Pressure and the heart - any truth to this?

[Rubicon]

I would disregard everything Rubicon posted...

Or you can do that.

I really don't give a FF.

[Janknitz]

Cool, but my point is that the group becomes significantly higher at CPAP >25 cmH2O.

There's NO indication that the OP has a machine capable of going over 20 cm/H2O, considering he was prescribed a fixed pressure of 12. CPAP and APAP machines do not go over 20 cm/H20. Nor is there any evidence that the OP has any signs or symptoms that would raise the concern. And even if the incidence doubles for people prescribed a PAP capable of higher pressures, it is still going to be exceedingly rare.

After an extensive review of literature, we found only 4 other cases of PTX occurring with the use of NPPV for OSA

(Emphasis added).
https://www.ncbi.nlm.nih.gov/pmc/articl ... 0is%20rare.

The literature cited in that article finding four cases spanned 22 years, from 1998 to 2020. And only one of those cases showed no underlying lung disease.

[Rubicon]

There's NO indication that the OP has a machine capable of going over 20 cm/H2O, considering he was prescribed a fixed pressure of 12. CPAP and APAP machines do not go over 20 cm/H20.

However, to your point, there aren't any machines that could provide that pressure, nor would anybody in their right mind order it or experiment with it.

Seriously-- do you have a learning disability?

[Rubicon]

No wait.

Palerider put you guys up to this.

Great prank!

[SleepGeek]

Palerider put you guys up to this.

Happiness is getting put on PRs Foe List.

[palerider]

No wait.

Palerider put you guys up to this.

Great prank!

No he didn't, he didn't get around to reading the forum until a few minutes ago. They did this all on their own!

[Rubicon]

Happiness is getting put on PRs Foe List.

Well, what did you do to get on the list?

[Rubicon]

After an extensive review of literature, we found only 4 other cases of PTX occurring with the use of NPPV for OSA

(Emphasis added).
https://www.ncbi.nlm.nih.gov/pmc/articl ... 0is%20rare.

The literature cited in that article finding four cases spanned 22 years, from 1998 to 2020. And only one of those cases showed no underlying lung disease.

That's completely irrelevant under any part of this discussion, even if we use your misinterpretation of what I said, because:

1. I guess it's kinda tough if you're one of the guys who gets a pnx tho, huh?

2. "Reported in the literature"? That's stupid, because not all cases are "reported in the literature". It's about incidence, and we'll get to that in a minute.

3. If people are doing their job, then patients with blebs won't end up on high CPAP/PEEP and get "reported in the literature" because they'll be identified beforehand and never have to suffer the risk by getting put on high level CPAP/PEEP.

If you take all comers for NIPPV and IPPV then the incidence of pnx ranges from 2-15%. And that's tons of people.

And if you take my original point that major risk occurs

Once you start hitting about 25 cmH2O.

if you have blebs I can guarantee you you'll get a pnx in about 2 breaths.

[Rubicon]

Personally I would dump the doctor and get a second opinion.

It wasn't a doctor it was

an AP-RN who works for the large medical practice that operates the center.

Does anybody read anything?

[Rubicon]

Cool, but my point is that the group becomes significantly higher at CPAP >25 cmH2O.

Nor is there any evidence that the OP has any signs or symptoms that would raise the concern. And even if the incidence doubles for people prescribed a PAP capable of higher pressures, it is still going to be exceedingly rare.

After an extensive review of literature, we found only 4 other cases of PTX occurring with the use of NPPV for OSA

(Emphasis added).

The literature cited in that article finding four cases spanned 22 years, from 1998 to 2020. And only one of those cases showed no underlying lung disease.

Well, that original discussion point included all complications for the entire

subset of people for whom too much pressure can present a danger.

but we can talk more on pnx if you want.

What's your closest association with pnx? In mine, I was actually touching the guy when his bleb blew.

What's yours?

[Pugsy]

Does anybody read anything?

I can answer that question.....and my thoughts are "no, not really and/or they often misinterpret what someone says when they do"...but my gut response is "rarely". Hence the gazillion questions we see here every day and it's an extreme rarity that we ever see a totally new question.

I got your original answer to the original question.

I've done quite a bit of reading about CPAP, and I've never come across that claim. Is there any truth to it?

and your response was

Once you start hitting about 25 cmH2O.

Very high pressures start to impinge upon the capillary bed, and blood starts to back up behind right heart and accumulate in the periphery.

Which tells me that it's not that much of a risk until people start hitting 25 cm pressure and apap/cpap can't go that high and the number of machines that will go above 25 is really, really small.

But then I have also read the warnings and contraindications that come with every cpap out there
It's right there for anyone to read in the manuals.

Contraindications
Positive airway pressure therapy may be contraindicated in some patients with the following pre-
existing conditions:
 severe bullous lung disease
 pneumothorax
 pathologically low blood pressure
 dehydration
 cerebrospinal fluid leak, recent cranial surgery, or trauma.

Duh....those are some rather serious problems that I just imagine if someone were to fall in those categories it wouldn't come as a total surprise to the patient and/or the medical care team involved.....and if it did someone isn't doing their job very well.

But back to the original question again....
OP was told something by an RN in the medical team....was it the truth???? Well technically I suppose it was if someone were to really stretch that out and give the benefit of the doubt but I don't think that fear was the reason behind the "don't go f....g around with pressures" warning. I think it was said to scare the bejesus out of someone because the medical care team (or at least that RN) was on a big power trip and didn't believe patients were smart enough to figure out pressure needs on their own.

Do doctors, RNs, DMEs or anyone else lie to people just to extend their power trip grip??? You bet your sweet ass they do.


Now you guys/gals quit with your fighting and get back on topic please.
I hadn't read this thread for quite a while because once I saw Rubicon's original answer (albeit in a bit of code) I didn't see the need for further response.
Question ...has anyone ever heard of that?
Answer....yes but at pressures of 25 or higher.

Then Rubicon gets attacked instead of politely asking him to explain further and we have another derailment going on here with a side dose of personal shit attacks. Leaves a bad taste in my mouth folks.

Get back on topic please.

[babydinosnoreless]

Personally I would dump the doctor and get a second opinion.

It wasn't a doctor it was

an AP-RN who works for the large medical practice that operates the center.

Does anybody read anything?

Same difference. Same advise. Get a second opinion. Doctors /nurses or whatever letters they have after their names they are all practicing. If you don't like what they have to say and you don't want to take medical advise from some random dude on the internet get a second opinion. Myself, I trust the random internet person over the doctors but thats my own hang up. You do you.

To the op: Sorry your thread is getting derailed. If there are no other sleep experts in your area you trust have you thought about telehealth ?

[Rubicon]

I trust the random internet person over the doctors

Congratulations!

With that comment you've earned Spot #1 on the (a) PR Beware List!

[babydinosnoreless]

I trust the random internet person over the doctors

Congratulations!

With that comment you've earned Spot #1 on the (a) PR Beware List!

Pr is one of the random internet people that helped me to get my own settings right when the doctors did not. He and pugsy have more pap related knowledge than any doctor I've ever met and I highly recommend them both as good resources for pap.

That being said I earned a place on pr's foe list a long time ago for something non pap related. I know for some reason you guys feel the need to whip out your measuring tapes but leave me out of your testosterone soaked squabbles.

[earlvillestu]

OP here with a couple of points of clarification.

1. I'm using a ResMed AirSense 11 AutoSet. Couldn't set it at 25 even if I wanted to.

2. Yes, I'm dealing directly with an RN. The sleep study with its recommendations was signed off on by two MDs, a resident and an attending, and the prescription was signed by an MD. I've never seen or talked to any of them. My only contacts have been with the aforementioned RN (two telehealth visits, before and after the study, and the latest visit, which was in-person), and with the technician during the study. As I mentioned, the sleep center is run by a large medical practice, and in general you mostly deal directly AP-RNs or PAs.

3. I'm happy with how the therapy is going and plan to continue doing what I'm doing. Since I'm self-pay, I don't have to worry about any of the compliance BS -- although since early June, there's been only one night where I didn't get 4 hours in.