Dados do Trabalho

Título

POSITIVE PRESSURE TITRATION ASSOCIATED WITH NOCTURNAL SUPPLEMENTAL OXYGEN THERAPY FOR PATIENTS WITH GRADE III OBESITY AND OBSTRUCTIVE SLEEP APNEA SYNDROME DURING HOSPITALIZATION: A CASE REPORT

Introdução

Positive pressure is the most effective treatment for OSAS, with CPAP being the main therapeutic line. However, when this does not bring results, it may be necessary to use bilevel PAP in cases of hypercapnia during hospitalization due to decompensation.In situations where obstructive events are not initially resolved with CPAP, therapy should be restored by NIV. Oxygen administration is necessary when, SpO2≤88% in ambient air, in the supine position and awake or SpO2≤88% for a period of more than 5 continuous minutes, even if obstructive events are controlled.

Objetivo

To report the most advanced stages of a patient undergoing noninvasive ventilation after decannulation for the treatment of OSAS.

Métodos

A case was referred from the ward to the sleep outpatient clinic of a public referral hospital in Recife-PE. Patient A. N. S. de M., female, 66 years old, BMI=40.84kg/m², with COPD,SAH, DM, Chagas disease, moderate tracheobronchomalacia and grade I laryngeal stenosis, was admitted for removal of suture thread secondary to previous tracheostomy. Due to the need for oxygen therapy, with the presence of phenotypes characteristic of OSAS and OHS, blood gas analysis and polygraphy were performed. After diagnostic confirmation, for therapeutic choice, the following were used: 1st-4th days: Auto-CPAP (6-11cmH2O); 5th day: Auto-CPAP added with O2 (2l/min), 6th day: Bilevel (IPAP 15cmH2O; EPAP 8cmH2O; target VT at 8-10ml/kg) and on the 7th day: CPAP fixed at 8.6cmH2O with use of O2 at 2l/min.

Resultados

Initial blood gases analysis (BGA): pH=7.38, PaO2=54.5, PaCO2=59, HCO3=34.6; and initial polygraphy: AHI=40.9, ODI=49, SpO2min=63%, SpO2mean=87%, SpO2basal=92%, SpO2<90%=400min, SpO2<85%=145min, SpO2<80%=21min). After days 1st-4th: AHI = 1.9, median pressure = 7.9 and SpO2 time <88% (T88) = 3h12min (35%); BGA in ambient air: pH = 7.44, PaO2 = 67.8, PaCO2 = 43.8, HCO3 = 29.3). After the 5th day: AHI = 4.9, median pressure = 8.3cmH2O and T88 = 10min (2%); with blood gases: pH = 7.42, PaCO2 = 40.8; PaO2 = 67.5, HCO3 = 26.2. After the 6th day: AHI = 5.0, T88 = 16min (2%), ODI = 13.2; without BGA. After the 7th day: AHI = 0.0 and T88 = 18min (2%), ODI = 6.6; without BGA. After the 7th day: AHI=0.0 and T88=18min (2%), ODI=6.6; no BGA.

Conclusões

As a better result was observed with the 7th day therapy, the patient continues treatment with fixed CPAP at 8.6cmH2O with the use of O2 at 2l/min, without complaints and well adapted.

Palavras -chave

Sleep Apnea, Obstructive; Noninvasive Ventilation; Oxygen Inhalation Therapy.