Chest news briefs: CPAP may cause facial changes

The use of a nasal continuous positive airway pressure (nCPAP) machine for more than 2 years may cause craniofacial changes in adults with obstructive sleep apnea (OSA). Researchers from The University of British Columbia, Vancouver, BC, Canada, analyzed baseline and follow-up radiographs from 46 Japanese patients with OSA who had used nCPAP for a minimum of 2 years. Changes in craniofacial structures were assessed. nCPAP use was associated with change in the craniofacial form by reducing maxillary and mandibular prominence and/or by altering the relationship between the two dental arches. There were no significant correlations between mean age, BMI, apnea-hypopnea index, or the average duration of nCPAP use (35.0±6.7 months) and the craniofacial changes. No patients reported any permanent craniofacial changes. Researchers conclude that the side effects of nCPAP use warrant more detailed studies over longer time periods, considering that nCPAP is often prescribed for long-term use. The article is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 138(4):870�.

INCREASED RISK FOR PICC DVT LINKED TO LARGER CATHETER SIZE

Larger catheter size, prior DVT, and having a prior surgery lasting longer than 1 hour are associated with an increased risk for peripherally inserted central catheter (PICC)-associated DVT. PICCs are often used to provide long-term IV antibiotic therapy, chemotherapy, and total parenteral nutrition. Researchers from the University of Utah and Intermountain Healthcare analyzed a total of 2,014 PICCs inserted at a level 1 trauma center in order to understand risk factors for PICC-associated DVT. Factors that best predicted DVT included patients who had a prior DVT, those who underwent prior surgery of duration greater than 1 hour, and the use of double lumen-5 French or triple lumen 6-French catheters. Researchers conclude that rates of PICC-associated DVT may be reduced by an improved selection of patients and catheter size. This article is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 138(4):803�.

NEW CPAP ADHERENCE CRITERIA MAY YIELD NEGATIVE EFFECTS

The application of new local coverage determination (LCD) adherence criterion for continued reimbursement of continuous positive airway pressure (CPAP) may have potential negative effects on patients with obstructive sleep apnea (OSA) and their clinical care. Researchers from National Jewish Health in Denver, Colorado, retrospectively examined a database of 150 patients who received neuropsychological testing prior to CPAP treatment and 3 to 6 months posttreatment. Patients were categorized using the new LCD criteria, and comparisons were made between adherent and nonadherent groups on neuropsychological variables. Fifty-five patients (37 percent) failed to meet the new criterion. Of the 63 patients who did not receive any special adherence intervention, 29 (46 percent) met the new criterion. Researchers conclude that controlled trials are needed to better understand the effect of the new guidelines on adherence and treatment outcomes. This article is published in the October issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians: CHEST 2010; 138(4):875�.

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