Joaquim Moita - Academia.edu (original) (raw)
Papers by Joaquim Moita
Noninvasive Mechanical Ventilation, 2016
Revista Portuguesa de Pneumologia, 2006
In ALS PEG tube placement attenuates malnutrition, secondary to bulbar dysphagia, and prevents ot... more In ALS PEG tube placement attenuates malnutrition, secondary to bulbar dysphagia, and prevents other frequently fatal complications such as chocking and respiratory arrest. Respiratory insufficiency may be associated to the complications observed in this procedure. PEG tubes were placed in 26 patients (10M/16F) with dysphagia using the Gauderer technique, mild sedatives and local anaesthetics. Results are presented in absolute numbers; average; standard deviation: Age -26, 64,3±11,5; CVF% - 17, 64,5±35,6; PaCO2 - 26, 41,6±7,1; PaO2 - 26, 81,6±14,3. Four of the seventeen patients with spirometric evaluation had FVC inferior to 50%. Nine patients had chronic respiratory failure (CRF). Complications were identified in 2 patients (transient laryngeal spasm) and most likely secondary to bulbar involvement rather than pulmonary function. Our experience shows PEG to be a safe procedure even in patients with advanced disease and reduced pulmonary capacity.
European Respiratory Journal, Sep 1, 2013
Number: 2652 Publication Number: P2492 Abstract Group: 2.2. Noninvasive Ventilatory Support
European Respiratory Journal, Sep 1, 2011
European Respiratory Journal, Sep 1, 2013
Number: 2652 Publication Number: P2492 Abstract Group: 2.2. Noninvasive Ventilatory Support
European Respiratory Journal, 2015
European Respiratory Journal, Sep 1, 2013
Revista Portuguesa de Pneumologia (English Edition), 2015
European Respiratory Journal, 2015
Revista Portuguesa de Pneumologia, 1995
ABSTRACT A presença e magnitude da hipertensão da hipertensão da artéria pulmonar (HTAP) tem um i... more ABSTRACT A presença e magnitude da hipertensão da hipertensão da artéria pulmonar (HTAP) tem um impacto negativo no prognóstico dos doentes com Insuficiência Respiratória Crónica Grave (IRCG), definida por PaO2 < 65 mmHg, secundária a Bronquite Crónica e Enfisema (BCE). O aumento de sobrevida destes doentes depende, em grande medida, da identificação precoce da HTA e da sua correcção com a administração de Oxigénioterapia de Longo Termo (OLT), motivo pelo qual a medição directa da Pressão da Artéria Pulmonar (PAP), por cateterismo de Swan-Ganz, integra o protocolo de avaliação a que subtemos todos os doentes com IRCG.
Revista Portuguesa de Pneumologia, 2001
ABSTRACT Nocturnal desaturation is well recnognized in patients with chronic respiratory failure ... more ABSTRACT Nocturnal desaturation is well recnognized in patients with chronic respiratory failure (CRF). Alveolar hypoventilation, particulary in REM sleep, is frequently assumed as the main physiopathological mechanism. This ocurrence is important in patients with mild basal hypoxemia (PaO2 55-70 mmHg) because of the particular position of the PaO2 in the oxyhemoglobin desaturation curve. However, disturbances of the quality of sleep that alter the normal structure of sleep in patients with chronic obstructive pulmonary disease (COPD) has been described in the literature.
Revista Portuguesa de Pneumologia, 1997
Acta médica portuguesa, 1997
The possibility of nocturnal oxygen desaturation (NOD) in patients with chronic bronchitis and em... more The possibility of nocturnal oxygen desaturation (NOD) in patients with chronic bronchitis and emphysema (CBE) even with basal hypoxemia greater that 55 mmHg is well recognised. Nocturnal hypoventilation is admitted as the main cause for this NOD. In this study we evaluate how the presence of left ventricular dysfunction (LVD) could aggravate NOD. Thirty-six patients with CBE and basal stabilised PaO2 55-70 mmHg underwent right heart catheterisation and polysomnographic study. NOD was defined as more than 30% of total sleep time with SaO2 less than 90%; LVD was defined as capillary pressure greater than 15 mmHg. Six patients were excluded from analysis because of sleep apnoea syndrome. In the remaining 30 patients (20 men, 10 women; mean age = 65.88.6 years; mean FEV1 = 0.970.31 litres; 43.316.6% predicted; mean basal PaO2 = 61.83.6 mmHg) 8 had LVD and 18 and NOD. Patients with NOD had a greater diurnal level of hypoventilation (basal PaCO2 = 44.63.8 vs. 414.1 mmHg; p = 0.025). Pati...
Revista Portuguesa de Pneumologia (English Edition), 2014
Revista Portuguesa de Pneumologia (English Edition), 2015
Adaptive servoventilation is a recent ventilatory mode initially designed to treat Cheyne-Stokes ... more Adaptive servoventilation is a recent ventilatory mode initially designed to treat Cheyne-Stokes respiration (CSR). Recently, the efficacy of ASV has been discussed for the treatment of central sleep apnea (CSA) and treatment-emergent central sleep apnea (treatment-emergent CSA) where other forms of traditional positive airway pressure (PAP) may be insufficient. To compare the clinical impact of ASV with other forms of PAP in treating patients with treatment-emergent CSA, CSA and CSR. Medical data of all the patients who underwent polysomnography (PSG) with ASV titration were evaluated. The patients were divided into two groups according to the mode of ventilation reimbursed: ASV and PAP (AutoCPAP/CPAP/BIPAP). All patients had a minimal follow-up of 6 months. Both groups were compared in terms of symptoms, apnea hypopnea index, compliance, cardiac function and cardiovascular events. ASV titration was performed in 33 patients (30M/3F) with a mean age of 69±8 years. The majority (58%) present a treatment-emergent SA and 42% a CSA and or CSR. The median initial diagnostic AHI was 46±22events/h. After the initial diagnosis, 28 patients were treated with PAP and 5 with servoventilation. All of the patients treated with PAP were posteriorly submitted to PSG and ASV titration because of suboptimal response to PAP. Despite a clear indication for ASV, due to differences in reimbursement, 15 patients continued treatment with PAP (12 with AutoCPAP, 1 with BIPAP and 2 with CPAP) and 16 changed to ASV. Two patients were lost in follow-up. In both groups, most of patients present a treatment-emergent SA (53% in ASV group vs. 67% in PAP group) or a CSA/CSR (29.4% in ASV group vs. 20% in PAP). After ASV titration, the mean follow-up was 25±14 months. Both groups (ASV vs. PAP) were similar in terms of compliance (77±23% vs.88±14%) and in terms of Epworth sleepiness scale score (6±5 vs. 7±5). There was a statistical difference in terms of residual AHI: mean AHI was 4±3 in ASV group and 9±3 in PAP group (P=0.005). We found no differences in terms of left ventricular fractional shortening (ASV 33±10% vs. PAP 32±10%). Although no difference was observed between the 2 groups in terms of non-fatal cardiovascular events (3 events in each group), 2 fatal cardiovascular events occurred in the PAP group (sudden death). These data confirm that ASV is an efficient treatment in patients with treatment-emergent CSA, CSA/CSR significantly decreasing residual AHI. In both groups, compliance rate was high and sleepiness improved. It is relevant that the 2 patients who died of sudden death were treated with PAP.
Acta médica portuguesa, 1997
The authors present the clinical of a male patient aged 45 years whose main complaints were loud ... more The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.
Revista portuguesa de pneumologia
Respiratory complications of systemic lupus erythematosus may involve every element of the respir... more Respiratory complications of systemic lupus erythematosus may involve every element of the respiratory system and are relatively common as the initial manifestation of this disease occurring in 60 -80% of patients during the course of the disease. The authors report a case of a lupic patient with a respiratory manifestation rarely recognized which diagnostic approach and treatment still represents a clinical challenge.
Noninvasive Mechanical Ventilation, 2016
Revista Portuguesa de Pneumologia, 2006
In ALS PEG tube placement attenuates malnutrition, secondary to bulbar dysphagia, and prevents ot... more In ALS PEG tube placement attenuates malnutrition, secondary to bulbar dysphagia, and prevents other frequently fatal complications such as chocking and respiratory arrest. Respiratory insufficiency may be associated to the complications observed in this procedure. PEG tubes were placed in 26 patients (10M/16F) with dysphagia using the Gauderer technique, mild sedatives and local anaesthetics. Results are presented in absolute numbers; average; standard deviation: Age -26, 64,3±11,5; CVF% - 17, 64,5±35,6; PaCO2 - 26, 41,6±7,1; PaO2 - 26, 81,6±14,3. Four of the seventeen patients with spirometric evaluation had FVC inferior to 50%. Nine patients had chronic respiratory failure (CRF). Complications were identified in 2 patients (transient laryngeal spasm) and most likely secondary to bulbar involvement rather than pulmonary function. Our experience shows PEG to be a safe procedure even in patients with advanced disease and reduced pulmonary capacity.
European Respiratory Journal, Sep 1, 2013
Number: 2652 Publication Number: P2492 Abstract Group: 2.2. Noninvasive Ventilatory Support
European Respiratory Journal, Sep 1, 2011
European Respiratory Journal, Sep 1, 2013
Number: 2652 Publication Number: P2492 Abstract Group: 2.2. Noninvasive Ventilatory Support
European Respiratory Journal, 2015
European Respiratory Journal, Sep 1, 2013
Revista Portuguesa de Pneumologia (English Edition), 2015
European Respiratory Journal, 2015
Revista Portuguesa de Pneumologia, 1995
ABSTRACT A presença e magnitude da hipertensão da hipertensão da artéria pulmonar (HTAP) tem um i... more ABSTRACT A presença e magnitude da hipertensão da hipertensão da artéria pulmonar (HTAP) tem um impacto negativo no prognóstico dos doentes com Insuficiência Respiratória Crónica Grave (IRCG), definida por PaO2 < 65 mmHg, secundária a Bronquite Crónica e Enfisema (BCE). O aumento de sobrevida destes doentes depende, em grande medida, da identificação precoce da HTA e da sua correcção com a administração de Oxigénioterapia de Longo Termo (OLT), motivo pelo qual a medição directa da Pressão da Artéria Pulmonar (PAP), por cateterismo de Swan-Ganz, integra o protocolo de avaliação a que subtemos todos os doentes com IRCG.
Revista Portuguesa de Pneumologia, 2001
ABSTRACT Nocturnal desaturation is well recnognized in patients with chronic respiratory failure ... more ABSTRACT Nocturnal desaturation is well recnognized in patients with chronic respiratory failure (CRF). Alveolar hypoventilation, particulary in REM sleep, is frequently assumed as the main physiopathological mechanism. This ocurrence is important in patients with mild basal hypoxemia (PaO2 55-70 mmHg) because of the particular position of the PaO2 in the oxyhemoglobin desaturation curve. However, disturbances of the quality of sleep that alter the normal structure of sleep in patients with chronic obstructive pulmonary disease (COPD) has been described in the literature.
Revista Portuguesa de Pneumologia, 1997
Acta médica portuguesa, 1997
The possibility of nocturnal oxygen desaturation (NOD) in patients with chronic bronchitis and em... more The possibility of nocturnal oxygen desaturation (NOD) in patients with chronic bronchitis and emphysema (CBE) even with basal hypoxemia greater that 55 mmHg is well recognised. Nocturnal hypoventilation is admitted as the main cause for this NOD. In this study we evaluate how the presence of left ventricular dysfunction (LVD) could aggravate NOD. Thirty-six patients with CBE and basal stabilised PaO2 55-70 mmHg underwent right heart catheterisation and polysomnographic study. NOD was defined as more than 30% of total sleep time with SaO2 less than 90%; LVD was defined as capillary pressure greater than 15 mmHg. Six patients were excluded from analysis because of sleep apnoea syndrome. In the remaining 30 patients (20 men, 10 women; mean age = 65.88.6 years; mean FEV1 = 0.970.31 litres; 43.316.6% predicted; mean basal PaO2 = 61.83.6 mmHg) 8 had LVD and 18 and NOD. Patients with NOD had a greater diurnal level of hypoventilation (basal PaCO2 = 44.63.8 vs. 414.1 mmHg; p = 0.025). Pati...
Revista Portuguesa de Pneumologia (English Edition), 2014
Revista Portuguesa de Pneumologia (English Edition), 2015
Adaptive servoventilation is a recent ventilatory mode initially designed to treat Cheyne-Stokes ... more Adaptive servoventilation is a recent ventilatory mode initially designed to treat Cheyne-Stokes respiration (CSR). Recently, the efficacy of ASV has been discussed for the treatment of central sleep apnea (CSA) and treatment-emergent central sleep apnea (treatment-emergent CSA) where other forms of traditional positive airway pressure (PAP) may be insufficient. To compare the clinical impact of ASV with other forms of PAP in treating patients with treatment-emergent CSA, CSA and CSR. Medical data of all the patients who underwent polysomnography (PSG) with ASV titration were evaluated. The patients were divided into two groups according to the mode of ventilation reimbursed: ASV and PAP (AutoCPAP/CPAP/BIPAP). All patients had a minimal follow-up of 6 months. Both groups were compared in terms of symptoms, apnea hypopnea index, compliance, cardiac function and cardiovascular events. ASV titration was performed in 33 patients (30M/3F) with a mean age of 69±8 years. The majority (58%) present a treatment-emergent SA and 42% a CSA and or CSR. The median initial diagnostic AHI was 46±22events/h. After the initial diagnosis, 28 patients were treated with PAP and 5 with servoventilation. All of the patients treated with PAP were posteriorly submitted to PSG and ASV titration because of suboptimal response to PAP. Despite a clear indication for ASV, due to differences in reimbursement, 15 patients continued treatment with PAP (12 with AutoCPAP, 1 with BIPAP and 2 with CPAP) and 16 changed to ASV. Two patients were lost in follow-up. In both groups, most of patients present a treatment-emergent SA (53% in ASV group vs. 67% in PAP group) or a CSA/CSR (29.4% in ASV group vs. 20% in PAP). After ASV titration, the mean follow-up was 25±14 months. Both groups (ASV vs. PAP) were similar in terms of compliance (77±23% vs.88±14%) and in terms of Epworth sleepiness scale score (6±5 vs. 7±5). There was a statistical difference in terms of residual AHI: mean AHI was 4±3 in ASV group and 9±3 in PAP group (P=0.005). We found no differences in terms of left ventricular fractional shortening (ASV 33±10% vs. PAP 32±10%). Although no difference was observed between the 2 groups in terms of non-fatal cardiovascular events (3 events in each group), 2 fatal cardiovascular events occurred in the PAP group (sudden death). These data confirm that ASV is an efficient treatment in patients with treatment-emergent CSA, CSA/CSR significantly decreasing residual AHI. In both groups, compliance rate was high and sleepiness improved. It is relevant that the 2 patients who died of sudden death were treated with PAP.
Acta médica portuguesa, 1997
The authors present the clinical of a male patient aged 45 years whose main complaints were loud ... more The authors present the clinical of a male patient aged 45 years whose main complaints were loud snoring and excessive daytime sleepiness. Polysomnographic study revealed a sleep obstructive apnea syndrome with an apnea/hypopnea index of 86.5. After being treated with nasal continuous positive air pressure, (12 cm H2O), the apneas ended and sleep architecture was corrected. Physical examination also indicated the presence of an acromegaly, and therefore, the patient was subjected to endocrinological and cerebral imagiological studies; the diagnosis confirmed it as a predisposing factor to the sleep breathing disorder. A brief literature review about the incidence of sleep apnea syndrome in acromegaly is also made; the authors conclude that there is still the need for a systematic screening of sleep breathing disorders in acromegalic patients in order to optimise the treatment and prognosis of this disorders.
Revista portuguesa de pneumologia
Respiratory complications of systemic lupus erythematosus may involve every element of the respir... more Respiratory complications of systemic lupus erythematosus may involve every element of the respiratory system and are relatively common as the initial manifestation of this disease occurring in 60 -80% of patients during the course of the disease. The authors report a case of a lupic patient with a respiratory manifestation rarely recognized which diagnostic approach and treatment still represents a clinical challenge.