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Relatório de estágio em fisiopatologia do sono e ventilação não invasiva hospital Senhora da Oliveira de Guimarães
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Este trabalho integra a avaliação final do Mestrado em Fisiologia Clínica, com especialização em Fisiopatologia do Sono e Ventilação Não Invasiva. Baseia-se na experiência adquirida durante o estágio no Laboratório de Sono e Ventilação Não Invasiva do Hospital da Senhora da Oliveira de Guimarães. O estágio permitiu a participação em diversos exames, como os vários tipos de polissonografia, capnografia, gasometria arterial e titulação de ventilação não invasiva em pacientes adultos.
O estágio teve como objetivo principal aprimorar competências, visando a aplicação dos conhecimentos adquiridos na prática hospitalar. Com este relatório pretende-se apresentar o local de estágio, discutir as atividades desenvolvidas e a exposição de dois casos clínicos.
A polissonografia é essencial para diagnosticar e caracterizar diversas patologias do sono, além de permitir a definição de estratégias terapêuticas mais eficazes. Embora seja considerada o padrão de referência para o diagnóstico dos distúrbios respiratórios do sono, o aumento da sua prevalência levou ao desenvolvimento de dispositivos portáteis como alternativas mais práticas e acessíveis para avaliação em ambulatório.
A ventilação não invasiva desempenha um papel crucial no tratamento de várias patologias, sendo utilizada tanto em cenários agudos como crónicos, contribuindo significativamente para a melhoria da qualidade de vida dos pacientes. A sua eficácia deve ser avaliada, sendo fundamental monitorizar as trocas gasosas através de oximetria, capnografia e/ou gasometria arterial. A seleção do modo ventilatório mais adequado e a sua correta parametrização são determinantes para garantir benefícios fisiológicos e clínicos, uma vez que cada algoritmo de ventilação apresenta vantagens e limitações específicas.
Cada paciente possui características únicas, o que requer um tratamento personalizado de acordo com a situação clínica, resposta ao tratamento e impacto na qualidade de vida, de forma a maximizar os resultados e a garantir a melhor abordagem terapêutica.
O técnico de Cardiopneumologia desempenha um papel fundamental no acompanhamento de pacientes com distúrbios respiratórios do sono, especialmente no contexto da ventilação não invasiva. É imprescindível que possua um conhecimento aprofundado, não apenas sobre os aspetos técnicos da ventilação, mas também sobre as doenças e comorbilidades associadas, bem como os efeitos dos fármacos. Este domínio permite realizar ajustes terapêuticos mais precisos e individualizados, minimizando riscos e maximizando os benefícios do tratamento.
Para ilustrar a abordagem clínica na ventilação não invasiva, são apresentados dois casos clínicos acompanhados durante o estágio. O primeiro descreve um paciente com síndrome de apneia obstrutiva do sono e síndrome de obesidade e hipoventilação, submetido a uma aferição de pressão positiva nas vias aéreas em laboratório, para otimização da terapêutica. O segundo caso retrata um paciente que, após o início da terapia com pressão positiva, desenvolveu síndrome de apneia do sono complexa, exigindo uma reavaliação da estratégia ventilatória.
Estes casos refletem a necessidade de um acompanhamento individualizado e reforçam a importância da correta seleção e adaptação da terapêutica, garantindo uma abordagem eficaz.
This work is part of the final assessment for the Master’s degree in Clinical Physiology, with a specialization in Sleep Pathophysiology and Non-Invasive Ventilation. It is based on the experience gained during the internship at the Sleep and Non-Invasive Ventilation Laboratory of Hospital da Senhora da Oliveira de Guimarães. The internship provided participation in various examinations, including different types of polysomnography, capnography, arterial blood gas analysis, and non-invasive ventilation titration in adult patients. The primary objective of the internship was to enhance skills for the practical application of acquired knowledge in a hospital setting. This report aims to present the internship site, discuss the activities carried out, and analyze two clinical cases. Polysomnography is essential for diagnosing and characterizing various sleep disorders, as well as for defining more effective therapeutic strategies. Although it is considered the gold standard for diagnosing sleep-disordered breathing, the increasing prevalence of these conditions has led to the development of portable devices as more practical and accessible alternatives for outpatient evaluation. Non-invasive ventilation plays a crucial role in treating various pathologies, being used in both acute and chronic settings, significantly contributing to improving patients' quality of life. Its effectiveness must be assessed by monitoring gas exchanges through oximetry, capnography, and/or arterial blood gas analysis. Selecting the most appropriate ventilation mode and correctly adjusting its parameters are crucial to ensuring physiological and clinical benefits, as each ventilation algorithm has specific advantages and limitations. Each patient has unique characteristics, requiring personalized treatment according to their clinical condition, response to therapy, and impact on quality of life, in order to maximize outcomes and ensure the best therapeutic approach. The Cardiopulmonary Technician plays a fundamental role in monitoring patients with sleep-disordered breathing, particularly in the context of non-invasive ventilation. It is essential to have an in-depth understanding not only of the technical aspects of ventilation but also of the associated diseases and comorbidities, as well as the effects of medications. This expertise allows for more precise and individualized therapeutic adjustments, minimizing risks and maximizing treatment benefits. To illustrate the clinical approach to non-invasive ventilation, two clinical cases followed during the internship are presented. The first describes a patient with obstructive sleep apnea syndrome and obesity hypoventilation syndrome, who underwent in-laboratory positive airway pressure titration to optimize therapy. The second case describes a patient who, after initiating positive airway pressure therapy, developed complex sleep apnea syndrome, requiring a reassessment of the ventilation strategy. These cases highlight the need for individualized follow-up and reinforce the importance of correctly selecting and adapting therapy to ensure an effective approach.
This work is part of the final assessment for the Master’s degree in Clinical Physiology, with a specialization in Sleep Pathophysiology and Non-Invasive Ventilation. It is based on the experience gained during the internship at the Sleep and Non-Invasive Ventilation Laboratory of Hospital da Senhora da Oliveira de Guimarães. The internship provided participation in various examinations, including different types of polysomnography, capnography, arterial blood gas analysis, and non-invasive ventilation titration in adult patients. The primary objective of the internship was to enhance skills for the practical application of acquired knowledge in a hospital setting. This report aims to present the internship site, discuss the activities carried out, and analyze two clinical cases. Polysomnography is essential for diagnosing and characterizing various sleep disorders, as well as for defining more effective therapeutic strategies. Although it is considered the gold standard for diagnosing sleep-disordered breathing, the increasing prevalence of these conditions has led to the development of portable devices as more practical and accessible alternatives for outpatient evaluation. Non-invasive ventilation plays a crucial role in treating various pathologies, being used in both acute and chronic settings, significantly contributing to improving patients' quality of life. Its effectiveness must be assessed by monitoring gas exchanges through oximetry, capnography, and/or arterial blood gas analysis. Selecting the most appropriate ventilation mode and correctly adjusting its parameters are crucial to ensuring physiological and clinical benefits, as each ventilation algorithm has specific advantages and limitations. Each patient has unique characteristics, requiring personalized treatment according to their clinical condition, response to therapy, and impact on quality of life, in order to maximize outcomes and ensure the best therapeutic approach. The Cardiopulmonary Technician plays a fundamental role in monitoring patients with sleep-disordered breathing, particularly in the context of non-invasive ventilation. It is essential to have an in-depth understanding not only of the technical aspects of ventilation but also of the associated diseases and comorbidities, as well as the effects of medications. This expertise allows for more precise and individualized therapeutic adjustments, minimizing risks and maximizing treatment benefits. To illustrate the clinical approach to non-invasive ventilation, two clinical cases followed during the internship are presented. The first describes a patient with obstructive sleep apnea syndrome and obesity hypoventilation syndrome, who underwent in-laboratory positive airway pressure titration to optimize therapy. The second case describes a patient who, after initiating positive airway pressure therapy, developed complex sleep apnea syndrome, requiring a reassessment of the ventilation strategy. These cases highlight the need for individualized follow-up and reinforce the importance of correctly selecting and adapting therapy to ensure an effective approach.
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Keywords
Sono Polissonografia Ventilação Titulação Sleep Polysomnography Ventilation Titration