COMPLICATIONS OF POSITIVE-PRESSURE VENTIL ATION, PRACTICAL CONSEQUENCES

Background: The prevalence of the obstructive sleep apnea syndrome is about 5% in the entire population. The amount of treatment-indications grows for this particular sleep-related breathing disorder due to the increasing usage of diagnostic screening tests. In most cases, the po sitive-pressure ventilation, PPV (nCPAP, nBiPAP(R)) is considered as a highly effective form of treatment, in comparison to other treating m ethods. The residential polysomnographic supervised adjustment of the treatment is optimally applied to most of the patients. Due to the inc reasing number of the treated patients, the reports about the appearan ce of short-termed side effects during the adjustment of the PPV becom e more frequent. Patients and Results: We report on 9 patients who sho wed complications during the initial stage of treatment. The most comm on one, during the nCPAP-therapy; was the increase of central apneas. Because of this complication, a rapid optimization of the respiratory pressure or a change to a nBiPAP(R)-therapy was necessary in 5 of the patients. 2 of the patients showed cardiac arrhythmias, some of which were severe. One patient produced a remarkable central hypoventilation during the initial phase of a nCPAP-therapy. The nBiPAP(R)-titration combined with right-heart-catheter monitoring could demonstrate in ano ther patient a possible cardiac decompensation through an increased ve ntilatory pressure.Conclusion: The risk of a positive-pressure ventila tion is higher in patients with accompanying cardiac, pulmonary neurop sychiatric and/or otorhinolaryngologic disorders. Considering the vari ous predisposing factors of the patients we suggest an intensive appar ative monitoring as well as stuff-supervision during the introduction to a respiratory treatment. If complications appear, a rapid improveme nt of the ventilatory pressure or a change to another respiratory trea tment is indicated.