Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study.

Empirically determined noninvasive ventilation (NIV) settings may not achieve optimal ventilatory support. Some ventilators include monitoring modules to assess ventilatory quality. We conducted a bench-to-bedside study to assess the ventilatory quality of the VPAPIII-ResLink (ResMed, North Ryde, Australia).

[Leak monitoring in noninvasive ventilation].

Nasal mask ventilation has been shown to be effective, but outcomes do not always match expectations because of mouth leaks, patient-ventilator asynchrony, or decreased upper airway patency. These developments are detected when they lead ultimately to circuit leaks that lower the effectiveness of ventilation through pressure loss, poor inspiratory triggering, and prolonged inspiratory time. The quality of sleep is affected, and adverse effects and treatment intolerance may arise.

[Acute respiratory failure in obesity].

Obstructive sleep apnea, obesity-related hypoventilation - a hypoventilation which is independent of apneas and increased by sleep -, and hypoxemia related to local ventilation-perfusion disorders are the main mechanisms of respiratory failure occurring during acute respiratory decompensation following an often minimal triggering event. Non-invasive ventilation has been found to be an effective treatment, particularly with a ventilator capable of maintaining positive expiratory and pressure. The level of the expiratory positive airway pressure must be adapted to cure episodes of obstructive apnea or hypopnea.

[Pathology of craniocervical junction and sleep disorders].

Sleep apnea is a manifestation which has recently been recognized in anomalies of craniovertebral junction. The main reported cases involve Arnold-Chiari malformation, and clinical manifestation is a central sleep apnea syndrome. The pathophysiological mechanisms of such a sleep apnea are a blunted bulbar chemical drive (in hypercapnic patients) or an increased bulbar chemical drive which destabilizes the breathing pattern during sleep (in normo/hypocapnic patients).