hare, dry as a bone” [Spanish: loco como una cabra, rojo como un tomate, ciego como un topo, seco como una piedra, caliente como el infierno] • The antidote for anticholinergic toxidrome is physostigmine. It is an acetylcholinesterase inhibitor and prevents the metabolism of acetylcholine. This increases the level of acetylcholine in both the central nervous system and peripheral nervous system. Physostigmine can cause seizures and arrhythmia, so close monitoring in the hospital is required during treatment. Cholinergic toxidrome and its antidotes atropine and pralidoxime: Acetylcholine is part of the parasympathetic nervous system and cholinergic substances can induce a parasympathetic response. Some of these substances include pesticides, organophosphates, carbamate, and nerve gas. Chlorpyrifos had been used to control insects in homes and fields since 1965. It has been used in our crops in Bakersfield, and the most recent mass exposure was in May 2017. it was banned on food crops in the US in August 2021. It has been banned for residential use for a longer period. Repeated exposure to chlorpyrifos causes autoimmune disorders and developmental delays in children and fetuses. The symptoms of cholinergic toxidrome can be summarized with the SLUDGE/ “triple” BBB acronym. This includes salivation, lacrimation, urination, defecation, gastrointestinal cramping, emesis, bradycardia, bronchorrhea, and bronchospasm. There can also be muscle fasciculations and paralysis. • The antidote is Atropine. Pralidoxime is used for organophosphates only because it cleaves the organophosphate-acetylcholinesterase complex to release the enzyme to degrade acetylcholine. Pralidoxime should be used in combination with atropine, not as monotherapy. It requires hospital admission, and a note for organophosphate, remember that the patient needs external decontamination (shower). Let's go to part 2 of our discussion, environmental exposure. Carbon Monoxide Toxidrome and the antidote oxygen: Carbon monoxide intoxication is usually due to smoke inhalation injury. Carbon monoxide is a silent gas produced by carbon-containing fuel or charcoal. Carboxyhemoglobin (COHb) forms in red blood cells when hemoglobin combines with carbon monoxide, reducing the binding and availability of oxygen at the tissue level. It's like CO falls in love with hemoglobin and hemoglobin cheats on Oxygen by binding to CO instead, and neglects oxygen delivery to tissues. Carbon monoxide also causes direct cellular toxicity. The symptoms and signs of poisoning include headache, altered mental status, nausea, vomiting, visual disturbance, Cherry-red lips, coma, and seizure. You can also see lactic acidosis and pulmonary edema. Neurological symptoms can be chronic, so it's important to follow up. The blood COHb level must be used to confirm the diagnosis because standard pulse oximetry (SpO2) and arterial partial oxygen pressure (PaO2) cannot differentiate COHb from normal oxygenated hemoglobin. You must obtain a serum COHb level. • The antidote is 100% oxygen or hyperbaric oxygen therapy and close follow-up. Consider intubating if there is edema of the airways due to inhalation injury. Cyanide Toxidrome which include sodium nitrite, sodium thiosulfate, and hydroxocobalamin In combination with Carbon Monoxide poisoning Cyanide poisoning can simultaneously be caused by inhalation of smoke or colorless hydrogen cyanide or ingestion of cyanide salts or prolonged use of sodium nitroprusside (ICU for hypertensive emergency). Symptoms are very similar to carbon monoxide poisoning. There may be long-term neurologic deficits and Parkinsonism. Diagnosis is clinical and waiting for serum cyanide levels can cause treatment delay. However, serum lactate levels over 10 mmol/L suggest cyanide poisoning. • Since cyanide poisoning resembles carbon monoxide poisoning and both toxidromes typically present simultaneously in the pathognomonic fire victim, treat simultaneously with sodium nitrite, sodium thiosulfate, and hydroxocobalamin as well as oxygen as mentioned with carbon monoxide poisoning. Hypnotic and sedative substances (antidote: flumazenil) Examples of hypnotic or sedative substances are alcohol, benzodiazepines, or zolpidem. Signs and symptoms of toxicity include slurred speech, ataxia, incoordination, disorientation, stupor, and coma with mild and rare hypoventilation and bradycardia. • The antidote is flumazenil which is a competitive antagonist at the benzodiazepine receptor. After treatment monitor patients for seizures in case of TCA poisoning, arrhythmia, or epilepsy. Opioid toxidrome (antidote: naloxone) Examples of opioid intoxication in children would be heroine in adolescents or accidental ingestion of pain medication in young children. Signs and symptoms are similar to the sedative toxidrome except for the pathognomonic finding of miosis or “pinpoint pupils” on physical exam. There will also be respiratory depression, hyporeflexia, bradycardia, muscle rigidity, and absent bowel sounds or constipation. Hypoventilation is severe and can cause death. • The antidote is naloxone which is a synthetic opioid receptor antagonist that can diagnose and treat opioid poisoning. It is indicated if the respiratory rate is less than 12. It has a short half-life and is repeatedly administered every 3-5 minutes until the respiratory drive is restored in order to avoid rebound respiratory depression and intubation. It has a rapid onset so the patient must be observed for 24 hours for opioid withdrawal symptoms. Summary: It is important to be able to recognize a toxidrome and antidote early. Once the antidote is administered, you should observe the patient 24 hours for symptoms of rebound toxicity or withdrawal. Consider repeat administration of the antidote if rebound symptoms occur and treat withdrawal symptoms as needed. Don't forget to consider multidrug poisoning if symptoms are non-specific. Thank you for having me on your podcast to review this topic. ____________________________ Conclusion: Now we conclude our episode number 108, “Antidotes to Toxidromes.” Remember you can start treatment of a patient with typical signs and symptoms of specific toxidromes, especially in patients who are unstable. We hope you enjoyed this episode. We thank Hector Arreaza, Aida Francis, and Arianna Lundquist. Audio Edition by Adrianne Silva. Even without trying you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________ References: 1) Jaelkoury, CC BY-SA 3.0 , via Wikimedia Commons. 2) Hon KL, Hui WF, Leung AK. Antidotes for childhood toxidromes. Drugs Context. 2021;10:2020 11-4. Published 2021 Jun 2. doi:10.7573/dic.2020-11-4, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177957/. 3) Royalty-free music used for this episode: Space Orbit by Scott Holmes, downloaded on July 20, 2022 from https://freemusicarchive.org/music/Scott_Holmes/.

Chapter 16:Hypoventilation to Small Animal Critical Care Medicine, 2e 2nd Edition by Deborah Silverstein DVM DACVECC, Kate Hopper BVSc MVSc DACVECC Host: Dr. Bobbi Conner Producer: Topher Conlan

Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com Saanvi is being treated by physical therapy for dizziness and functional decline. Hypoventilation is NOT a breathing pattern commonly associated with which of the following conditions? A. Guillain-Barre B. Myasthenia Gravis C. Hypoxemia D. Amyotrophic lateral sclerosis Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. --- Support this podcast: https://anchor.fm/thepthustle/support

Originally posted: https://wellawaresystems.com/what-is-a-bipap-machine/If you suffer from sleep apnea or another breathing disorder, your doctor may have recommended a bilevel positive airway pressure machine, or BiPAP. It's a gadget that helps you breathe. It's also known as a BPAP.CPAP and APAP devices are well-known, but there are also bilevel positive airway pressure (BPAP) machines.We'll look at what BPAP machines are, how they function, and what to expect if you use one in this post. What exactly is a bipap machine? Your diaphragm, a muscle in your chest that helps you breathe, moves downward as you take in air. This lowers the pressure in your lungs' tubes and sacs, allowing air to enter. If you have a condition like sleep apnea, there may be moments when you can't get the air you need (for example, when sleeping).A BiPap machine can assist force air into your lungs if you have problems breathing. A mask or nasal plugs connected to the ventilator are worn. The gadget inflates your lungs with pressurised air. It's called “positive pressure ventilation” because the gadget uses air pressure to help open your lungs.A BPAP is a type of non-invasive ventilation (NIV) therapy that helps people breathe more easily.BPAP machines are available for use in hospitals and at home for persons who require them.BPAP machines for home use are small, around the size of a toaster. A tube connects the machine to a mask, which is worn over your nose and mouth.BPAP devices, like other ventilators, employ pressure to force air into your lungs. This opens the lungs, increasing the amount of oxygen in the blood and decreasing carbon dioxide levels, depending on the settings.The term “bilevel” refers to the fact that these machines have two air pressure settings:When you inhale, BPAP machines increase the air pressure. Inspiratory positive airway pressure is another name for this (IPAP).The gadget lowers the air pressure when you exhale. Expiratory positive airway pressure is the term for this (EPAP).A timer on some BPAP devices can be set to maintain a specified number of breaths per minute. Who should use a bipap machine?If you have a medical condition that makes it difficult for you to breathe at times, you may benefit from a BiPAP. BiPAPs can help with obstructive sleep apnea, a dangerous disorder in which your breathing continuously stops and starts while you sleep. It can be life-threatening in some circumstances.If you have:An asthma flare-up, your doctor may consider a BiPAP.COPD (chronic obstructive pulmonary disease) is a condition that affects the lungs (COPD)Coronary artery disease or congestive heart failureYou have a neurological or neuromuscular condition.Hypoventilation syndrome due to obesityDifficulty breathing following a medical operation or as a result of another medical issueA BiPAP is generally not for you if you have problems breathing most or all of the time, or if you have trouble swallowing. Instead, your doctor might suggest that you use another gadget to help you obtain adequate oxygen.Support the show (https://wellawaresystems.com/)

Tom Peled is a breath coach and freediving coach from Tel Aviv, Israel. Join us for this fascinating conversation on the power of the breath, working with trauma, helping athletes to their peak performance and much more.In this episode we discuss:Shout out to Madison and Alice ModoloTom is from Tel Aviv, IsraelHe joined the Navy when he was 18 and eventually became a scuba instructor.Discussing the diving conditions off the coast of Israel.Did Tom get involved in the competitive scene?Meeting up with Aharon Solomons!The research phase begins...How Tom's teaching methodology developed.How does Tom define breathwork and how is it applied?Helping victims of trauma with breathwork.Inspiration from the oxygen advantage method.How breathwork is integrated into the athlete's training strategy.Hypoventilation and reduced breathwork.When complementary training is and isn't useful.Tom's thoughts on the benefits of running.What a year of training would look like?Respiratory health, treating asthma, COPD with breath work.Tom's take on respiratory training devices.Tom's thoughts on supplementation, what is garbage and what is worth taking? Creatine, beta alanine, citrulline, NAC, ashwagandha.Mental work, long distance athlete's mentality.Talking about the 2 minutes before the dive, the "breathe-up".Hyperventilation - is it always bad?How to get in touch with Tom and get some coaching.DESERT ISLAND QUESTIONS - Patreon ExclusiveTom's plans for the future.Why does he freedive?

Does obesity hypoventilation syndrome (OHS) give you respiratory distress? Are you baffled by bilevel? The wait is over! Learn all the ins and outs about OHS from Dr. Aneesa Das, @AneesaDas,  a sleep specialist and pulmonologist at The Ohio State University! You’ll learn tips and tricks regarding the diagnosis and management of OHS, the important role PCPs can play, and why on earth we’re discussing the didgeridoo! Free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Produced by: Cyrus Askin, MD Infographic: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Cyrus Askin, MD; Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD Reviewer: Leah Witt, MD Editor: Matthew Watto, MD (written materials); Clair Morgan of nodderly.com Guest: Aneesa Das, MD Sponsor: The American College of PhysiciansJoin the American College of Physicians today! Post-training physicians can take advantage of a special limited-time $100 dues discount. Visit acponline.org/acp100 and use the code CURBSIDERS. Membership discount is available only until May 31, 2021.  Sponsor: Birch by Helix birchliving.com/curb Birch is giving $200 dollars off ALL mattresses and 2 free eco-rest pillows at birchliving.com/curb   Sponsor: HRSA National Health Service Corps NHSC.HRSA.gov Applications will be accepted through May 6. Visit NHSC.HRSA.gov to learn about eligibility and the application process. CME Partner: VCU Health CEThe Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org.Show Segments Intro, disclaimer, guest bio Guest one-liner Picks of the Week Case from Kashlak Basic risk factors for OHS and red flags That pathophysiologic trifecta Physical Exam & History - OHS Surveys and specific testing Labs and other tests (PFTs, Echo, and more) OSA, OHS, and Central Sleep Apnea Treating OSA: CPAP vs Bilevel The importance of weight loss Keys for inpatient management Perioperative considerations Take-home points Outro

BPAP Titration for non-OSA Hypoventilation: In this episode of “Talking Sleep” we bring you Dr. Lisa Wolfe, a nationally recognized authority in non-invasive mechanical ventilation. She'll discuss the pros and cons of empiric and in-lab bilevel titration therapy.

Dr. John Fleetham is joined by Dr. Babak Mokhlesi to discuss the recently published ATS Guideline on the evaluation and treatment of OHS.

In this podcast, Babak Mokhlesi, MD, discusses the recent guideline for evaluating and treating obesity hypoventilation syndrome, which was published by the American Thoracic Society. More at: www.consultant360.com/pulmonology.

Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and common cause of right heart failure. Nighttime hypoventilation leads to pulmonary hypertension, causing right heart strain followed by right heart failure OHS criteria includes obesity, sleep disordered breathing, and alveolar hypoventilation (PaCO2 > 45 mmHg) The causes of OHS are multifactorial, and include mechanical problems with breathing and hormonal changes References Balachandran JS, Masa JF, Mokhlesi B. Obesity Hypoventilation Syndrome Epidemiology and Diagnosis. Sleep Med Clin. 2014;9(3):341–347. doi:10.1016/j.jsmc.2014.05.007 Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

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PPC ou VNI dans le SAOS associé au syndrome obésité-hypoventilation ?

Mit der vorliegenden Arbeit sollte der Frage nachgegangen werden, welches Narkoserisiko, bei 2.440 in Allgemeinanästhesie untersuchten beziehungsweise behandelten Pferden der Chirurgischen Abteilung der Klinik für Pferde der Ludwig–Maximilians–Universität München, in einem Zeitraum von 2006 bis 2011 bestanden hat. Ferner sollte geprüft werden, welche Faktoren zu einer Erhöhung des Narkoserisikos beigetragen haben. Unter 1.989 auswertbaren Narkosen traten zehn Todesfälle im Zusammenhang mit der durchgeführten Narkose auf. Die anästhesiebedingte Gesamttodesfallrate beträgt demnach 0,5% (10/1.989). Die Häufigkeit perioperativ zu versterben korreliert in der vorliegenden Arbeit mit dem Gesundheitszustand des Patienten. So sinkt die perioperative Sterblichkeit nach Ausschluss der Risikopatienten auf 0,3% (6/1.859). Dem gegenüber steigt sie für Pferde mit Vorerkrankungen (ASA 2-5) auf 3% (4/130). Für Pferde mit Kolik, die oft ein hoch- bis höchstgradig gestörtes Allgemeinbefinden (ASA 4-5) aufweisen, wurde eine narkosebedingte Sterberate von 3,6% (2/55) ermittelt. Kein Pferd starb in der intraoperativen Phase. Vier Pferde kamen im Rahmen der Aufstehphase ums Leben. Demzufolge beträgt die hier errechnete Todesfallrate für den unmittelbaren Zeitraum einer Narkose 0,2% (4/1.989). Eine Hypotonie wurde mit 8,2% (164/1.989) am häufigsten als intraoperative Narkosekomplikation protokolliert, gefolgt von einer Hypoventilation mit 6,9% (138/1.989). Erschwerte Aufstehphasen, in denen die Tiere über eine Stunde brauchten um sich zu erheben (24/1.989) sowie Verletzungen, die einer längeren postoperativen Nachversorgung bedurften (23/1.989), machten mit je 1,2% die am meisten verzeichneten Komplikationen während der Aufwachphase aus. In der postoperativen Phase traten vor allem Venenschäden (2,4%; 46/1.989) und Erkrankungen des Atmungsapparates (0,7%; 12/1.989) auf. Das Allgemeinbefinden vor der Anästhesie (p = 0,004) und die Länge einer Narkose (p = 0,002) beeinflussten das Risiko perioperativ zu versterben signifikant. Weiterhin waren vornehmlich alte Pferde von erschwerten Aufstehphasen betroffen (p < 0,001) während Fohlen häufiger in der Narkose erwachten (p = 0,006). Pferde mit einem gestörtem Allgemeinbefinden erlitten öfters eine intraoperative Hypotonie (p < 0,001) und zeigten vermehrt erschwerte Aufstehphasen (p < 0,001). Zusätzlich bestand ein signifikanter Zusammenhang zwischen einem schlechtem Allgemeinzustand und der Entstehung von postoperativen Nervenschäden (p = 0,009). Während Weichteiloperationen kam es am häufigsten zu intraoperativen Hypotonien (p < 0,001) während Operationen im Kopf-/Halsbereich den höchsten Anteil an unkontrollierbaren Blutungen aufwiesen (p < 0,001), welche den Anästhesisten zu einer umfangreichen Volumensubstitution zwangen. Pferde in Rückenlage zeigten öfters einen Blutdruckabfall (p < 0,001) genauso wie jene, die lange in Narkose waren (p < 0,001).  Eine lange Narkosedauer stellte sich außerdem als hoch signifikant für die Entstehung einer intraoperativen Bradykardie (p < 0,001) sowie postoperativer Nervenschäden (p < 0,001) und schlechter Aufstehphasen (p < 0,001) heraus. Zwischen der Gabe von Acepromazin und der Entstehung einer intraoperativen Hypotonie bestand ein signifikanter Zusammenhang (p = 0,003). Zusätzlich hing eine intraoperative Hypoventilation signifikant von der präoperativen Gabe von Acepromazin (p < 0,001) ab.

Das kongenitale zentrale Hypoventilationssyndrom (Undine-Syndrom) ist eine multisymptomale Erkrankung des autonomen Nervensystems, durch Störung der Migration der Neuralleistenzellen, im Rahmen der embryologischen Entwicklung. Klinisches Hauptmerkmal stellt die alveoläre Hypoventilation der Patienten im Schlaf dar. Den Patienten fehlt der Automatismus des Atemantriebs, die Atmung im Wachen ist im klassischen Fall unbeeinträchtigt, nachts ist eine Beatmung erforderlich. Die Diagnosestellung dieses Syndroms, war bislang nur als Ausschlussdiagnose, mit entsprechendem Zeitaufwand und klinischen Belastungen des Patienten, durch invasive Diagnostik möglich. Im Jahr 2003 wurden Mutationen im PHOX2B Gen als ursächlich für das Auftreten eines kongenitalen zentralen Hypoventilationssyndroms nachgewiesen. Es gelang im Rahmen dieser Arbeit, in Anlehnung an ein in der Literatur veröffentlichtes Protokoll, eine genetische Diagnostik des CCHS in unserem Labor zu etablieren. Die initial auch in der Literatur beschriebenen Probleme der Allelverluste im Rahmen der PCR, konnten durch Modifikationen der Methode behoben werden. Zusätzlich wurden die im Gelbild erhobenen Befunde durch Fragmentlängenanalysen und Sequenzierungen des Genabschnittes verifiziert. Es konnten von 2004 bis 2008 bei 12 Patienten Mutationen im PHOX2B Gen nachgewiesen werden. Eine der nachgewiesenen Expansionsmutationen stellt die längste bislang in der Literatur beschriebene Expansion dar. In unserem Patientengut besteht bei 92 % der Patienten eine Mutation im 20 Alanine umfassenden Polyalaninrepeat des PHOX2B Gens. Mit einem im Rahmen dieser Arbeit entwickelten Fragebogen, wurden bei den einsendenden Ärzten Informationen zum Krankheitsbild erhoben. Eine Genotyp--Phänotyp Korrelation konnte nachgewiesen werden. Die genetische Untersuchung ermöglicht somit, neben der reinen Krankheitsdiagnose, auch noch eine prognostische Einschätzung des Krankheitsverlaufes, sowie eine Anpassung weiterer diagnostischer Schritte. Zusammenfassend sind die für das CCHS ursächlichen PHOX2B Mutationen durch eine Mutationsanalyse gut und sicher nachweisbar. Amplifikation und Geldarstellung des Polyalaninrepeats stellen ein methodisch gut durchführbares, und für mögliche Verdachtspatienten kaum belastendes, Verfahren dar. Eine frühe und sichere Diagnosestellung des CCHS und - aufgrund der bestehenden Genotyp-Phänotyp Korrelation - auch eine Prognosebeurteilung, werden hierdurch ermöglicht. Der Status als „Ausschlussdiagnose” mit der Notwendigkeit multipler, belastender und invasiver Diagnostik, ist für das kongenitale zentrale Hypoventilationssyndrom, nach heutigem Stand, nicht mehr gerechtfertigt.

Apnées obstructives du sommeil, Obésité Hypoventilation

Apnées obstructives du sommeil, Obésité Hypoventilation

Die Kapnometrie ist ein einfach anwendbares, nicht-invasives Monitoringverfahren zur endexpiratorischen Messung des Kohlenstoffdioxid-Gehaltes in der Atemluft und somit Ventilationssituation des Patienten. Trotz der weiten Verbreitung in der Anästhesie und in der Intensivmedizin fand die Kapnometrie bei der Überwachung der Patienten mit einem zerebralen Infarkt bisher nur wenig Anwendung. Ziel dieser prospektiven klinischen Studie war es, Patienten mit frischen zerebralen Hirninfarkten auf Unterschiede in der Ventilation im Vergleich zu gesunden Patienten zu untersuchen und mögliche Zusammenhänge mit den Neuroscores, Entzündungsparameter, biochemischen Marker für neurologische Schädigung sowie Krankenhaus- und Reha- Liegedauer aufzudecken. Im Untersuchungszeitraum von Juni 2003 bis August 2004 wurden 45 Patienten mit einem radiologisch gesicherten Schlaganfall und 25 Kontrollpatienten in die Studie aufgenommen. Die Messung dauerte mindestens 2 Stunden und lag innerhalb der ersten 72 Stunden nach Beginn der Schlaganfall- Symptomatik. Zu 3 verschiedenen Zeitpunkten erfolgte eine Beurteilung der Neuroscores (Barthel- Index und NIHSS): Aufnahme in die Klinik, Entlassung aus der Klinik, Entlassung aus der Reha- Klinik. Es wurden NSE und Protein S 100 sowie Leukozyten und CRP in Patientenblut bestimmt. Das Messprotokoll wurde auf mögliche Messfehler und Einhalt der Mindestmessdauer von 2 Stunden überprüft. Nach Abschluss der Patientenakte wurden Liegedauer im Krankenhaus und in der Reha- Klinik ermittelt. Patienten sind auf Vorhandensein der Ausschlusskriterien überprüft worden. Die endgültige Patientenzahl betrug 18 bei Kontrollpatienten und 34 bei Schlaganfallpatienten. Diese Gruppe wurde nochmals in 2 Gruppen geteilt- Patienten mit Schlaganfällen im Versorgungsgebiet A. cerebri media (23) und Patienten mit anderen Schlaganfällen (11). Diese prospektive klinische Studie zeigte, dass Patienten mit Schlaganfällen in den ersten 72 Stunden nach Onset signifikant mehr zu Hyperventilation neigen (58,8% der Messzeit) als Kontrollpatienten (36,1% der Messzeit). In der Schlaganfallgruppe sind 2 Subgruppen unterschieden worden: Schlaganfall im Versorgungsgebiet von A. cerebri media und Schlaganfälle in den anderen zerebralen Arterien. Die Hyperventilationswerte lagen für diese Gruppen etwa gleich (57,6% und 58,3%), dafür neigten Patienten mit Media- Schlaganfällen deutlich mehr zu Hypoventilation (23,7% gegen 0,7%). • Die Korrelationsanalyse hat den Zusammenhang zwischen Normoventilation und besseren Neuroscores gezeigt. Hyper- und Hypoventilation korrelierte positiv mit den schlechteren neurologischen Indices. • Ein signifikanter Zusammenhang der Ventilation mit erhöhten Entzündungswerten konnte nicht nachgewiesen werden. • Eine Korrelation der Ventilation mit NSE und Protein S100 konnte nicht eindeutig nachgewiesen werden. • Für die gesamte Gruppe der Schlaganfälle konnte kein eindeutiger Zusammenhang der Ventilation mit dem Outcome nachgewiesen werden. Die Korrelationsanalyse zeigte eine signifikante, leicht negative Korrelation zwischen Normoventilation und Dauer des Reha-Aufenthaltes bei Patienten mit „Media-Schlaganfällen“ und positive Korrelation zwischen Hypoventilation und Liegedauer in der Reha-Klinik. Bei Patienten mit „Nicht-Media Schlaganfällen“ bestand eine positive Korrelation zwischen Normoventilation und Krankenhausliegedauer sowie zwischen Hyperventilation und Krankenhausliegedauer. Insgesamt legen die vorliegenden Ergebnisse einen positiven Zusammenhang zwischen der Normoventilation und dem Zustand des Patienten sowie Outcome nahe. Die Hyper- und Hypoventilation sind mit einem ungünstigen Verlauf assoziiert. Das macht umso deutlicher, dass Überwachung der Ventilation bei Patienten mit frischen zerebralen Infarkten und Einhalten dieser im Normbereich ganz wichtig ist. Die Kapnometrie eignet sich dazu hervorragend durch einfache Anwendung und fehlende Invasivität. Die Aussagekraft dieser Analyse ist durch eine kleine Fallzahl eingeschränkt. Die Ergebnisse dieser Arbeit sind zu Hypothesegenerierung geeignet, um weitere Studien mit größerer Patientenanzahl anzustoßen. Diese könnten weitere Rolle des Kohlenstoffdioxids bzw. Ventilation bei Schlaganfällen klären.