International Consensus Document on Obstructive Sleep Apnea.

The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 specialists from a wide geographical area (including the participation of 4 international societies), an expert in methodology, and a documentalist from the Iberoamerican Cochrane Center. The document consists of a main section containing the most significant innovations and a series of online manuscripts that report the systematic literature searches performed for each section of the international consensus document.

Monitoring of noninvasive ventilation: comparative analysis of different strategies.

Background: Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored.

Significance of soluble triggering receptor expressed on myeloid cells-1 elevation in patients admitted to the intensive care unit with sepsis.

Background: Among septic patients admitted to the intensive care unit (ICU), early recognition of those with the highest risk of death is of paramount importance. Since clinical judgment is sometimes uncertain biomarkers could provide additional information likely to guide critical illness management. We evaluated the prognostic value of soluble Triggering Receptor Expressed by Myeloid cells 1 (sTREM-1), procalcitonin (PCT) and leucocyte surface expression of CD64.

[Proposal for a systematic analysis of polygraphy or polysomnography for identifying and scoring abnormal events occurring during non-invasive ventilation].

Non-invasive ventilation (NIV) is recognised as an effective treatment for chronic hypercapnic respiratory failure. Monitoring NIV during sleep may be preferable to daytime assessment. This paper reports the findings of an international consensus group, which systematically analysed nocturnal polygraphic or polysomnographic tracings recorded with either volume-cycled or pressure-cycled ventilators.

Ventilator modes and settings during non-invasive ventilation: effects on respiratory events and implications for their identification.

Compared with invasive ventilation, non-invasive ventilation (NIV) has two unique characteristics: the non-hermetic nature of the system and the fact that the ventilator-lung assembly cannot be considered as a single-compartment model because of the presence of variable resistance represented by the upper airway. When NIV is initiated, the ventilator settings are determined empirically based on a clinical evaluation and diurnal blood gas variations. However, NIV is predominantly applied during sleep.

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.

[Our experiences with the frontal flap. Apropos of 105 cases].

The plastic qualities and vascular reliability of the frontal flap have been widely used for reconstruction of facial tissue. We revised the files of 105 patients who had undergone surgical repair of facial tissue loss with frontal flaps. The epidemiology, etiology of the repaired tissue loss and indications for frontal flap as well as the various techniques were analyzed: 66.

Vascular manifestations in homocystinuria.

Homocystinuria was discovered in a 21-year-old woman when she presented with lower limb ischemia and pulmonary embolism. This patient had a partial deficit in cystathionine-synthetase and took strongly dosed oral contraceptive medication. This report underscores: (1) the value of searching for this type of pathology even in the adult; (2) the possibility of disclosure by another condition, and particularly, drug-induced; (3) the importance of searching for other involved members of the same family; and (4) the possibility of treatment in vitamin sensitive patients.