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TNI ® Studies 20 Therapy Diagnostics Influence of the transnasal insufflation (TNI) on respiratory pressure amplitude and respiratory middle pressure in comparison to spontaneous respiration and CPAP in people with healthy lungs Bräunlich, J.; Beyer, D.; Hammerschmidt, S.; Seyfarth, H.-J.; Wirtz, H. University Leipzig, Department of Pneumology, Department internal medicine , Neurology and Dermatology Introduction: The already in neonatology established transnasal insufflation implies application of a heated, humidified and continuous airflow between 16 and 24 l/min. The clinical application shows significant decline of pC02. The therapeutic mechanisms and efficiency of this method are however indistinct in adults. First examinations showed increased respiratory pressure, decline of dyspnea, decrease of respiratory frequency and enhanced oxygenation. Method: By means of a thin water-filled tube system the measured pressures in nose and tounge area were transferred via amplifier to a recorder. The experiments were executed nasal and orally, while sitting, lying and under spontaneous respiration, TNI and CPAP. Pressure gradients between in- and exspiration as well as variation of respiratory middle pressures were detected while using the corresponding methods. As test persons people with healthy lungs were adducted. Pressure in mbar �� Spontaneous breathing Pressure in mbar �� Spontaneous breathing TNI �� Medium-pressure breathing, sitting nose n=16 Results: All combinations showed significant increase of respiratory pressure amplitude under TNI in comparison to spontaneous respiration. Application of a CPAP with low pressure (4 mbar) did not show significant modifications. All experiments showed significantly increased respiratory middle pressure by transnasal insufflation in comparison to spontaneous respiration. Application of CPAP resulted in reaffirmed increase of respiratory middle pressure. 1 McGinley et al. (2007): A nasal cannula can be used to treat obstructive sleep apnoe. 2 Chatila et al. (2004): The effects of High-flow vs. Low-Flow oxygen in exercise in advanced obstructive airway disease. Discussion: At continuous compliance the transnasal insufflation increases the ventilation by accentuation of the respiratory pressure amplitude and increase of respiratory middle pressure. The middle respiratory pressure will hereby only be increased slightly, thus an alveolar recruitment not being in the foreground. Ventilation work seems to be minimized by overcoming the statical and dynamical resistances. As how far the respiratory muscle pump will be released is not yet defined. Using TNI leads to a shifting on the pressure-volume-curve. Whether or not an additional elution effect supports CO2-decrease , i.e. which patients profit from this breathing support, has to be subject to further investigations.
TNI ® Studies Correct Citation for publication: Therapy Diagnostics Treatment of Sleep-Disordered Breathing in Chronic Obstructive Pulmonary Disease with Nocturnal Nasal Insufflation. C.D. Brown, M.D., L.B. Herpel, M.D., K.L. Goring, M.D., P.L. Smith, M.D., R.A. Wise, M.D., H. Schneider, M.D., Ph, A.R. Schwartz. Proc Am Thor Soc 2007,, A709 Poster Board #F64] Treatment of Sleep-Disordered Breathing in Chronic Obstructive Pulmonary Disease with Nocturnal Nasal Insufflation, [Publication Page: A709] C.D. Brown, M.D., L.B. Herpel, M.D., K.L. Goring, M.D., P.L. Smith, M.D., R.A. Wise, M.D., H. Schneider, M.D., Ph, A.R. Schwartz, M.D., Baltimore, MD Introduction: Sleep-disordered breathing (SDB) with inspiratory flow limitation (IFL) is common in patients with COPD, even without frank apneas or hypopneas. Nocturnal nasal insufflation (NNI) may relieve IFL and upper airway obstruction during sleep to improve gas exchange and sleep quality in COPD. Methods: Non-hypoxemic individuals with a wide range of COPD severity underwent baseline polysomnography to determine the severity of sleep-disordered breathing. On a separate night, subjects were exposed to alternating trials of NNI (20 L/min), oxygen (2 L/min), and room air during NREM sleep. SDB indices including arousal-terminated IFL event rates, the apnea-hypopnea index (AHI) and transcutaneous carbon dioxide (TcCO2) were compared among conditions. Results: NNI decreased the arousal frequency, AHI, and TcCO2 from the room air and oxygen conditions. NNI resulted in a 50% reduction in IFL events compared to room air (p=0.04) whereas oxygen was associated with a 120% increase in IFL events. TcCO2 increased during oxygen treatment and fell during NNI compared to the room air condition (Figure 1, p=0.001 for NNI vs. room air). Conclusion: NNI decreased SDB and improved nocturnal ventilation in patients with COPD. The CO2 response to NNI suggests that IFL contributes to the development of nocturnal hypoventilation in COPD and that NNI may constitute a novel treatment for SDB in COPD. 21
Page 1 and 2: PRODUCT CATALOGUE We like to suppor
Page 3 and 4: Index Therapy Diagnostics Product O
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Page 7 and 8: Products TNI ® products TNI ® - T
Page 9 and 10: Products ADVANTAGES: Therapy Diagno
Page 11 and 12: Products Large options � PLM opti
Page 13 and 14: TNI ® Effectiveness Possible Effec
Page 15 and 16: TNI ® Effectiveness Resp. Insuffiz
Page 17 and 18: TNI ® Studies O2 (l) 9 8 7 6 5 4 3
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Page 61 and 62: Accessory PG system MS310 part numb
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Page 67 and 68: Accessory Nasal Insufflation Cannul
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