Post cardiac surgery patients' experiences using continuous positive airway pressure (CPAP) via mask therapy to treat post-surgical atelectasis
Main Article Content
Cardiac surgery procedure especially CABG is usually associated with post-surgical atelectasis. CPAP via mask therapy is one of the intervention treatments to re-open collapsed alveoli (atelectasis) after cardiac surgery. This study aims to evaluate the compliance and periodicity of CPAP via mask therapy use to treat or prevent post-surgical atelectasis after CABG.
Sixty two post cardiac surgery patients who used CPAP via mask therapy every two or four hours were invited to participate in this study. All the participants used CPAP machine in the first three post- cardiac surgery days during waking hours. The participants were given a questionnaire to answer before hospital discharge. The questionnaire was composed of items about the compliance, the periodicity of CPAP therapy use and the side effects of the CPAP mask used such as pain over bridge of the nose, dry mouth, allergy or teeth and gum pain. Also, the questionnaire was linked to informal open-end question to clarify the patient's
history of these illnesses before the use of CPAP therapy.
Sixty two patients participated in this study from the two difference frequency group (CPAP therapy every two or four hours) with response rate approximately 85%. Twenty seven males and three females belonged to the CPAP2hr group (ages; 58 ± 6.4 years). Twenty eight males and four females were in the CPAP4hr group (ages; 57 ± 7.2 years). All the participants started to use CPAP therapy in the first post-operative day immediately after extubation from mechanical ventilation. No one from either of the groups suffered from nose bleeding, excessive sneezing, eczema or asthma either before or after therapy. More than half
of the participants (60%) complained a dry mouth after the therapy. Twenty eight participants (93%) from CPAP2hrs group reported treatment compliance from CPAP machine use and 27 participants (84%) in CPAP4hrs group.
The result showed high acceptance rate of compliance toward CPAP therapy use especially in CPAP2hrs group.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2- Nolan, G. M., Ryan, S., Oconnor, T. M. & McNicholas, W. T. (2006). Comparison of three auto-adjusting positive pressure devices in patients with sleep apnoea. The European Respiratory Journal, 28 (1), 159-64.
3- Bakker, J., Campcell, A. & Neill, A. (2010). Randomized controlled trial comparing flexible and continuous positive airway pressure delivery: effects on compliance, objective and subjective sleepiness and vigilance. Sleep, 33 (4), 523-529.
4- McArdle, N., Devereux, G., Heidarnejad , H., Engleman, H. M., Mackay, T. W. & Douglas, N. J. (1999). Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. American Journal of Respiratory and Critical Care Medicine, 159, 1108-1114.
5- Kryger, M. H. (2005). Management of obstructive sleep apnoea: Review in Principle and Practice of Sleep Medicine, (5th Edition). Philadelphia, Saunders.
6- Richard, W., Venker, J., den Herder, C., Kox, D., van den Berg, B., Laman, M., van Tinteren, H. & de Vries, N. (2007). Acceptance and long-term compliance of nCPAP in obstructive sleep apnea. European Archives of Oto-rhino-laryngology, 264 (9), 1081-1086.
7- Smith, I., Nadig, V. & Lasserson, T. J. (2009). Educational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea. The Cochrane Database of Systematic Reviews, 15, (2), CD007736.
8- Chai, C. L., Pathinathan, A. & Smith, B. (2006). Continuous positive airway pressure delivery interfaces for obstructive sleep apnoea. The Cochrane Database of Systematic Reviews, 18, (4), CD005308.
9- Kalan, A., Kenyon, G. S., Seemungal, T. A. & Wedzicha, J. A. (1999). Aderse effects of nasal continuous positive airway pressure therapy in sleep apnoea syndrome. The Journal of Laryngoloy and Otology, 113 (10), 888-892.
10- Kakkar, R. K. & Berry, R. B. (2007). Positive airway pressure treatment for obstructive sleep apnea. Chest, 132 (3), 1057-1072.
11- Montserrat, J. M., Ferrer ,M., Hernandez, L., Farre, R., Vilagut, G., Navajas, D., Badia, J. R., Carrasco, E., De Pablo, J. & Ballester, E. (2001). Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. American Journal of Respiratory and Critical Care Medicine, 164(4), 608-613.
12- Weaver, T. E., Maislin, G., Dinges, D. F., Bloxham, T., George, C. F., Greenberg, H., Kader, G., Mahowald, M., Younger, J. & Pack, A. I. (2007). Relationship between hours of CPAP use and achieving normal levels of sleepiness and daily functioning. Sleep, 30, 711-719.
13- Massie, C. A., Hart, R. W., Peralez, K. & Richards, G. N. (1999). Effects of humidification on nasal symptoms and compliance in sleep apnea patients using continuous positive airway pressure. Chest, 116 (2), 403-408.
14- Kushida, C. A., Littner, M. R., Hirshkowitz, M., Morgenthaler, T. I., Alessi, C. A., Baily, D., Boehlecke, B., Brown, T. M., Coleman, J., Friedman, L. & et al. (2006). Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep, 29, 375-380.
15- Gay, P. C., Herold, D. L. & Olson, E. J. (2003). A randomized, double-blind clinical trial comparing continuous positive airway pressure with a novel bilevel pressure system for treatment of obstructive sleep apnea syndrome. Sleep, 26, 864-869.
16- Ryan, S., Doherty, L. S., Nolan, G. M. & McNicholas ,W. T. (2009). Effects of heated humidification and topical steroids on compliance, nasal symptoms, and quality of life in patients with obstructive sleep apnea syndrome using nasal continuous positive airway pressure. Journal of Clinical Sleep Medicine, 5 (5), 422-427.
17- Ryan, S., Garvey, J. F., Swan, V., Behan, R. & McNicholas, W. T. (2011). Nasal pillows as an alternative interface in patients with obstructive sleep apnoea syndrome initiating continuous positive airway pressure therapy. Journal of Sleep Research, 20 (2), 367-373.
18- Pepin, J. L., Leger, P., Veale, D., Langevin, B., Robert, D. & Levy, P. (1995). Side effects of nasal contiuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest, 107 (2), 375-381.
19- Baltzan M. A., E lkholi O. & Wolkove N. (2009). Evidence of interrelated side effects with reduced compliance in patients treated with nasal continuous positive airway pressure. Sleep Medicine, 10 (2), 198-205.
20- Sopkova, Z., Dorkova, Z. & Tkacova, R. (2009). Predictors of compliance with continuous positive airway pressure treatment in patients with obstructive sleep apnea and metabolic syndrome. Wiener Klinische Wochenschrift, 121 (11), 398-404.
21- Weaver, T. E. & Grunstein, R. R. (2008). Adherence to continuous positive pressure therapy: the challenge to effective treatment. Proceedings of the American Thoracic Society, 15 (2), 173-178.
22- Beecroft, J., Zanon, S., Lukic, D. & Hanyl, P. (2003). Oral continuous positive airway pressure for sleep apnea: effectiveness, patient preference, and adherence. Chest, 124, 2200-2208.
23- Budhiraja, R., Parthasarathy, S., Drake, C. L., Roth, T., Sharief, I., Budhiraja, P., Saunders, V. & Hudgel, D. W. (2007). Early CPAP use identifies subsequent adherence to CPAP therapy. Sleep, 30, 320-324.
24- Scharf, S. M., Seiden, L., DeMore, J. & Carter-Pokras, O. (2004). Racial difference in clinical presentation of patients with sleep-disordered breathing. Sleep and Breath, 8, 173-183.
25- Joo, M. J. & Herdegen, J. J. (2007). Sleep apnea in an urban public hospital: assessment of severity and treatment adherence. Journal of Clinical Sleep Medicine, 3, 285-288.
26- Gay, P., Weaver, T., Loube, D. & Iber, C. (2006). Evaluation of positive airway pressure treatment for sleep related breathing disorders in adult. Sleep, 29 (3), 381-401.
27- Hollandt, J. H. & Mahlerwein, M. (2003). Nasal breathing and continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA). Sleep and Breath, 7 (2), 87-94.
28- Barbe, F., Mayoralas, L. R., Duran, J., Masa, J. F., Maimo, A., Montserrat, J. M., Monasterio, C., Bosch, M., Ladaria, A., Rubio, M., Rubio, R., Medinas, M., Hernandez, L., Vidal, S., Douglas, N. J. & Agusti, A. G. (2001). Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness. A randomized controlled trial. Annals of Internal Medicine, 134 (11), 1015-1023.
29- Nakata, S., Noda, A., Yagi, H., Yanagi, E., Mimura, T., Okada, T., Misawa, H. & Nakashima, T. (2005). Nasal resistance for determinant factor of nasal surgery in CPAP failure patients with obstructive sleep apnea syndrome. Rhinology, 43, 296-299.
30- Sugiura, T., Noda, A., Nakata, S., Yasuda, Y., Soga, T., Miyata, S., Nakai, S. & Koike, Y. (2007). Influence of nasal resistance on initial acceptance of continuous positive airway pressure in treatment for obstructive sleep apnea syndrome. Respiration, 74 (1), 56-60.
31- Engleman, H. M. & Wild, M. R. (2003). Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Medicine Reviews, 7, 81-99.
32- Weaver, T. E. (2001). Adherence to CPAP treatment and functional status in adult obstructive sleep apnea. In: Pack AI, editor. Sleep apnea: pathogenesis, diagnostic and treatment. New York: Marcel Decker.
33- Means, M. K., Edinger, J. D. & Husain, A. M. (2004). CPAP compliance in sleep apnea patients with and without laboratory CPAP titration. Sleep and Breath, 8, 7-14.