Positive Pressure Devices Research Articles

Pilot Randomized Clinical Trial of a Passive Non-invasive Positive End-Expiratory Pressure (PEEP) Device for Delivering Positive Pressure Therapy Compared to Standard Care in Non-critically Ill Patients With COVID-19.

During the COVID-19 pandemic, there were reports of a shortage of ventilators and oxygen supply, particularly in resource-limited settings. We report the preliminary evaluation of a non-invasive positive end-expiratory pressure (PEEP) mask in hospitalized non-critically ill patients with COVID-19. We randomly assigned hospitalized adult patients with confirmed COVID-19 infection and requiring greater than 40% supplemental oxygen to either standard care oxygen delivery (control) or via Materialise passive non-invasive PEEP device mask (intervention; Belgium). The primary outcome was a change in mean respiratory rate from baseline over the first three hours after the commencement of the intervention. Secondary outcomes included dyspnea score, need for escalation of respiratory or cardiovascular support, days alive and free of ICU, and day-28 mortality. Between April 30, 2021, and October 10, 2021, we enrolled 132 (65 control, 67 intervention) patients in the study. The mean respiratory rates at baseline were 23 ± 3 and 23 ± 3 in the control and intervention groups, with no significant differences at three hours (23 ± 2.3 vs. 23 ± 2.1, p=0.14). The control group had a higher mean dyspnea score compared to the intervention group (day 5: 5.4 ± 1.6 vs. 4.7 ± 1.4, p=0.015; day 6: 4.7 ± 1.7 vs. 4.0 ± 0.7, p=0.008). A higher proportion of patients in the control group required escalation of respiratory support (38%), as compared to intervention (12%) (p=0.0004). The two groups had no significant differences across other secondary outcomes or with respect to adverse events (barotrauma, aspiration pneumonia, need for vasopressor support). The use of the novel mask compared to standard care in hospitalized non-critically ill patients with COVID-19 was not associated with reductions in the respiratory rate but was associated with a reduction in the need for escalation of respiratory support without an increase in adverse effects. Large-scale clinical trials of this device are warranted.

Central Sleep Apnea: An Update of Current Treatment and the Role of Positive Pressure Devices

Central Sleep Apnea: An Update of Current Treatment and the Role of Positive Pressure Devices

Respiration-triggered olfactory stimulation reduces obstructive sleep apnea severity: A prospective pilot study.

Obstructive sleep apnea is a prevalent sleep-disordered breathing condition characterized by repetitive reduction in breathing during sleep. The current care standard for obstructive sleep apnea is continuous positive air pressure devices, often suffering from low tolerance due to limited adherence. Capitalizing on the unique neurocircuitry of olfactory perception and its retained function during sleep, we conducted a pilot study to test transient, respiration-based olfactory stimulation as a treatment for obstructive sleep apnea markers. Thirty-two patients with obstructive sleep apnea (apnea-hypopnea index ≥ 15 events per hr) underwent two polysomnography sessions, "Odour" and "Control", in random order. In "Odour" nights, patients were presented with transient respiratory-based olfactory stimulation delivered via a computer-controlled commercial olfactometer (Scentific). The olfactometer, equipped with a wireless monitoring, analysed respiratory patterns and presented odour upon detection of respiratory events. No odours were presented in "Control" nights. Following exclusions, 17 patients entered the analysis (four women, 47.4 (10.5) years, body mass index: 29.4 (6.3) kg m-2). We observed that olfactory stimulation during sleep reduced the apnea-hypopnea index ("Odour": 17.2 (20.9), "Control": 28.2 (18.6), z = -3.337, p = 0.000846, BF10 [Bayesian Factor 10]= 57.9), reflecting an average decrease of 31.3% in the number of events. Relatedly, stimulation reduced the oxygen desaturation index by 26.9% ("Odour": 12.5 (15.8), "Control": 25.7 (25.9), z = -3.337, p = 0.000846, BF10 = 9.522). This effect was not linked to the severity of baseline obstructive sleep apnea markers (ρ = -0.042, p = 0.87). Olfactory stimulation did not arouse from sleep or affect sleep structure, measured as time per sleep stage (F1,16 = 0.088, p = 0.77). In conclusion, olfactory stimulation during sleep was effective in reducing the severity of obstructive sleep apnea markers without inducing arousals, and may provide a novel treatment for obstructive sleep apnea, prompting continued research.

MT15 Adherence to Positive Airway Pressure Therapy in a Cohort of Colombian Patients with Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) is an important risk factor for several cardiovascular diseases including stroke and coronary heart disease. Positive air pressure (PAP) devices are part of the treatment for OSAS. We describe adherence to the use of PAP devices in a cohort of patients with OSAS in Colombia, and their hospitalization rates and cardiovascular comorbidities.

Respirometry Rate Measurement by Pyroelectric Effect of a Piezo Sounder—Monitor and Alarm by Single Device

This article describes a novel application of a piezoelectric sounder on an acoustic device as a respiratory detector. When human exhaled air at a temperature of 36.5 °C is blown onto the piezoelectric device in the sounder in a room of 26.4 °C, a peak voltage of 1–2 V directly appears without an amplifier. We herein present a theoretical model of how the device works, experimentally prove its validity, and show its potential to be used as a spirometry detector. The output voltage changes alongside the output of a medical spirometer for forced vital capacity test respiration. The device is noise robust under a variety of measurement conditions, including different masks, shields, snorkels, and sustained airway positive pressure devices. The S/N ratios for quiet sitting, walking, quick face swing, and mask movement were 38, 33.3, 32.3, and 30.9 dB, respectively. The piezoelectric sounder considered herein can return to the original function and generate an alarm if the measured reparation is abnormal.

Negative Pressure Ventilation for COVID-19 Respiratory Failure: A Phoenix from the Ashes?

Aim:To critically review the clinical question: does negative pressure ventilation (NPV) have a role in the management of COVID-19-associated respiratory failure?Background: NPV was commonly used in the management of respiratory failure until the 1950s when positive pressure devices began to be utilized. Physiological responses to NPV differ from responses to positive pressure ventilation, PPV, in a number of ways that may have clinical advantages in the management of respiratory failure in general, and specifically in the care of COVID-19-associated respiratory failure.Design:Narrative review based on systematic literature research.Data sources:A search on OVID MEDLINE and EMBASE for NPV provided key publications, which were combined with recent relevant literature related to the present COVID-19 pandemic.Results:A total of 83 papers are included in the review and analysis. NPV has been used for >100 years across a range of clinical conditions including polio, adult respiratory distress syndrome, acute respiratory failure in chronic obstructive pulmonary disease patients, a range of neuromuscular disorders, chest wall disease, and post-cardiothoracic and spinal surgery. The potential benefits of NPV, in comparison the treatment of COVID-19 patients, may include improved ventilation, decreased lung damage, improved hemodynamics, ease of proning, and prevention of escalation to intubation.Conclusions:Historic and recent published evidence from animals and man support the use of NPV in acute respiratory failure in general, and strongly suggests that it may be particularly useful in COVID-19-associated respiratory failure. Clinical evaluation of a new lightweight, cost-effective NPV device is justified as it may result in a safe, effective, and economical solution to COVID-19-associated respiratory failure. It could be useful worldwide, but particularly in low and middle-income countries.

Assessment of Nurses' knowledge about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit

Background: One of the most unpleasant and painful NCPAP related complication is the risk of nasal skin breakdown. It commonly occurs on areas under high pressure of nasal interface, mostly on the nasal bridge but can take place at any area under pressure of mask or prong which are used to connect the ventilation system to the patient’s nose. Objective: Evaluation of nurses' knowledge about Neonatal Continuous Positive Airway Pressure (CPAP) Nasal Injuries at Neonatal Intensive Care Unit. Methodology: A Descriptive cross-sectional study, quantitative research has been carried throughout the present study to evaluate their management about nasal injury related to CPAP at neonates’ intensive care units in hospitals of Medical City director in Baghdad and it examined the type of relationship between variables. During the period from 3rd October 2021 to 15th May 2022. Results of the study: Results that observed responses of high evaluated generally assigned, and they are accounted 27(81.82%) items, while leftover items were a assigned moderate evaluation 5(15.15%), and low evaluation 1(3.03%). Conclusion: In concerning nursing management about neonatal continuous positive airway pressure (CPAP) nasal injuries at neonatal intensive care unit are assigned at the established level in which that achieving goal of this study. Recommendations: Training courses to increase nurses' knowledge and practices about working on the continuous positive air pressure device. Keywords: Nurses' Knowledge, Neonatal Continuous Positive Airway Pressure (CPAP), Nasal Injuries, Neonatal Intensive Care Unit.

The effects of lateral pharyngoplasty on carotid intima-media thickness in patients with obstructive sleep apnoea.

IntroductionObstructive sleep apnea (OSA) is a known risk factor for development of carotid atherosclerosis. The treatment of OSA, through positive pressure devices or surgical procedures, may reduce the signs of subclinical atherosclerosis in apneic patients.ObjectiveThe decrease of carotid intima-media thickness (CIMT) after treatment of OSA remains a highly controversial issue. Our purpose is to compare CIMT, which represents an early sign of atherosclerosis, before and at least 6 months after lateral pharyngoplasty in patients with OSA.Material and MethodsA total of 17 patients with OSA who underwent lateral pharyngoplasty were submitted to common carotid Doppler ultrasonography, 24-hour ambulatory blood pressure monitoring and type-1 polysomnography before and at least 6 months after surgery.ResultsThe median apnoea-hypopnoea index decreased from 22.6 to 5.9 (p<0.001). There were significant improvements in the arousal index, minimum oxyhaemoglobin saturation, Epworth sleepiness scale and reported snoring intensity. The surgical success rate (Shers criteria) obtained with the procedure was 76.4%. There was no significant variation in the mean CIMT after surgeries (right carotid artery, mean, 0.67 and 0.72 mm; left carotid artery, mean, 0.69 and 0.70 mm, pre- and postoperative, respectively, both p>0.05). Blood pressure measurements also did not significantly change.ConclusionNotwithstanding a significant improvement in OSA after lateral pharyngoplasty, there was no significant reduction in CIMT in a follow-up of 6 months.

The effects of mechanical insufflation-exsufflation on lung function and complications in cardiac surgery patients: a pilot study

BackgroundPostoperative positive pressure lung expansion is associated with decreased pulmonary complications and improved clinical outcomes. The aim of the present study was to compare the differences in post-operative pulmonary complications and clinical outcomes between two groups of study subjects who underwent cardiac surgery; one included subjects who received mechanical insufflation-exsufflation (MI-E) and the other included subjects who received intermittent positive pressure breathing (IPPB) therapy.MethodsThis retrospective study included 51 subjects, who underwent cardiac surgery in an intensive care unit of a tertiary hospital during the time period from June 2017 to February 2018. After liberation from mechanical ventilation, the subjects received lung expansion therapy by means of two types of positive pressure devices, MI-E (n = 21) or IPPB (n = 30). The pulmonary complications, lung function, and clinical outcomes were compared between the two groups.ResultsSubjects in both groups displayed similar baseline characteristics and underwent similar types of surgical procedures. Compared to subjects who received non-oscillatory therapy, those who received MI-E therapy had higher post-operative force vital capacity (58.4 ± 4.74% vs. 46.0 ± 3.70%, p = 0.042), forced expiratory volume in one second (62.4 ± 5.23% vs. 46.8 ± 3.83%, p = 0.017), and peak flow rate (67.1 ± 5.53 L vs. 55.7 ± 4.44 L p = 0.111). However, the incidence of chest pain was higher in the MI-E group (n = 13, 61.9%) than in the IPPB group (n = 4, 16.7%; odds ratio, 0.123, 95% confidence interval, 0.03–0.45; p = 0.002). The length of hospital and ICU stay, development of atelectasis, pneumonia, and pleural effusion were similar in both the groups.ConclusionBoth IPPB and MI-E therapies have similar effects on preventing post-operative complications in cardiac surgery patients. However, compared to IPPB therapy, MI-E therapy was associated with better-preserved pulmonary function and higher incidence of chest pain.

Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study.

Obstructive sleep apnea (OSA) is a multilevel problematic disease. Major septal deviation (SD) can lead to severe nasal congestion, which, in turn, can lead to sleep apnea. Although SD seems to be related to OSA, very few studies have quantitatively examined this relationship. In this study, we investigate this using a 9-year large-scale cohort study. The SD group was selected out of 1 million individuals randomly extracted by the National Health Insurance Service. The non-SD group was obtained through propensity score matching considering several variables. The primary end point was OSA diagnosis. The study (SD) group included 11,238 individuals and the non-SD group (control group) included 22,476 persons. The overall hazard ratio for OSA in the SD group was 4.39 (95% confidence interval [CI]: 3.56-5.42). In subgroup analysis, the hazard ratio for OSA of male individuals was 3.77 (95% CI: 2.83-5.03), high economic status was 1.27 (95% CI: 1.05-1.56), metropolitan area was 1.31 (95% CI: 1.07-1.62), young age was 0.79 (95% CI: 0.64-0.98), hypertension was 1.00 (95% CI: 0.37-2.7), and diabetes mellitus was 2.44 (95% CI: 1.15-5.21). In the SD group, the hazard ratio for OSA after septoplasty was 0.71 (95% CI: 0.54-0.94). From long-term follow-up, the prevalence of OSA was 4.39 times higher in the SD group compared with the control group. This phenomenon was more pronounced with increasing body mass index and decreased significantly after septoplasty. Yeom SW, Chung SK, Lee EJ, etal. Association between septal deviation and OSA diagnoses: a nationwide 9-year follow-up cohort study. J Clin Sleep Med. 2021;17(10):2099-2106.

Effects of large volume, isotonic nasal saline irrigation for acute rhinosinusitis: a randomized controlled study.

The purpose of this study was to compare the effects of nasal saline irrigation (large volume, positive pressure isotonic saline) in addition to standard treatment in patients with acute rhinosinusitis (ARS). This parallel, randomized controlled trial was conducted at a tertiary hospital. The adult patients with ARS (age ≥18 years) were randomly assigned to two groups. The irrigation group received 0.9% saline irrigation twice daily, using a 250-ml squeeze bottle, in addition to standard treatment. The no-irrigation group received standard treatment only. Patients were evaluated at baseline, 1week, and 2weeks. The quality of life, rhinologic subscore, symptom score, endoscopy score, and cure rate were compared. Sixty-one patients (30: irrigation, 31: no-irrigation) were enrolled. There were 17 males and 44 females. The mean age was 41.06 years. Although both groups showed improvements, the improvement of each outcome was not different between the groups. Subgroup analysis by ARS subtype showed benefits of irrigation in the common cold subgroup; the improvements that were greater than control included: rhinologic subscore, intergroup mean difference -4.15 [95% confidence interval (CI), -7.49, -0.80] at 1week and -5.23 [95% CI, -9.69, -0.78] at 2weeks; combined symptom score -5.35 [95% CI, -10.55, -0.14] at 1week and -8.02 [95%CI, -14.36, -1.70] at 2weeks. The add-on isotonic nasal saline irrigation using a large volume, positive pressure device did not add benefits equally for all ARS patients. The benefits of irrigation on quality of life and nasal symptoms were only observed in the common cold patient subgroup.

Analysis of 3-D Kinematics Using H-Gait System during Walking on a Lower Body Positive Pressure Treadmill.

Recently, treadmills equipped with a lower-body positive-pressure (LBPP) device have been developed to provide precise body weight support (BWS) during walking. Since lower limbs are covered in a waist-high chamber of an LBPP treadmill, a conventional motion analysis using an optical method is impossible to evaluate gait kinematics on LBPP. We have developed a wearable-sensor-based three-dimensional motion analysis system, H-Gait. The purpose of the present study was to investigate the effects of BWS by a LBPP treadmill on gait kinematics using an H-Gait system. Twenty-five healthy subjects walked at 2.5 km/h on a LBPP treadmill under the following three conditions: (1) 0%BWS, (2) 25%BWS and (3) 50%BWS conditions. Acceleration and angular velocity from seven wearable sensors were used to analyze lower limb kinematics during walking. BWS significantly decreased peak angles of hip adduction, knee adduction and ankle dorsiflexion. In particular, the peak knee adduction angle at the 50%BWS significantly decreased compared to at the 25%BWS (p = 0.012) or 0%BWS (p < 0.001). The present study showed that H-Gait system can detect the changes in gait kinematics in response to BWS by a LBPP treadmill and provided a useful clinical application of the H-Gait system to walking exercises.

Effects of unweighting on gait kinematics during walking on a lower-body positive-pressure treadmill in patients with hip osteoarthritis

BackgroundHip osteoarthritis (OA) is a musculoskeletal condition that makes walking difficult due to pain induced by weight-bearing activities. Treadmills that support the body weight (BW) reduce the load on the lower limbs, and those equipped with a lower-body positive-pressure (LBPP) device, developed as a new method for unweighting, significantly reduce pain in patients with knee OA. However, the effects of unweighting on gait kinematics remain unclear in patients with hip OA. Therefore, we investigated the effects of unweighting on kinematics in patients with hip OA during walking on a treadmill equipped with an LBPP device.MethodsA total of 15 women with hip OA and 15 age-matched female controls wore a three-dimensional (3-D) motion analysis system and walked at a self-selected speed on the LBPP treadmill. Data regarding self-reported hip pain using a numeric rating scale (NRS) in which the scores 0 and 10 represented no pain and the worst pain, respectively, under three different BW conditions (100, 75, and 50%) were collected. Moreover, 3-D peak joint angles during gait under each condition were calculated and compared.ResultsIn the hip OA group, the NRS pain scores at 50 and 75% BW conditions significantly decreased compared with that at 100% BW condition (50%, P = 0.002; 75%, P = 0.026), and the peak hip extension angle decreased compared with that in the healthy controls (P = 0.044). In both groups, unweighting significantly decreased the peak hip (P < 0.001) and knee (P < 0.001) flexion angles and increased the peak ankle plantar flexion angle (P < 0.001) during walking.ConclusionsUnweighting by the LBPP treadmill decreased pain in the hip OA group but did not drastically alter the gait kinematics compared with that in the control group. Therefore, regarding the use of the LBPP treadmill for patients with hip OA, clinicians should consider the benefits of pain reduction rather than the kinematic changes.

MANEJO TERAPÊUTICO DO PACIENTE COM DISFUNÇÃO OLFATÓRIA: REVISÃO DA LITERATURA

Objetivo: A disfunção olfatória vem se mostrando uma alteração muito prevalente nos pacientes com COVID-19, tanto como apresentação clínica como sequela de duração ainda não determinada. Dessa forma, essa pesquisa busca entender o que as novas publicações sobre o tratamento da hiposmia e anosmia vem trazendo de oportunidades terapêuticas. Metodologia: Trata-se de uma revisão sistemática da literatura sobre artigos publicados sobre o tema disfunção olfatória e tratamento, na base de dados MEDLINE + PUBMED. A pesquisa foi delineada utilizando os seguintes descritores: “hyposmia OR anosmia AND treatment”. Em seguida foram utilizados os filtros: “últimos 05 anos” e “humanos”. Além dos seguintes tipos de estudo: “Ensaio Clínico”, “Revisão Sistemática” e “Metanálises”. Totalizando 55 artigos, dos quais destacamos 13 artigos com resumo condizente com o objetivo desta revisão. Conclusão: A maioria dos estudos recentemente publicados foca no tratamento com base em duas intervenções: o uso do corticoide e o treinamento olfatório, apresentando bons resultados, porém em estudos frágeis. Além disso, oportunidades terapeuticas com o uso da insulina intranasal, dos aparelhos de pressão positiva e da lavagem nasal com citrato de sódio vem aparecendo em publicações recentes.&#x0D; Palavras-chave: Transtorno do olfato; Terapêutica; Tratamento Farmacológico e olfato.

Response of Maximum Inspiratory Pressure and Functional Capacity to Positive End-Expiratory Pressure Device after Valvular Heart Surgery

Background: Pulmonary complications following valvular heart surgery are common and contribute to increased duration of hospital stay, rate of morbidity, and mortality. The purpose of the present study was to investigate the response of maximum inspiratory pressure and functional capacity to Positive End-Expiratory Pressure device in patients who underwent valvular heart surgery. Materials and Methods: Thirty males and females who underwent valvular heart surgery aged from 12-18 years old and recruited from the national heart institution enrolled in this study. They were assigned into two matched groups: the intervention group consisted of 15 patients, received Positive End-Expiratory Pressure (PEEP) with the mouthpiece in addition to routine chest physiotherapy program; the control group consisted of 15 patients, received routine chest physiotherapy program only. The program continued for four weeks, then the results compared in two groups. Results: According to the results of data analysis, there was a statistically significant difference between pretreatment and post-treatment data in both groups regarding inspiratory muscle strength and functional capacity (p < 0.001). There was no significant difference between groups regarding post-treatment data of Maximal Inspiratory Pressure (MIP), and VO2 max (p=0.084, p=0.325), respectively. Conclusion: According to the results, expiratory training using a PEEP device with mouthpiece improved inspiratory muscle strength and functional capacity after valvular heart surgery.

Home PAP devices in patients infected with COVID-19.

Citation:Kryger MH, Thomas R. Home PAP devices in patients infected with COVID-19. J Clin Sleep Med. 2020;16(7):1217–1219.

Symptomatic Respiratory Physiotherapy Management Strategies for COVID-19 Patients

The role of physiotherapy while dealing with the current pandemic of COVID 19 is by using various methods included as an adjuvant therapy such as- Deep breathing exercises, Bronchial hygiene techniques Permissive hypercapnia Iontophoresis with zinc ion (Zn2+), Diaphragmatic pacing, Active movement of extremities (lower and upper) Mechanical airway clearance and oscillating devices such as positive pressure devices, high-frequency chest oscillation, oral high-frequency chest oscillation, flutter device and Cornet devices along with NIV, HNFC, and COT. The benefit of these techniques and devices is to loosen the adhesion of mucus, reducing the load from mechanical ventilation and facilitate its transport from smaller to higher airways respectively. So that the mucus gets easily removed, improves in systemic & peripheral airflow, exchange in oxygen, and for maintaining lung hygiene in mild, moderate, and severe complications.

A New FDA Cleared ExpiratoryResistance Device for Treatment ofSnoring and Low Levels ofObstructive Sleep Apnea

Expiratory Positive Airway Pressure (EPAP) devices have been successfully used to treat obstructive sleep apnea and snoring. A new EPAP device called “Optipillows EPAP Mask” has recently been cleared by the FDA for treatment of snoring. The goal of this study is to describe the new EPAP mask and characterize its resistance properties. The EPAP mask consists of a nasal pillow type mask with head straps and with a proprietary micro valve on the front of it. The EPAP mask allows inhalation with minimal resistance, but with more resistance during exhalation causing the pressure to be elevated. The expiratory resistance can be adjusted according to patient’s comfort. The pressure generated by the EPAP mask was evaluated using a breathing system that simulated normal breathing pattern at rest. With the expiratory resistance fully open (minimal resistance) peak expiratory pressure generated by the mask was 1.3 to 3.2 cm H2O depending on tidal volume. A larger tidal volume generated more pressure during expiration. Peak expiratory pressure increased as the expiratory resistance was increased. The expiratory resistance range of the EPAP mask is comparable to previous EPAP devices. EPAP devices have limitations. A patient must take as long as necessary to learn to sleep comfortably with low resistance on the EPAP mask, before rushing to increase the resistance. For treatment of snoring a low level of expiratory resistance may be sufficient. The EPAP mask may also be useful for treatment of low levels of obstructive sleep apnea.

The SuperNO2VA to treat upper airway obstruction and respiratory compromise after major head and neck surgery: a case report

Postoperative pulmonary complications are common after major neck surgery, with airway compromise a leading cause for hypoxemia, hypercarbia, and reintubation. There are advantages to tracheal extubation upon emergence from anesthesia when appropriate. Recognizing that reintubation in the setting of upper airway obstruction or respiratory compromise may be challenging with presence of a cervical collar or anatomic changes following surgery. We present a 42-year-old man who underwent emergent cervical decompression and fusion with corpectomy following blunt force trauma. Upon emergence, a deep extubation was performed directly to the SuperNO2VA nasal mask connected to a Mapleson C circuit. This is a nasal positive pressure device used to maintain upper airway patency and provide ventilatory support during emergence. While in the intensive care unit, the patient was weaned to nasal cannula. However, mental status remained poor; and upper airway obstruction ensued leading to hypoxemic respiratory insufficiency, as shown by arterial blood gas. The SuperNO2VA was replaced with normalization of respiratory function and blood gas analysis. After 14 hours, including the use of SuperNO2VA during transport to and use inside the computed tomography scanner, the patient’s mental status recovered and ventilatory support was downgraded to nasal cannula without further events. Nasal positive pressure via the SuperNO2VA device as described may offer an inexpensive, transportable option for providing airway and ventilatory support in high-risk patients with anticipated difficult airways.

0530 Adherence to Positive Airway Pressure (PAP) devices: Feasibility of a Web-based Self Management Program.

0530 Adherence to Positive Airway Pressure (PAP) devices: Feasibility of a Web-based Self Management Program.