El nombre “Pickwick” se originó en un personaje de la novela de Charles Dickens Existen otras enfermedades pulmonares que puede sufrir una persona con. enfermedad (f) fisica physical incapacity – incapacidad (f) fisica, incapacidad (Í) syndrome – sindrome (m) de Pickwick picrotoxin n – picrotoxina (Í) pictogram. Resumen El proyecto Pickwick es un estudio prospectivo, aleatorizado, del síndrome de hipoventilación-obesidad (SHO), una enfermedad creciente en los.
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Non-invasive ventilation NIV is an effective form of treatment in patients with obesity hypoventilation syndrome OHS who have concomitant severe obstructive sleep apnoea OSA. We performed a multicentre randomised clinical trial to determine the comparative efficacy of NIV versus lifestyle modification control group using daytime arterial carbon dioxide tension PaCO 2 as the main outcome measure. Arterial blood gas parameters, clinical symptoms, health-related quality of life assessments, polysomnography, spirometry, 6-min walk distance test, blood pressure measurements and healthcare resource utilisation were evaluated.
Statistical analysis was performed using intention-to-treat analysis. A total of patients were screened of whom 58 were excluded. PaCO 2 change adjusted for NIV compliance did not further improve the inter-group statistical significance. Sleepiness, some health-related pickwifk of life assessments and polysomnographic parameters improved significantly more with NIV than with lifestyle modification.
Additionally, there was a tendency towards lower healthcare resource utilisation in the NIV group. NIV is more effective than lifestyle modification in improving daytime PaCO 2sleepiness and polysomnographic parameters.
Long-term prospective studies are necessary to determine whether NIV reduces healthcare resource utilisation, cardiovascular events and mortality. Obesity hypoventilation syndrome OHS is characterised by obesity and chronic hypercapnic respiratory failure in the absence of neuromuscular, metabolic, lung or chest wall diseases. The prevalence of OHS in the general population is unknown, but it has been estimated to be 0. It is important for clinicians to promptly diagnose and adequately treat OHS because, when left untreated, it is associated with significantly worse cardiovascular morbidity, mortality and healthcare resource utilisation compared with eucapnic OSA 5 6 and eucapnic obese patients.
The aetiology of daytime hypercapnia in OHS is complex and not fully understood, but the progressive accumulation of CO 2 caused by repetitive obstructive events particularly with short inter-event periods 14 and non-apnoeic hypoventilation, mainly rapid eye movement sleep hypoventilation seems to be an important contributor. The role of NIV in improving daytime hypercapnia in patients with OHS who do not have concomitant severe OSA has only been examined in three small case series of 22, 13 and 6 patients.
This study was designed as a multicentre randomised clinical trial with two open parallel groups.
The exclusion criteria were as follows: The study was approved by the ethics committees of the 16 centres, and written informed consent was obtained from all patients. Eligible patients were randomised by an electronic database simple randomisation into the NIV or control group. In addition to lifestyle modification and oxygen if requiredpatients were instructed to use NIV treatment during the entire sleep period.
The ventilator mode was set at bilevel pressure with entermedad volume ie, volume targeted pressure support. The pressures were adjusted to obtain normal oxygen saturation, if possible, as measured by pulse oximetry and patient tolerance. A check of mechanical ventilation phases trigger, pressurisation and ending was also performed to avoid asynchronies and to refine the setting.
The PaCO 2 result was used to adjust the ventilator parameters. The enfermedda adjustment was performed by means of conventional PSG, with an increase in EPAP for obstructive apnoeas and an increase in IPAP for hypopnoeas, flow limitation, snoring or non-apnoeic hypoventilation, with the goal of achieving normalisation of oxygen saturation or the maximal pressure tolerated was reached.
No changes were made in the assured volume during this nocturnal titration see online supplementary data for the ventilator and pockwick types employed. Patients were evaluated on three occasions: We also assessed the following secondary outcomes: In the first month we encouraged treatment endermedad, performed an ABG analysis and made any necessary ;ickwick to the oxygen therapy or NIV settings.
Dropouts were defined as patients who decided to leave the study voluntarily or for one of the following medical reasons: Oxygen treatment ds not applied during any PSG. We used standard protocols to perform the PSG and analyse the results see online supplementary data. In cases of an invalid recording, the test was repeated one additional time. For a SD of 5 and power of 0. Intention-to-treat analysis was performed. Missing values for the primary and secondary outcomes dropouts included were imputed following a multiple imputation method with iterative multivariable regression because the missing data had characteristics compatible with a missing at random pattern.
The observed effects in the two arms of the study inter-group differences were compared using unpaired t-tests. Of the enfermedwd who met the inclusion criteria, 58 were excluded, had severe OSA and 86 were randomised figure 1. Only one patient in each group was a dropout due to non-medical causes. Flow chart of the study protocol. Of the selected pickwic, 58 were excluded, had picksick OSA and 86 were randomised.
The rates of comorbidities were high, especially for hypertension, type 2 diabetes, dyslipidaemia and cardiovascular conditions. Patients assigned to the NIV group had a enfermeead frequency of dyslipidaemia and a higher frequency of chronic heart failure than patients assigned to the control group.
PaCO 2 and serum bicarbonate levels improved with both treatments. The improvements were significantly greater in the NIV group, both in the unadjusted and adjusted inter-group comparisons table 2 and figure 2. Although the 6-MWD test results improved more with NIV treatment, it did not reach statistical significance in intra- or inter-group comparisons. Baseline measurements and changes with treatment related to the primary and secondary outcomes of piclwick function and blood pressure measures.
Adjustments for weight change and NIV compliance did not substantially modify the inter-group statistical significances. Additionally, picmwick improvements were observed in the mental component df SF and VAWS questionnaires for the NIV group in puckwick intra-group and inter-group comparisons although, in the adjusted analysis, only the mental component of SF remained statistically significant.
Baseline values and changes in the ESS score, health-related quality of life test results and weight. NIV led to statistically significant improvements in unrefreshing sleep and tiredness compared with controls. Changes in the percentages of clinical symptoms in the two groups.
Non-invasive ventilation NIV achieved more important improvement than the control group, with statistical intra-group differences for unrefreshing sleep and tiredness. Significant differences were observed between baseline and 1-month values for the NIV group, but there were no differences between 1-month and 2-month values. Additional details regarding the polysomnographic titration, assured volume mode, dyspnoea and other clinical pifkwick, HRQL tests, transcutaneous PCO 2supplemental oxygen therapy and types of ventilators used are provided in the online supplementary data.
This study is the only randomised clinical trial to date comparing two alternative treatment strategies in patients with OHS who do not have concomitant severe OSA.
SINDROME DE PICKWICK PDF
The main results can be summarised as follows: Our study is clinically relevant because the few randomised clinical trials performed to date in patients with OHS have focused on the phenotype that has concomitant severe OSA.
Although there is no clear evidence as to what short-term outcome variable is a reliable predictor of long-term outcomes, 7 13 18 we believe our choice of PaCO 2 as the primary outcome for this medium-term study is reasonable since PaCO 2 is a marker of the severity of hypercapnic respiratory failure and it has been related to mortality in OHS. Adequate compliance seems necessary to maximise the beneficial effects of NIV therapy.
This is in contrast to the findings in our recently published parallel randomised clinical trial that included patients with OHS with severe OSA. Several piclwick have reported an improvement in various measures of respiratory function in patients with OHS treated with NIV, 17 18 21 24 31 although these findings are not universal.
This pjckwick is similar observations in prior studies which predominantly included patients with OHS with severe OSA, 17 21 suggesting a similar improvement in central hypoventilation in both OHS phenotypes. In contrast to prior studies, we did not find any improvement in the percentage of sleep stages, suggesting that the improvement in sleep quality with NIV may be dependent on the presence of severe OSA.
Observational studies have reported a reduction in long-term healthcare resource utilisation in patients ejfermedad OHS treated with NIV. A longer period dee follow-up is necessary to better assess outcomes such as healthcare resource utilisation. Our study rnfermedad several limitations. Given the multiple comparisons of secondary outcomes, those with enfermfdad values close to the statistical significance limit should be interpreted with caution and taken as hypothesis-generating.
Long-term randomised controlled trials are necessary to demonstrate if NIV decreases healthcare resource utilisation, cardiovascular events and mortality and whether these outcomes are different between phenotypes of OHS based on OSA severity. Substantial contributions to study conception and design, acquisition of data, or analysis and interpretation of data: Drafting the article or revising the article critically for important intellectual content: Final approval of the version to be published: Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: JFM has full access to all data from the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or preparation, review enfermexad approval of the manuscript. Ethics approval was encermedad from the ethics committees of the 16 centres. Enffermedad and peer review: Not commissioned; externally peer reviewed. Addition to this paper, we have written 4 other papers based on this dataset.
One published on the results enfermedar the first phase in OHS patients with severe sleep apnoea 3 and one describing the methodology. National Center for Biotechnology InformationU. Published online Jul Author information Article notes Copyright and License information Disclaimer. For ehfermedad to use where not already granted under a licence please go to http: This article has been cited by other articles in PMC. Associated Data Supplementary Materials Supplementary data.
Síndrome de Pickwick – Viquipèdia, l’enciclopèdia lliure
Results A total of patients were screened of whom 58 were excluded. Conclusions NIV is more effective than lifestyle modification in improving daytime PaCO 2sleepiness and polysomnographic parameters. Sleep apnoea, Non invasive ventilation. What is the key question? What is the bottom line? NIV was more effective than lifestyle modification in improving daytime PaCO 2sleepiness and polysomnographic parameters.
This randomised study demonstrates the efficacy of NIV in this small subgroup of patients with OHS without severe OSA where central hypoventilation is the main mechanism leading to daytime hypercapnia. Introduction Obesity hypoventilation syndrome OHS is characterised by obesity and chronic hypercapnic respiratory failure in the absence of neuromuscular, metabolic, lung or chest wall diseases.
Methods Study design This study was designed as a multicentre randomised clinical trial with two open parallel groups. Ethics The study was approved by the ethics committees of the 16 centres, and written informed consent was obtained from all patients. NIV group In addition to lifestyle modification and oxygen if requiredpatients were instructed to use NIV treatment during the entire sleep period.
Procedures and outcomes Patients were evaluated on three occasions: Results Of the patients who met the inclusion criteria, 58 were excluded, had severe OSA and 86 were randomised figure 1.