Claudio RabecLausanne University Hospital | CHUV
Claudio Rabec
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Publications (156)
First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endoth...
Background. Sleep apnea (SA) is a common breathing disorder characterized by repetitive upper airway narrowing and closure. Although SA has been demonstrated to be an independent risk factor for all-cause mortality, the direct contribution of SA to worse cardiovascular prognosis may be difficult to evaluate, and its independent association with the...
Background and objective:
Continuous positive airway pressure (CPAP) in the treatment of severe obstructive sleep apnoea (OSA) can be used in fixed CPAP or auto-adjusted (APAP) mode. The aim of this prospective randomized controlled clinical study was to evaluate the 3 month-efficacy of CPAP used either in fixed CPAP or APAP mode.
Methods:
Eight...
Becker muscular dystrophy (BMD) is one of the most frequent among neuromuscular diseases, affecting approximately 1 in 18,000 male births. It is linked to a genetic mutation on the X chromosome. In contrast to Duchenne muscular dystrophy, for which improved care and management have changed the prognosis and life expectancy of patients, few guidelin...
Background:
The ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeut...
Background
Non-invasive ventilation (NIV) is a standard of care for hypercapnic chronic respiratory failure (CRF). Obstructive sleep apnea (OSA) frequently contribute to hypoventilation in CRF. CPAP improves hypercapnia in selected COPD and obese patients. We describe the profile of patients switching from NIV to CPAP in a cohort of patients on lon...
Introducción: La experiencia clínica ha permitido la ventilación no invasiva fuera de unidades críticas. Describimos el perfil clínico y evolución de pacientes que recibieron ventilación no invasiva en sala general. Material y métodos: Estudio retrospectivo en pacientes con soporte ventilatorio durante un año en un hospital general. Resultados: Se...
Introduction:
Clinical experience has allowed the use of non-invasive ventilation out side the acute-care setting. We describe the clinical profile and evolution of patients who received non-invasive ventilation in a regular ward.
Materials and methods:
Retrospective study in patients with ventilatory support for one year in a general hospital.
R...
Background:
Long-term noninvasive ventilation (LTNIV) is widely used in patients with chronic hypercapnic respiratory failure (CHRF) related to COPD. Prognosis of these patients is however poor and heterogenous.
Research question:
In COPD patients under LTNIV for CHRF, is it possible to identify specific phenotypes which are predictive of probab...
Background:
Home respiratory equipment (HRE) designed for the management of chronic respiratory failure includes oxygen therapy (O2), noninvasive ventilation (NIV) and mechanical insufflation-exsufflation (MI-E). The growth of the number of patients treated by HRE, the prevalence and the associated costs in France have not been determined.
Method...
Long term noninvasive ventilation (LTNIV) is a recognized treatment for chronic hypercapnic respiratory failure (CHRF). COPD, obesity-hypoventilation syndrome, neuromuscular disorders, various restrictive disorders, and patients with sleep-disordered breathing are the major groups concerned. The purpose of this narrative review is to summarize curr...
Background:
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive diaphragm weakness and deteriorating lung function. Bulbar involvement and cough weakness contribute to respiratory morbidity and mortality. ALS-related respiratory failure significantly affects quality of life and is the leading cause of de...
Objectif
Il a été récemment recommandé d’insérer un filtre antibactérien dans le circuit de certains appareils de pression positive afin de prévenir l’inhalation de particules. Cependant, l’ajout d’un filtre antibactérien ne correspond pas aux conditions d’utilisation normale et peut perturber le fonctionnement de l’appareil. Notre objectif était d...
Volume-assured pressure support (VAPS) modes are supposed to automatically adjust pressure to maintain a ventilation target. Auto-adjusted expiratory pressure (auto-EPAP) features were introduced to VAPS modes allowing automatically adjusting the EPAP to maintain upper airway patency. This chapter aims to explain the principles of these new hybrid...
Introduction
Le programme ETAPES (2018–2021) vise à développer et évaluer la télésurveillance dans l’insuffisance respiratoire chronique sévère nécessitant une ventilation non invasive (VNI) nocturne. Il associe un accompagnement thérapeutique et l’analyse automatique des données télétransmises quotidiennement par les ventilateurs permettant de gén...
Introduction
ETAPES (2018–2021) vise à développer et évaluer la télésurveillance dans l’insuffisance respiratoire chronique sévère nécessitant une ventilation non invasive (VNI) nocturne. Le programme associe un accompagnement thérapeutique et la gestion d’alertes générées à partir des données télétransmises quotidiennement par le ventilateur. L’ob...
Introduction
Le programme ETAPES (2018–2021) de l’insuffisance respiratoire chronique sous ventilation non invasive (VNI) nocturne associe un accompagnement thérapeutique et la gestion d’alertes générées à partir des données télétransmises par le ventilateur. L’objectif (1) est de détecter les fuites, une observance basse ou suspecter une exacerbat...
Introduction
Pour l’insuffisance respiratoire chronique sous ventilation non invasive (VNI), le cahier des charges ETAPES prévoit un accompagnement thérapeutique, la gestion d’alertes générées à partir des données télétransmises par le ventilateur et l’administration mensuelle du questionnaire DIRECT (1) aux patients BPCO ou non. L’objectif de ce t...
Introduction
Un fabriquant de ventilateurs de domicile a récemment recommandé de mettre un filtre antibactérien sur les circuits des machines de pression positive continue (PPC) et de ventilation non invasive (VNI) afin de limiter les risques liés à la mousse de polyuréthane utilisée dans ses appareils. L’objectif de notre travail était d’évaluer l...
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 speciali...
Background
Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF). The Chilean Ministry of Health started a program for adults in 2008.
Methods
This study examined the following data from a prospective cohort of patients with CRF admitted to the national HMV program: characteristics...
The main aim of this international consensus document on obstructive sleep apnea is to provide guidelines based on a critical analysis of the latest literature to help health professionals make the best decisions in the care of adult patients with this disease. The expert working group was formed primarily of 17 scientific societies and 56 speciali...
Background: Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF) of different causes. The Chilean Ministry of Health started in 2006 a program for HMV in Children and in 2008 it began a program for HMV in adults. All belonged to the state health insurance.
Methods: Prospective coho...
Objectif
Pour expliquer la surmortalité cardiovasculaire associée à la Ventilation Auto-Asservie (VAA) de l’étude SERVE-HF, il a été évoqué que les réglages de la VAA auraient induit une hyperventilation. Les objectifs de cette étude sont de décrire:
– les réglages de la VAA et,
– la ventilation minute (VM) en fonction de l’algorithme de la VAA (VA...
Background
SARS-CoV-2 aerosolization during noninvasive positive pressure ventilation may endanger healthcare professionals. Various circuit setups have been described in order to reduce virus aerosolization. However, these setups may alter ventilator performances.
Research question
What are the consequences of the different suggested circuit setu...
El objetivo principal de este Documento Internacional de Consenso (DIC) sobre Apnea Obstructiva del Sueño es proporcionar unas directrices que permitan a los profesionales sanitarios tomar las mejores decisiones en la asistencia de los pacientes adultos con esta enfermedad según un resumen crítico de la literatura más actualizada. El grupo de traba...
Background
For some patients, Continuous Positive Airway Pressure (CPAP) remains an uncomfortable therapy despite the constant development of technological innovations. To date, no real life study has investigated the relationship between mask related side-effects (MRSEs) and CPAP-non-adherence (defined as < 4 h/day) or residual-excessive-sleepines...
Introduction
L’hypoventilation nocturne (HN) a un impact pronostique chez les patients avec atteinte neuromusculaire, l’instauration précoce d’une assistance ventilatoire (AV) améliore le pronostic. La capnographie nocturne transcutanée (TcPCO 2) est le gold standard pour diagnostiquer une HN. Cet examen reste onéreux et complexe. Plusieurs définit...
Introduction
L’oxygénothérapie pulsée (OTP) a été développée afin d’augmenter l’autonomie de marche des patients utilisant des concentrateurs d’oxygène portables. Ces dispositifs sont maintenant largement utilisés dans la pratique clinique. Cependant, leur impact sur la capacité à la marche est mal évalué. L’objectif de cette étude était d’évaluer...
Introduction
Les patients atteints d’une infection grave par la COVID-19 sont susceptibles de recevoir une assistance respiratoire par pression positive continue (PPC) ou ventilation non invasive (VNI). L’utilisation de ces traitements est associée à une aérosolisation du virus qui peut mettre en danger le personnel soignant et contre laquelle dive...
Background
Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial bl...
Backgrounds:
To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The...
With first cases noted towards the end of 2019 in China, COVID19 infection was rapidly become a devastating pandemic. Even if most patients present with a mild to moderate form of the disease, the estimated prevalence of COVID19-related severe acute respiratory failure (ARF) is 15-20% and 2-12% needed intubation and mechanical ventilation. In addit...
Background and objective:
Average volume-assured pressure support-automated expiratory positive airway pressure (AVAPS-AE) combines an automated positive expiratory pressure to maintain upper airway patency to an automated pressure support with a targeted tidal volume. The aim of this study was to compare the effects of 2-month AVAPS-AE ventilatio...
Introduction
Les données logicielles des ventilateurs sont la pierre angulaire du télé-suivi de la VNI à domicile. Une gestion pertinente de ces données est primordiale, mais reste mal définie. L’objectif de cette étude était d’évaluer l’impact potentiel qu’aurait l’utilisation des données de télé-suivi dans la prise en charge des patients en utili...
Introduction
Chez les patients BCPO distendus, l’augmentation des pressions intrathoraciques peut modifier le gradient de pression de retour veineux avec comme conséquence une modification du débit cardiaque et du volume d’éjection systolique. Des études physiologiques ont démontré que la diminution de l’hyperinflation peut améliorer le volume d’éj...
Discharging a chronic critically ill patient is a risky procedure if the clinician does not have full control of his prescription. This is even more important when applying a machine to replace a failing organ, as is the case for home ventilation. Even if modern home ventilators fulfil quality and safety criteria and, ‘on paper’, ventilators and ma...
Background
Whereas telemedicine usage is growing, the only clinical algorithm for Continuous Positive Airway Pressure (CPAP) adherence management is that stipulated by the 2013 American Thoracic Society (ATS). The capacity of the latter to predict non-adherence in long-term CPAP-treated patients has not been validated.
Methods
Patients from the pr...
Abstract Backgrounds As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions. Methods The OTRLASV-study is a prospective, 5-...
Episodes of patient-ventilator asynchrony (PVA) occur during acute and chronic non-invasive positive pressure ventilation (NIV). In long-term NIV, description and quantification of PVA is not standardised, thus limiting assessment of its clinical impact. The present report provides a framework for a systematic analysis of polygraphic recordings of...
Objectif
La place du médecin généraliste (MG) dans le dépistage et le diagnostic du syndrome d’apnées obstructives du sommeil (SAOS) reste encore à définir. L’objectif de ce travail était d’évaluer l’efficacité d’un dépistage par polygraphie ventilatoire (PV) en médecine générale.
Méthodes
Étude rétrospective incluant tous les patients ayant bénéf...
Introduction
Peu de données sur l’usage de la Ventilation Auto-Asservie (VAA) en vie réelle existent. Dans ce contexte post SERVE-HF, les cliniciens sont dans l’attente de nouvelles données. Le but de cette étude est de décrire les caractéristiques cliniques des patients traités actuellement en conditions de vie réelle par VAA.
Méthodes
L’étude OT...
Introduction
Le syndrome obésité hypoventilation (SOH) est habituellement traité par une ventilation non invasive (VNI) en mode ST. Le mode AVAPS-AE est également un mode barométrique qui permet de déterminer un volume cible et qui titre automatiquement le niveau de pression expiratoire positive pour maintenir la perméabilité des voies aériennes su...
Résumé
Bien que l’efficacité clinique de la ventilation non invasive (VNI) soit clairement démontrée, aucune étude française récente n’indique les conditions de prescription et d’utilisation de celle-ci selon les pathologies respiratoires. La fédération ANTADIR avec l’appui et en partenariat avec le Groupe assistance ventilatoire de la SPLF, a mis...
Introduction
Bien que l’efficacité clinique de la ventilation non invasive (VNI) soit clairement démontrée, il n’existe aucune étude récente à propos des conditions de prescription et d’utilisation de celle-ci selon les différentes pathologies respiratoires. La cohorte ANTADIR–GAV a pour objectif d’analyser prospectivement les données en France des...
Introduction
L’efficacité de la ventilation non invasive (VNI) est établie pour contrôler l’hypoventilation alvéolaire dans l’insuffisance respiratoire chronique des patients neuromusculaires (NM). Elle doit être mise en place selon des critères cliniques et fonctionnels défini par l’HAS [1] pour chaque maladie NM. Les objectifs de notre étude étai...
Background
Combined effects of leaks, mechanical property of respiratory system and upper airway (UA) patency on patient-ventilator synchrony (PVA) and the level of clinically “tolerable” leaks are not well established in home ventilators.
Methods
We comparatively assessed on a bench model, the highest leak level tolerated without inducing signifi...
Background:
Polygraphy (PG) remains the standard method of assessing noninvasive ventilation (NIV) effectiveness. Built-in software (BIS) of recent NIV equipment provides estimates of some ventilator parameters, but their usefulness is unclear.
Objectives:
To assess the reliability of BIS compared with PG in a cohort of obesity hypoventilation s...
Background:
Noninvasive ventilation (NIV) titration may be difficult when dynamic airway obstruction episodes persist, even with high expiratory positive airway pressure (EPAP). We aimed to determine the usefulness of videolaryngoscopy during NIV for identifying mechanisms and sites of obstruction and for providing a guide for their resolution in...
A task force issued from the Groupe Assistance Ventilatoire (GAV) of the Société de Pneumologie de Langue Française (SPLF) was committed to develop a series of expert advice concerning various practical topics related to long-term non invasive ventilation by applying the Choosing Wisely® methodology. Three topics were selected: monitoring of noninv...
Background and objective:
Nocturnal hypoventilation is now an accepted indication for the initiation of non-invasive ventilation. Nocturnal hypoventilation may be an under diagnosed condition in chronic respiratory failure. The most appropriate strategy to identify sleep hypoventilation is not yet clearly defined. In clinical practice, it is indir...
Algorithms for monitoring home non-invasive ventilation (NIV) have been recently proposed.1–3 Following this strategy, we detected three cases of transient ineffective ventilation due to the use of a ‘ramp’ option on home pressure support (PS) ventilators. The ‘ramp’ option is a comfort setting initially made available on CPAP devices. This option...
Introduction
Malgré l’ancienneté du traitement par pression positive continue (PPC) du syndrome d’apnées hypopnées obstructives (SAHOS), le choix du mode ventilatoire constant ou auto piloté reste toujours aléatoire. Afin d’optimiser cette stratégie thérapeutique, nous avons évalué le caractère prédictif de critères cliniques et polygraphiques, ain...
Since the early 1980s, when noninvasive ventilation (NIV) showed efficacy in the management of some forms of respiratory failure [1–3], the number of patients receiving this treatment both in the acute setting and at home has steadily increased. This is explained by a growing number of indications in which the effectiveness of NIV has been proven,...
Non-invasive ventilation is useful to treat some forms of respiratory failure. Hence, the number of patients receiving this treatment is steadily increasing. Considerable conceptual and technical progress has been made in the last years by manufacturers concerning this technique. This includes new features committed to improve its effectiveness as...
Background: NIV is effective to treat chronic or acute respiratory failure (RF). However, abnormal events (AE) may affect NIVefficacy. Among them, upper airway obstruction with (UAO/IE+) or without (UAO/IE-) inspiratory effort are expressed as desaturation dips (DD) on SpO2 tracings.
Aim : 1) To assess the prevalence and epidemiology of DD in pati...
During the last few decades, attention has increasingly focused on noninvasive ventilation (NIV) in the treatment of chronic respiratory failure. The University of Leuven and the University Hospitals Leuven therefore chose this topic for a 2-day working group session during their International Symposium on Sleep-Disordered Breathing. Numerous Europ...
Objectif
L’atteinte respiratoire dans la SLA se traduit classiquement par une hypoventilation nocturne puis diurne et/ou par un syndrome d’apnees du sommeil (SAS) dont la prevalence est discutee. L’objectif de l’etude est d’evaluer la pertinence de la PCO2 transcutanee nocturne(TcCO2) avant l’apparition d’une hypoventilation diurne, en complement d...
Objectif
Le SAHOS de l’enfant est une entité différente de celle de l’adulte. Sa prévalence varie de 0,7 à 2,2 %. Ses facteurs de risque sont : l’obésité, l’hypertrophie amygdalienne, les malformations cranio-faciales. Il est fréquent chez les enfants atteints de Prader Willi ou d’une trisomie 21. Le traitement par pression positive continue (PPC)...
INTRODUCTION: Polysomnography (PSG) is the recording during sleep of physiological parameters
enabling to diagnose sleep disorders and to characterize sleep fragmentation. This work we propose to
build a mathematical model of sleep fragmentation diagnosis based on three main sleep characteristics
each having its own threshold and weight values for...
La polysomnographie (PSG) est l’examen de référence dans le diagnostic des troubles du sommeil. Il consiste en l’enregistrement d’un très grand nombre de variables ventilatoires et neurophysiologique permettant par leur analyse simultanée le codage en stades de sommeil.
Afin de déterminer la qualité du sommeil d’un patient, le clinicien évalue sa...
Noninvasive ventilation is recommended to correct the nocturnal hypoventilation and relieve the symptoms of patients with the obesity-hypoventilation syndrome (OHS). The benefits of fixed pressure ventilation (S/T technology) are recognized but limited on account of the variability of nocturnal ventilatory requirements. The new technique AVAPS-AE (...
La ventilation non invasive (VNI) est reconnue comme un traitement efficace de l’insuffisance respiratoire chronique hypercapnique. Surveiller la qualité de la VNI pendant le sommeil peut être préférable à son évaluation pendant la journée. Cet article rapporte les données d’un groupe international francophone qui a analysé de façon systématique de...
