Latest news with #BiPAP
Medscape
13-06-2025
- Health
- Medscape
Rapid Rx Quiz: Sleep Apnea Devices
CPAP (continuous positive airway pressure), along with other devices such as APAP (automatic positive airway pressure) and BiPAP (bilevel positive airway pressure), have been the mainstay in treating obstructive sleep apnea (OSA) for decades. Despite their proven effectiveness, patients can struggle with discomfort or intolerance of these treatments, which can lead to suboptimal adherence. As a result, alternative devices have been developed to address the needs of individuals who cannot tolerate traditional therapy, offering other approaches to maintaining airway patency and managing related health outcomes. What do you know about devices for sleep apnea? Test yourself with this brief quiz. Current clinical practice guidelines from the AASM recommend the use of either APAP or CPAP in OSA treatment in adults. No clinically meaningful differences were found in outcomes of APAP treatment vs CPAP treatment, and benefits and harm were similar between the two modalities. Patient tolerance and symptom response should guide the choice of one over the other. APAP or CPAP are recommended over BiPAP for initial treatment of OSA in adults. BiPAP might provide an expiratory pressure that is too low to prevent obstructive breathing. However, BiPAP therapy for OSA might be appropriate in certain patients, such as those who have not responded to treatment with APAP and CPAP or those who require very high pressures (> 20 cm H2O). Learn more about sleep-disordered breathing and CPAP. According to current guidelines from the AADSM, patients should be seen by their dentist for a follow-up evaluation within 30 days after appliance insertion. During the first year, patients should be re-evaluated every 6 months, and at least once annually after that to assess treatment efficacy and adherence. At these visits, the treating dentist should use the same standardized tools and questionnaires employed during the initial evaluation to monitor symptoms and treatment response. Adjustment of the oral appliance depends on several factors, including the patient's mandibular range of motion, OSA severity, comfort, and observed changes in symptoms. A collaborative protocol between the treating dentist and the patient's medical provider should be in place to support objective and coordinated assessment. Learn more about oral appliance therapy for OSA. The implantable hypoglossal nerve stimulator received US Food and Drug Administration (FDA) approval in 2014 for the treatment of moderate to severe OSA in patients who have not responded to or cannot tolerate PAP therapy. As hypoglossal nerve stimulation has been shown to be most efficacious in those with a BMI < 32, an adult with moderate OSA and a BMI of 28 probably would be a good candidate for this treatment approach. Hypoglossal nerve stimulation has not been approved in patients aged < 18 years, so a boy aged 15 years would not be a candidate. Also, the stimulator is contraindicated in patients with central sleep apnea. The safety of hypoglossal nerve stimulation has not been established in pregnant patients and should not be undertaken. Learn more about upper airway evaluation in snoring and OSA. An external tongue muscle stimulator device was cleared by the FDA in 2020. Intended for use 20 min/d for 6 weeks and then twice per week subsequently, the device requires far less patient time commitment than some other OSA therapy devices. The tongue muscle stimulator is designed to be used while awake for 20-minute increments. It is indicated for snoring and mild OSA and is not indicated to treat OSA with an apnea-hypopnea index (AHI) > 15. The device is approved only for adults aged ≥ 18 years. Learn more about macroglossia. EPAP devices are noninvasive, valve-based devices for the treatment of mild to moderate OSA. They function by creating resistance during expiration, generating back pressure that helps keep the upper airway open during sleep. Unlike CPAP therapy, which provides constant pressure during both inhalation and exhalation, EPAP devices are passive and provide pressure only during expiration. These devices do not require batteries or power sources. They resemble nasal pillows, like those used with many CPAP machines. Unlike oral appliances, EPAP devices do not require custom fitting. Monthly calibration is also not needed. Learn more about pathologic conditions associated with OSA.
Indian Express
11-06-2025
- Health
- Indian Express
Gujarat's active Covid tally crosses 1,200 mark; 1 death reported officially, hospitals confirm 4 more
The number of active Covid cases in Gujarat reached 1,227 on Tuesday, just a day after it crossed the 1,000 mark. Meanwhile, while the state health department has officially reported just one Covid death, at least four other patients with comorbidities have lost their lives during the latest surge in cases. A total of 105 patients were discharged on Tuesday. Of the active cases, 23 patients have been admitted to various hospitals, while 1,204 are in home isolation. While four women have recently died due to Covid in Ahmedabad, a man admitted to Rajkot Civil Hospital died on Tuesday, confirmed the hospital administration. The state government, however, has confirmed only one death in Ahmedabad after the fresh spate of cases. The five deaths and co-morbidities The 55-year-old man who died on Tuesday, had been suffering from hypertension since the last one year. There was a recent detection of diabetes. He had been admitted to Rajkot Civil Hospital after he complained of breathlessness along with fever. He was also a patient of acute leukemia (blood cancer). The patient, who was under treatment at a private hospital initially, was later transferred to AIIMS Rajkot after doctors conducted an HRCT scan. AIIMS Rajkot then referred him to Rajkot Civil Hospital, where he died on Tuesday. Notably, the man had taken all three doses of Covid vaccination. Ahmedabad's LG Hospital has reported deaths of two Covid patients with comorbidities. One 47-year-old woman from Danilimda with hypertension was admitted on May 23. Her condition deteriorated rapidly, suffering septiscemia, leading to further complications and death on May 28. Another was an 18-year-old who had delivered a child just a week before being admitted to the hospital on May 30. She was said to have developed cardiomyopathy and died at the hospital on June 2. Two other patients, who were admitted at GMERS Sola Civil Hospital in Ahmedabad, also lost their lives. A 20-year-old Covid patient, who was admitted on May 13, delivered a pre-term baby in the seventh month of her pregnancy on May 27, and was kept on BiPAP oxygen support. On May 30, while she tested negative for Covid, her three-day-old child tested positive. On June 3, the woman suddenly left the hospital with her child, taking Discharge Against Medical Advice (DAMA). She died at her residence later that day. This is the only Covid death to have been confirmed and reported by the state government during the recent spike in cases. The second patient to have died at GMERS Sola Civil Hospital was a 16-year-old girl from Sabarkantha, who was admitted on June 4. Medical tests confirmed that she had tested positive for Covid-19 and Hepatitis B virus. She died during treatment on June 8.
Yahoo
06-06-2025
- Health
- Yahoo
Testimony differs between doctor, family in Grace Schara's wrongful death case vs Ascension
The doctor and registered nurse who cared for Grace Schara were among the witnesses to testify during the first week of the wrongful death trial, providing the jury their first opportunity to hear details from those responsible for her care. Grace, who had Down syndrome, died at age 19 on Oct. 13, 2021, after being admitted to Ascension NE Wisconsin − St. Elizabeth Hospital in Appleton for symptoms of COVID-19. Her father filed a wrongful death lawsuit a year and a half later. The hospital, Dr. Gavin Shokar and Hollee McInnis, a registered nurse, are named in the lawsuit. Testimony provided by Shokar and McInnis highlighted differences from testimony earlier in the week from Grace's parents, Scott and Cindy Schara. It also stood in stark contrast to the testimony given by the family's medical expert, who argued Grace failed to be correctly diagnosed and died of a drug overdose as a result of an illegal do not resuscitate order, not COVID-19 pneumonia. The jury is being provided the chance to submit questions to the judge following testimony from each witness. Outagamie Circuit Court Judge Mark McGinnis then decides if witnesses are allowed to answer them. More: Grace Schara's family wants jury to decide hospital caused her death, not COVID-19. What to know about the case. More: Grace Schara's wrongful death trial against Ascension St. Elizabeth begins As of June 6, those questions have sought clarity on whether Grace had power of attorney and do not resuscitate documents in her chart and how confusion over Grace's code status, specifically the fact a "do not resuscitate" order was placed in her chart by Shokar on the day of her death. Grace's parents and her older sister, Jessica Vander Heiden, were Grace's powers of attorney. They had two phone conversations with Shokar regarding what should occur in the event her health deteriorated. The first took place on Oct. 12, the day prior to Grace's death. Shokar told the family he really had no more 'wiggle room' to continue treating her on the BiPAP breathing machine, should her lungs continue to deteriorate. Shokar told the family that Grace's lungs were scarring, and the BiPAP machine was operating at its maximum capacity. The only breathing machine remaining as an option was a ventilator, Shokar said he told the family. When asked, he told the family there was a "roughly 20% survival rate" for patients in Grace's condition, if the family chose intubation, Shokar said. Shokar said he discussed what recovery could look like, including the possibility Grace might need a tracheotomy, the life-long use of supplemental oxygen, or a lengthy amount of time on a ventilator and rehabilitation. If a ventilator was not an option, discussions including keeping her on BiPAP and 'hope for the best," Shokar said while testifying. Shokar said he asked the family to decide quickly, "as Grace could crash at any time," and the night team would like to know what to do if that happens. Failing to receive a callback, Shokar called the family on the morning of Oct. 13, 2021. 'Doctor, thank you for all your time and explaining everything. I talked about this with my family and we have decided to move forward with a DNI,' Shokar said he recalled being told by Scott Schara. A DNI means a patient should not be intubated. It is a separate order from a do not resuscitate order. 'Absent of intubation,' Shokar testified all he could do was attempt to slow her breathing rate, which eventually included giving her morphine. It was unclear from Shokar's testimony if this was his rational for placing a DNR order on Grace's chart. He stressed he spoke with the family on two occasions, each time for close to an hour, and was clear about the futility of chest compressions, should Grace need to be resuscitated. He also testified he had "never unilaterally placed a DNR order on a patient's chart." McInnis, the nurse, testified she could not remember if Grace was wearing the purple, do not resuscitate bracelet that St. Elizabeth health care staff place on DNR patients. McInnis said if she was not wearing it, it was only because she had gotten too busy to put it on Grace. A normal breathing or respiratory rate is 12 to 20 breaths per minute. The day of Grace's death she was taking 60 breaths per minute. Breathing this fast is unsustainable and an emergency situation, McInnis and Shokar said while testifying. Prior to the start of the trial, Grace's parents and her older sister detailed how Vander Heiden made a FaceTime call to her parents when she saw Grace's condition worsening during the early evening hours of Oct. 13. With phone in hand, Vander Heiden said she ran out of Grace's room, shouting for someone to help her sister. It was at this point they learned Grace was a "do not resuscitate," they said. When they shouted, "save our daughter," no staff responded, the family members said. "I have no recollection of this," McInnis said. Neither did Shokar, according to his testimony. A patient's code status is not static, medical professionals told the Milwaukee Journal Sentinel, it can be changed at anytime. Dr. Gilbert Berdine is an associate professor of internal medicine and medical education at the Texas Tech University Health Sciences Center and earned his medical degree from Harvard University School of Medicine. Berdine testified it is his belief that Grace died when she failed to be diagnosed and then be treated for metabolic acidosis, a condition that occurs when too much lactic acid builds up in the body. Lactic acid is produced by muscle and red blood cells when a body is low on oxygen, and consequently low on energy. "Your heart consists of muscle fibers, and when your blood is too acidic, muscle fibers can no longer contract," he said. "Your heart stops beating." He said instead of Shokar administering ativan and morphine, Grace should have been given bicarbonate to counter the acidity in her body, Narcan to reverse the impacts of the drugs, and norephedrine to increase blood pressure and heart rate. Berdine cited various results of Grace's blood-gas lab tests as evidence she was experiencing, but not being treated, for the condition. Instead, she continued to be given drugs that lowered her respirator and heart rates, namely precedex, lorazepam and morphine. There was no discussion of metabolic acidosis during Shokar's testimony. Berdine said placing Grace on a ventilator on Oct. 13 would have been a good idea, but not for the same reasons as her doctors. "Placing her on a ventilator would have led to a blood-gas test," Berdine said. "They would not have been able to miss the metabolic acidosis anymore. And yes, it would have been helpful but it was not necessary on the 12th, for the same reason. It would have led to the correct diagnosis." He said it is a "breach of the standard of care," if Grace's family was not made aware of all the drugs she was receiving and informed of oversedation episodes. Scott Schara testified he was not aware his daughter was being given any of these drugs. "Patients or their advocates can't make correct decisions without being informed," Berdine said. "That is not a good way to run a hospital." Jessica Van Egeren is a health care reporter and assistant breaking news editor with the Milwaukee Journal Sentinel. She can be reached at jvanegeren@ This article originally appeared on Milwaukee Journal Sentinel: Grace Schara's wrongful death trial: Ascension doctor, nurse testify during week 1
Time of India
03-06-2025
- General
- Time of India
Season's 1st Covid death in state is 43-yr-old with comorbidities
1 2 Kolkata: Bengal saw its first Covid-related death this year, after a 43-year-old woman passed away at a south Kolkata hospital on Tuesday. The deceased had heart and kidney ailments, said sources. This was among the five Covid deaths reported across the country on Tuesday. While the current spike is causing mostly mild infections, individuals with comorbidities need to remain cautious as they were vulnerable to severe infections, said health experts. The state reported 41 fresh cases in the past 24 hours, taking its total active caseload to 372, most of which are concentrated in Kolkata. At present, almost all major hospitals across the city have patients admitted for Covid treatment. The 43-year-old woman was admitted to CMRI Hospital on May 28 with complaints of a two-week-long bout of fever and respiratory distress. Suspected of an infection, her respiratory samples were sent for a viral panel test and she tested positive for Covid-19. While she apparently had no existing health conditions, tests revealed her heart ejection fraction was as low as 20%. Her urine output kept declining, due to which she was given dialysis. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like 5 Books Warren Buffett Wants You to Read In 2025 Blinkist: Warren Buffett's Reading List Undo Initially under BiPAP support, doctors had to put her on ventilation as she kept sinking. "On finding sepsis indications, our medical team put up their best. But the decline in her condition, including the organ damage, was very swift. Some adjuvant health conditions were probably the cause of such a fast decline," said the unit medical head of the hospital. The death report cites acute coronary syndrome, acute kidney injury and septic shock in a case of Covid-19. Of the eight Covid-19 positive patients admitted at the hospital, the 43-year-old was the only one under intensive care. Reacting to this, Peerless Hospital chief microbiologist Bhaskar Narayan Chaudhuri said: "Whenever there is an outbreak of any infection like influenza, adenovirus, or Covid-19, there would be a few mortalities. That is the reason why the vulnerable need to remain protected." Peerless's lab detected three positive cases on Tuesday, including that of a child, who is admitted at the hospital. Critical care and ECMO specialist Arpan Chakraborty of Apollo Multispecialty Hospital said that a section of patients with comorbidities was likely to need intensive care if they tested positive for Covid. Among the seven Covid positive patients admitted at the hospital was an 80-year-old man who had heart issues. "Timely detection and close monitoring in hospital are required for patients," said infectious diseases specialist Sayan Chakraborty of Manipal Hospital Dhakuria. "We have three Covid patients, including one in the ICU, while we discharged two recently," said Doli Biswas, chief nursing officer of Fortis Hospital Anandapur. RN Tagore Hospital has two Covid-19 positive patients.
The Advertiser
03-06-2025
- Business
- The Advertiser
Tech giant sued over sleep aid foam inhalation 'risk'
An alleged risk of patients breathing in or swallowing small particles of foam from degrading sleep aids has prompted the federal government to take legal action. Multinational health technology company Philips is accused of selling defective ventilators aimed at assisting with sleep apnoea and, after those products were recalled in June 2021, selling a further device which was also dangerous. In the lawsuit filed on Monday, the Therapeutic Goods Administration claims both sets of devices did not meet Australian safety standards. Devices sold prior to June 2021 contained a polyester-based polyurethane foam used for noise suppression. "There was a real risk of the (foam) degrading and then particulates being inhaled or ingested by the patient," the agency wrote in a statement. The potential harms from these devices included skin, eye and respiratory tract irritation, headaches, asthma and impacts on the reproductive system. Long-term exposure could damage or kill a patient's cells, cause genetic damage or cause cancer, the health watchdog alleges. "The probability of degradation, and consequential harm to the patient, was unacceptable, given the potentially serious consequences," the lawsuit claims. Philips did not conduct any risk analysis on the products until early 2021, the government agency says. Ten devices sold under the BiPAP, DreamStation, OmniLab and REMstar brands were recalled globally in June that year. After this date, Philips allegedly sold a further defective device, the Trilogy 100. This contained silicone foam which could become detached from its housing, obstructing the air path. Potential adverse health effects included increased carbon dioxide levels or low oxygen levels in the patient's blood. The TGA is seeking pecuniary penalties and orders that Philips pay its legal costs. A Philips spokeswoman said the lawsuit only revolved around the company's activities before and during the 2021 recall. "The proceeding does not make allegations about the quality and safety of products currently marketed in Australia by Philips," she said. The spokeswoman said extensive testing had been conducted internally as well as with five independent laboratories and third-party experts since June 2021. This testing concluded that the use of Philips sleep therapy devices presently sold on the market "is not expected to result in appreciable harm to health in patients". Philips would review the court documents filed by the TGA and engage constructively as required, she said. An alleged risk of patients breathing in or swallowing small particles of foam from degrading sleep aids has prompted the federal government to take legal action. Multinational health technology company Philips is accused of selling defective ventilators aimed at assisting with sleep apnoea and, after those products were recalled in June 2021, selling a further device which was also dangerous. In the lawsuit filed on Monday, the Therapeutic Goods Administration claims both sets of devices did not meet Australian safety standards. Devices sold prior to June 2021 contained a polyester-based polyurethane foam used for noise suppression. "There was a real risk of the (foam) degrading and then particulates being inhaled or ingested by the patient," the agency wrote in a statement. The potential harms from these devices included skin, eye and respiratory tract irritation, headaches, asthma and impacts on the reproductive system. Long-term exposure could damage or kill a patient's cells, cause genetic damage or cause cancer, the health watchdog alleges. "The probability of degradation, and consequential harm to the patient, was unacceptable, given the potentially serious consequences," the lawsuit claims. Philips did not conduct any risk analysis on the products until early 2021, the government agency says. Ten devices sold under the BiPAP, DreamStation, OmniLab and REMstar brands were recalled globally in June that year. After this date, Philips allegedly sold a further defective device, the Trilogy 100. This contained silicone foam which could become detached from its housing, obstructing the air path. Potential adverse health effects included increased carbon dioxide levels or low oxygen levels in the patient's blood. The TGA is seeking pecuniary penalties and orders that Philips pay its legal costs. A Philips spokeswoman said the lawsuit only revolved around the company's activities before and during the 2021 recall. "The proceeding does not make allegations about the quality and safety of products currently marketed in Australia by Philips," she said. The spokeswoman said extensive testing had been conducted internally as well as with five independent laboratories and third-party experts since June 2021. This testing concluded that the use of Philips sleep therapy devices presently sold on the market "is not expected to result in appreciable harm to health in patients". Philips would review the court documents filed by the TGA and engage constructively as required, she said. An alleged risk of patients breathing in or swallowing small particles of foam from degrading sleep aids has prompted the federal government to take legal action. Multinational health technology company Philips is accused of selling defective ventilators aimed at assisting with sleep apnoea and, after those products were recalled in June 2021, selling a further device which was also dangerous. In the lawsuit filed on Monday, the Therapeutic Goods Administration claims both sets of devices did not meet Australian safety standards. Devices sold prior to June 2021 contained a polyester-based polyurethane foam used for noise suppression. "There was a real risk of the (foam) degrading and then particulates being inhaled or ingested by the patient," the agency wrote in a statement. The potential harms from these devices included skin, eye and respiratory tract irritation, headaches, asthma and impacts on the reproductive system. Long-term exposure could damage or kill a patient's cells, cause genetic damage or cause cancer, the health watchdog alleges. "The probability of degradation, and consequential harm to the patient, was unacceptable, given the potentially serious consequences," the lawsuit claims. Philips did not conduct any risk analysis on the products until early 2021, the government agency says. Ten devices sold under the BiPAP, DreamStation, OmniLab and REMstar brands were recalled globally in June that year. After this date, Philips allegedly sold a further defective device, the Trilogy 100. This contained silicone foam which could become detached from its housing, obstructing the air path. Potential adverse health effects included increased carbon dioxide levels or low oxygen levels in the patient's blood. The TGA is seeking pecuniary penalties and orders that Philips pay its legal costs. A Philips spokeswoman said the lawsuit only revolved around the company's activities before and during the 2021 recall. "The proceeding does not make allegations about the quality and safety of products currently marketed in Australia by Philips," she said. The spokeswoman said extensive testing had been conducted internally as well as with five independent laboratories and third-party experts since June 2021. This testing concluded that the use of Philips sleep therapy devices presently sold on the market "is not expected to result in appreciable harm to health in patients". Philips would review the court documents filed by the TGA and engage constructively as required, she said. An alleged risk of patients breathing in or swallowing small particles of foam from degrading sleep aids has prompted the federal government to take legal action. Multinational health technology company Philips is accused of selling defective ventilators aimed at assisting with sleep apnoea and, after those products were recalled in June 2021, selling a further device which was also dangerous. In the lawsuit filed on Monday, the Therapeutic Goods Administration claims both sets of devices did not meet Australian safety standards. Devices sold prior to June 2021 contained a polyester-based polyurethane foam used for noise suppression. "There was a real risk of the (foam) degrading and then particulates being inhaled or ingested by the patient," the agency wrote in a statement. The potential harms from these devices included skin, eye and respiratory tract irritation, headaches, asthma and impacts on the reproductive system. Long-term exposure could damage or kill a patient's cells, cause genetic damage or cause cancer, the health watchdog alleges. "The probability of degradation, and consequential harm to the patient, was unacceptable, given the potentially serious consequences," the lawsuit claims. Philips did not conduct any risk analysis on the products until early 2021, the government agency says. Ten devices sold under the BiPAP, DreamStation, OmniLab and REMstar brands were recalled globally in June that year. After this date, Philips allegedly sold a further defective device, the Trilogy 100. This contained silicone foam which could become detached from its housing, obstructing the air path. Potential adverse health effects included increased carbon dioxide levels or low oxygen levels in the patient's blood. The TGA is seeking pecuniary penalties and orders that Philips pay its legal costs. A Philips spokeswoman said the lawsuit only revolved around the company's activities before and during the 2021 recall. "The proceeding does not make allegations about the quality and safety of products currently marketed in Australia by Philips," she said. The spokeswoman said extensive testing had been conducted internally as well as with five independent laboratories and third-party experts since June 2021. This testing concluded that the use of Philips sleep therapy devices presently sold on the market "is not expected to result in appreciable harm to health in patients". Philips would review the court documents filed by the TGA and engage constructively as required, she said.
