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Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report

INTRODUCTION: Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO(2) levels. A nasal high-flow oxygen therapy system using a special nasal cann...

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Autores principales: Okuda, Miyuki, Kashio, Makoto, Tanaka, Nobuya, Matsumoto, Tomoshige, Ishihara, Sumiko, Nozoe, Tatsuo, Fujii, Takashi, Okuda, Yoshinari, Kawahara, Toshiomi, Miyata, Keigo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198978/
https://www.ncbi.nlm.nih.gov/pubmed/25312578
http://dx.doi.org/10.1186/1752-1947-8-341
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author Okuda, Miyuki
Kashio, Makoto
Tanaka, Nobuya
Matsumoto, Tomoshige
Ishihara, Sumiko
Nozoe, Tatsuo
Fujii, Takashi
Okuda, Yoshinari
Kawahara, Toshiomi
Miyata, Keigo
author_facet Okuda, Miyuki
Kashio, Makoto
Tanaka, Nobuya
Matsumoto, Tomoshige
Ishihara, Sumiko
Nozoe, Tatsuo
Fujii, Takashi
Okuda, Yoshinari
Kawahara, Toshiomi
Miyata, Keigo
author_sort Okuda, Miyuki
collection PubMed
description INTRODUCTION: Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO(2) levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system. CASE PRESENTATION: We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO(2) narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO(2) had increased from 89 to 93%, percentage time with SpO(2) ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO(2) narcosis and has been able to continue home treatment. CONCLUSIONS: Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.
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spelling pubmed-41989782014-10-17 Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report Okuda, Miyuki Kashio, Makoto Tanaka, Nobuya Matsumoto, Tomoshige Ishihara, Sumiko Nozoe, Tatsuo Fujii, Takashi Okuda, Yoshinari Kawahara, Toshiomi Miyata, Keigo J Med Case Rep Case Report INTRODUCTION: Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO(2) levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system. CASE PRESENTATION: We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO(2) narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO(2) had increased from 89 to 93%, percentage time with SpO(2) ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO(2) narcosis and has been able to continue home treatment. CONCLUSIONS: Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure. BioMed Central 2014-10-13 /pmc/articles/PMC4198978/ /pubmed/25312578 http://dx.doi.org/10.1186/1752-1947-8-341 Text en Copyright © 2014 Okuda et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Okuda, Miyuki
Kashio, Makoto
Tanaka, Nobuya
Matsumoto, Tomoshige
Ishihara, Sumiko
Nozoe, Tatsuo
Fujii, Takashi
Okuda, Yoshinari
Kawahara, Toshiomi
Miyata, Keigo
Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title_full Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title_fullStr Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title_full_unstemmed Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title_short Nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
title_sort nasal high-flow oxygen therapy system for improving sleep-related hypoventilation in chronic obstructive pulmonary disease: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198978/
https://www.ncbi.nlm.nih.gov/pubmed/25312578
http://dx.doi.org/10.1186/1752-1947-8-341
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