Monday, April 10th, 2017

The Benefits Of Using CPAP

December 13, 2010 by  
Filed under CNA Training

Most patients I encountered in the ICU / CCU with a diagnosis of sleep apnea do not use their CPAP. Those who use them seem to have better results.

I work in a cardiac intensive care unit, CCU and SICU together. Since the nurse in the ICU, are very familiar with the correlation between untreated sleep apnea and heart disease, stroke or sudden death. And I wish I had dollar for every patient with “Obstructive Sleep Apnea” diagnosis in the table, and no CPAP when taken in the ICU.

Pauline (not his real name) came to MI and continued to have bypass surgery, but at the same time, stroking the intensive care unit.  Asked if he took her to the CPAP, Respironics has proudly supported a scholarship. At bedtime, I opened it and found an old CPAP face mask that may be suitable for his 100 pounds ago (I did mention that he was 5 feet 0 inches and weighed 140 pounds.?) Humidifier missing a piece and the tube is It was teeth marks – the dog or cat teeth marks.

“When was the last time you used this,”  I asked, thinking that perhaps this is his free time and his car is right at home in his bedside table.

“Oh, I don’t use it,” she said. “I just brought it in because the office nurse told me I ought to.”

Mentally slapping myself on the side of my head, I ask “Why don’t you use it?” 

“I don’t like having all that air forced into me,” he says. While the fans are going to be caught in a much more pleasant? (I’m so proud that I managed to bite my tongue before I say this to yourself.) Sure enough, he made his first three companies extubation, tracheostomy, but is now a structure of long-term care on a ventilator.

Hermann has a HeartMate II ventricular assist device. He was readmitted to the long transmission line recurrent infection. As part of the admissions process, I was on their list of problems with it – and during obstructive sleep apnea has been indexed. “Did you bring your CPAP?” I asked.

“I don’t need to use it anymore,” he said. “I have my HeartMate now!”  (For all nurses who have not worked with HeartMate, is a left ventricular assist device. They are used as bridge to transplantation, or destination therapy for heart failure. The blood is transported from the left ventricle through device and returned to the aorta).

Worse, when I read about his clinical notes, memoranda had been a nurse for a doctor with something to the effect “Patient refuses to use CPAP at night. Instructed to use it for 2 or 3 hours during the day when he’s watching TV, so he’ll get at least some benefit from it.” Really? I suspect that the man is not sleep apnea, when watching TV. By definition, one is in bed with sleep apnea.

Then there was the man who came to the valve surgery semi-elective. Once again, obstructive sleep apnea noted on its list of problems. “Did you bring your CPAP?” I asked. “Oh, no,” cried his wife. “He doesn’t like it, so he never uses it.” It has been five months and counting – he is still in intensive care. Hypertension, he developed after untreated sleep apnea caused left ventricular hypertrophy and was arrested after the surgery….

I loved when the patient has promised last week that he used his CPAP faithfully. “I don’t have it with me because I didn’t think I needed it in the hospital and all,”  he said. “But my wife can go home and get it.”

His wife went home and got the CPAP. Interestingly, neither the patient nor his wife had an idea of how to set or adjust mask worked. What were you using the CPAP? A clipboard? He is in his third admission for heart failure and are now talking about transplantation. I wonder if some of their problems could have been avoided if he had been using the CPAP won four years ago.

Could be my imagination but I swear there appear correlations with the CPAP and how to use it and the end result. . . that will take him and use it seems to do well in and out of intensive care soon. Those who do not make it, that only parts of it, can not do or do not even pretend to use it tend to hurt. Maybe it’s just that those who actually use CPAP are consistent with patients in general, and compliant patients do better, but I swear that the treatment of sleep apnea can improve patient outcomes.

I am a woman today admitted – with sleep apnea and heart disease – he says. “has sleep apnea, but I don’t need to use a CPAP. They told me I only had to use it at night, and I sleep during the day.”  I tried to teach the correlation between sleep apnea and heart disease. “Oh,”  he said. “I guess I could use it, but it’s just so difficult. You have no idea how difficult it is, strapping that thing on your face and trying to go to sleep.”

I know how hard it is. I pulled one on each night when I go to sleep – and in the evening when I take a nap, too. It’s uncomfortable, unattractive, uncomfortable, and against nature. It could save your life, however.

CPAP: Use it and live.