are CPAP machines bad for us after valvuloplasty?

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are CPAP machines bad for us after valvuloplasty?

Postby Cece » Tue Sep 04, 2012 11:24 am

http://www.ncbi.nlm.nih.gov/pubmed/3631396
Am J Surg. 1987 Aug;154(2):220-4.

Anatomic and pathophysiologic studies of the human internal jugular valve.

Dresser LP, McKinney WM.

Abstract

The results of anatomic and hemodynamic studies of the human internal jugular valve, which is the only venous valve between the right atrium of the heart and the brain, have been reported. Tricuspid internal jugular valves were present in two cadaver subjects without any observed compromise in competency. Most valves tested were competent, with the exception of those from one cadaver which were apparently congenitally incompetent. Acquired or congenital internal jugular valve incompetence may impair cerebral venous return, especially when intrathoracic pressure is increased by positive-pressure ventilation. Screening for internal jugular valve incompetence with a Doppler flowmeter before utilizing this type of mechanical ventilation may help prevent the deleterious effects of cerebral venous congestion.

Two thoughts here:
1) one cadaver had bilateral IJV valve congenital incompetence - could that mean congenitally malformed valves as seen in CCSVI? This was in 1987. It is good to see historical data noticing IJV valve malformations even before they were implicated as CCSVI.

2) If we have had the CCSVI procedure, and if we had valvular stenoses ballooned, the treatment is successful if the valves are obliterated. But if the valves are obliterated, we now have IJV valve incompetence, meaning there are no valves to block flow from refluxing from the heart. In this condition, mechanical positive-pressure ventilation can lead to cerebral venous congestion.

What is nonvinvasive positive pressure ventilation?
What is noninvasive positive pressure ventilation?

With NIPPV, the patient wears a tightly fitting nasal or full facial mask, avoiding the need for an endotracheal tube, laryngeal mask, or tracheostomy (Figure 1).2 The mask can be connected to a standard mechanical ventilator or, more commonly, to a continuous positive airway pressure or bi-level airway pressure unit. NIPPV has been used with variable success in a variety of conditions, including COPD exacerbations,3–6 acute cardiogenic pulmonary edema,7 hypoxemic respiratory failure,8 and ventilator weaning.9

https://www.clevelandclinicmeded.com/me ... rshman.htm

That would include a CPAP machine, wouldn't it?
CPAP performs a needed function for those with sleep apnea. But after a CCSVI procedure, if the jugular valves are treated, the pressure created by the CPAP might contribute to further cerebral venous congestion. If possible, the best case scenario might be to lose weight or treat the throat surgically as alternatives to CPAP. Losing weight might be enough to reduce the amount of pressure needed.

These are all thoughts based on my understanding of the research and not intended as medical advice! I am no doctor. But I am going to do my best to avoid COPD, respiratory failure, or anything that might land me on a ventilator...

it also notable that CPR may no longer work on us either! so I am also going to avoid heart attacking. For me the benefits of having my jugular valvular stenoses treated has outweighed these possible concerns.
These findings may have important implications concerning the failure, in some cases, of closed-chest cardiac resuscitation to maintain forward blood flow at adequate pressure.

http://www.ncbi.nlm.nih.gov/pubmed/3455235
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Re: are CPAP machines bad for us after valvuloplasty?

Postby 1eye » Tue Sep 04, 2012 12:59 pm

I doubt if a CPAP machine pack the kind of pressure that would be bad (depending of course on individual anatomy). It is much lower than that required to pop your eardrums, for instance, by Valsalva, than even what you get from a bad cough or straining. 1987! Holy wick!

The bad cough reminds me: that is exactly what I had when I had EBV. It was easily the worst cough I've ever had. My doctor said "you are a very sick puppy." It was adult-acquired, or maybe reactivated. Could that be the connection between EBV and "MS"? Was I coughing my brains out?

All the pressure of CPAP does is to hold your airways open, and gently blow air into you. Since they are usually open when you are upright, that can't be too hard.
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Re: are CPAP machines bad for us after valvuloplasty?

Postby Cece » Wed Sep 05, 2012 2:53 pm

thanks for the info, 1eye, that does sound like less pressure than I'd envisioned!

If EBV tends to cause very severe coughing, that could be an interesting connection. But if we have stenoses in our jugulars, those stenoses would actually prevent the reflux that occurs from coughing from getting up past the stenoses.
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Re: are CPAP machines bad for us after valvuloplasty?

Postby 1eye » Mon Sep 10, 2012 7:08 pm

Or perhaps the stenoses mean resistance increases, and when high reverse pressure occurs (coughing), the reflux turns into a back jet. Maybe the jets reach deep into the brain, with known effects...
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Re: are CPAP machines bad for us after valvuloplasty?

Postby EJC » Thu Sep 20, 2012 2:43 pm

I use a CPAP machine with a nasal mask. The flow of air is what I'd describe as a strong breeze. The flow itself keeps the airway open.

Think of it like blowing up a balloon the first breath that expands and opens the rubber requires all the pressure, once there a steady flow will continue to inflate. CPAP works on the same principal of flow stopping the collapse of the windpipe by creating a nice steady flow of air.
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Re: are CPAP machines bad for us after valvuloplasty?

Postby HappyPoet » Fri Sep 21, 2012 9:28 am

Cece wrote:it also notable that CPR may no longer work on us either! so I am also going to avoid heart attacking.

Hi Cece, only ~ 5% of people who receive CPR survive, so imho, I don't think it's much of a worry.

Edit: http://faculty.deanza.edu/donahuemary/s ... eader$1865

CPR alone rarely saves lives: some statistics

Statistically, CPR without an Automated External Defibrillator (AED) only works 3% to 4% of the time. (A 1996 study by the New England Journal of Medicine showed that in television shows CPR was portrayed as successful 75% of the time.) CPR is crucial to keep enough oxygen to the brain until more advanced life support can get to the victim. That advanced life support is mainly an AED.

If CPR is started right away, 911 is contacted and an AED can get to the person quickly, they stand about a 60% to 70% chance of survival. (An answer to a test question in our class will be that for every one minute defibrillation is delayed, the victim loses 10% chance of survival.)

Survival of CPR with AED often has some degree of permanent brain damage.
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