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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Nasal mask ventilation has been shown to be effective&#44; but outcomes do not always match expectations because of mouth leaks&#44; patient-ventilator asynchrony&#44; or decreased upper airway patency&#46; These developments are detected when they lead ultimately to circuit leaks that lower the effectiveness of ventilation through pressure loss&#44; poor inspiratory triggering&#44; and prolonged inspiratory time&#46; The quality of sleep is affected&#44; and adverse effects and treatment intolerance may arise&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">A number of ways to detect leaks and their practical consequences are proposed in this article&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">We applied 310 leak-detection procedures to 177 patients who had disappointing clinical&#44; gasometric&#44; or polysomnographic outcomes of ventilation&#46; The leak-detection procedures varied according to the type of ventilation and the supposed underlying pathophysiological mechanism&#46; Significant leaks were detected in 132 patients &#40;76&#37;&#41;&#59; therapeutic changes were then prescribed to optimize outcomes&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">We present a practical method to apply in patients with suboptimal ventilation outcomes&#46; If leaks can be detected during treatment&#44; the probable cause of treatment failure can sometimes be established and possible pathophysiological mechanisms better understood&#46; With this knowledge&#44; it may be possible to improve ventilation&#46;</p>"
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Vol. 40. Issue 11.
Pages 508-517 (November 2004)
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Vol. 40. Issue 11.
Pages 508-517 (November 2004)
Original Articles
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Leak Monitoring in Noninvasive Ventilation
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C.A. Rabec
Corresponding author
claudio.rabec@chu-dijon.fr

Correspondence: Dr. C.A. Rabec. Service de Pneumologie et Réanimation Respiratoire. Centre Hospitalier et Universitaire de Dijon. 2 Bd Marechal de Lattre de Tassigny. 21079 Dijon Cedex France
, O. Reybet-Degat, P. Bonniaud, A. Fanton, P. Camus
Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier et Universitaire de Dijon, Dijon, France
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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.

A number of ways to detect leaks and their practical consequences are proposed in this article.

We applied 310 leak-detection procedures to 177 patients who had disappointing clinical, gasometric, or polysomnographic outcomes of ventilation. The leak-detection procedures varied according to the type of ventilation and the supposed underlying pathophysiological mechanism. Significant leaks were detected in 132 patients (76%); therapeutic changes were then prescribed to optimize outcomes.

We present a practical method to apply in patients with suboptimal ventilation outcomes. If leaks can be detected during treatment, the probable cause of treatment failure can sometimes be established and possible pathophysiological mechanisms better understood. With this knowledge, it may be possible to improve ventilation.

Key Words:
Noninvasive ventilation
Monitoring
Leaks
Respiratory insufficiency
Sleep apnea-hypopnea syndrome

La ventilación por mascarilla nasal ha dado sobradas pruebas de su eficacia. Sin embargo, en ciertos casos los re-sultados no son los esperados. Tres mecanismos pueden ex-plicar estos fallos: apertura bucal, desincronización pacien-te-respirador y disminución de la permeabilidad de la vía respiratoria superior. Éstos pueden detectarse por su mani-festación última: las fugas en el circuito, que reducen la eficacia de la ventilación (fallo de presurización, disfunción del trigger inspiratorio y prolongación del tiempo inspiratorio), alteran la calidad del sueño y producen efectos adversos e intolerancia al tratamiento.

Proponemos aquí varias técnicas de detección de fugas y sus consecuencias prácticas.

Se sometió a 177 pacientes, con resultados de la ventilación inferiores a los esperados (clínicos, gasométricos o poligráfi-cos), a 310 procedimientos de detección de fugas, con montajes que variaron según la modalidad ventilatoria y el mecanismo fisiopatológico juzgado como responsable. Se detectaron fugas significativas en 132 pacientes (76%), lo cual impuso modifica-ciones terapéuticas para optimizar los resultados.

Presentamos un método de aplicación práctica en casos en que se asista a resultados insuficientes de la ventilación. La detección de fugas bajo tratamiento ofrece la posibilidad de establecer la causa probable del fracaso, comprender el mecanismo fisiopatológico potencialmente responsable e inter-venir en consecuencia.

Palabras clave:
Ventilación no invasiva
Monitorización
Fugas
Insuficiencia respiratoria
Síndrome de apnea del sueño
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