Samodejni osnutek

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ZAHVALA

Spoštovani ustvarjalci in udeleženci tečaja Motnje dihanja z osnovami poligrafije pri novorojenčkih!

Veseli smo, da smo tečaj uspešno izpeljali do konca. Posebej ponosni smo na učbenik, ki je izšel skupaj s tečajem.

Iskreno se zahvaljujemo vsem slovenskim in tujim avtorjem za vrhunske strokovne članke in odlična predavanja, ki so jih pripravili.

Posebno zahvalo si zaslužita oba recenzenta, prof. dr. David Neubauer in prof. dr. Irena Hočevar Boltežar ter lektorici za slovenski in angleški jezik, Cvetana Tavzes in Sara Hajdarević.

Vrhunsko avtorsko delo je opravil Matevž Trdan, ki je oblikoval učbenik, ga opremil s fotografijami in poskrbel za celostno grafično in video podobo tečaja.

Brez pomoči sponzorjev takšnega finančnega zalogaja ne bi zmogli. Na prvem mestu se zahvaljujemo glavnemu sponzorju podjetju Medicotehna, d.o.o. iz Ljubljane ter ostalim podjetjem: Chiesi Slovenija, d.o.o., Sapio plini, d.o.o., Mediasi, d.o.o., Pulmodata, d.o.o. in Inspira, d.o.o. Vsem iskrena hvala.

Najbolj pa smo veseli smo dobrega obiska tečaja. Iskreno upamo, da ste bili udeleženci s tečajem zadovoljni. Za udeležbo se vsem še posebej zahvaljujemo. Upamo, da ste na tečaju pridobili nova strokovna znanja, da ste se pri nas dobro počutili, in da ste spletli nove strokovne in osebne stike.

Uredniki ter člani strokovnega in organizacijskega odbora

V Ljubljani, 27. oktobra 2023

Dear authors, co-workers, and participants of the course Breathing Disorders with Basic Principles of Neonatal Polysomnography!

We are pleased that we have successfully completed the course. We are especially proud of the textbook that was published alongside the course.

We would sincerely like to thank all Slovenian and foreign authors for their excellent professional articles and outstanding presentations. Special thanks are due to both reviewers, Prof. Dr. David Neubauer and Prof. Dr. Irena Hočevar Boltežar, as well as the Slovene and English language proofreaders, Cvetana Tavzes and Sara Hajdarević.

Outstanding creative work was carried out by Matevž Trdan, who designed the textbook, accompanied it with photographs, and designed the overall graphic and video presentation of the course.

Such a financial endeavour would not have been possible without the support of our sponsors. We express our gratitude, first and foremost, to the main sponsor, Medicotehna, d.o.o. from Ljubljana, and other companies: Chiesi Slovenija, d.o.o., Sapio plini, d.o.o., Mediasi, d.o.o., Pulmodata, d.o.o., and Inspira, d.o.o. Sincere thanks to all.

We are especially pleased that the course was so well attended. We sincerely hope that the participants were satisfied with the scientific content and organisation of the course. A special thanks to all of you for your attendance. We hope that you have gained new professional knowledge and made new professional and personal contacts.

Editors and members of the Professional and Organising Committee

 

Ljubljana, October 27, 2023.

Razvoj pediatrične poligrafije v Sloveniji

V članku so opisani prvi začetki uporabe zapisovanja srčno-dihalnih vzorcev s  poligrafijo v Sloveniji. Najprej se seznanimo z metodo preproste kardiorespirografije, ki smo jo dolga leta uporabljali na neonatalnem oddelku, predvsem za diagnostiko in spremljanje učinka kofeinske terapije za idiopatsko apnejo nedonošenosti. V nadaljevanju  je predstavljena »prava« poligrafija, ki s  spremljanjem različnih parametrov: dihanja na treh ravneh, srčnega ritma, oksigenacije, položaja telesa, detekcije smrčanja in izkoristka ali učinkovitosti spanja omogoča diagnostiko tako centralnih kot obstrukcijskih dihalnih premorov. Kot taka je bila odličen pripomoček pri ugotavljanju ogroženosti zaradi premorov dihanja pri dojenčkih s sumom na idiopatsko apnejo (tudi v sklopu proučevanja nenadne nepričakovane smrti dojenčka) in pri vseh starostih otrok s sumom na težave zaradi obstrukcijskih premorov zaradi povečane žrelnice ali mandljev. Na koncu je omenjena tudi možnost uporabe poligrafije na znanstvenoraziskovalnem področju.

Historical Review of Paediatric Polygraphy in Slovenia

The article describes the first implementation of recording cardio-respiratory patterns by poligraphy in Slovenia. The first method to be described is the simple cardiorespirography (CRG), which has been introduced and used for years at the neonatal unit of the UMC Ljubljana’s Division of Paediatrics. It was mainly used for follow-up of neonates which have been treated with caffeine for idiopathic apnoea of prematurity. After CRG the method of full-scale polygraphy has been introduced which enables registration of different parameters: breathing at three different levels (nasal, thoracic, and abdominal), heart rate, oxygenation, body position, detection of snoring and effectiveness of sleep and as such can differentiate between central and obstructive apnoeas. As such it has been used in diagnostic of infants at risk for apnoeas due to infantile idiopathic apnoea (also including those with suspicion of near-death events in infants at risk for sudden infant death syndrome), and for children at different ages who have had problems with breathing due to obstructive apnoea, mainly because of enlarged adenoids and tonsils. A possible application of polygraphy to scientific research is also discussed at the end.

David Neubauer

Fiziološki principi uravnavanja ventilacije od dojenčka do odraslega

Dihanje je homeostatski mehanizem, ki primarno nasprotuje spremembam pO2 in pCO2 v organizmu, ki jih povzroča okolje ali organizem, in vključuje izmenjavo plinov z okoljem (ventilacijo), prenos plinov skozi alveolokapilarno pregrado (difuzija), transport plinov v krvi in celično uporabo pO2 oziroma proizvodnjo pCO2. Dihanje je uravnavano na vseh teh ravneh, čeprav uravnavanje dihanja običajno enačimo z uravnavanjem ventilacije. Ventilacijo uravnava zapleten sistem, ki vključuje generator centralnega dihalnega ritma / vzorca in integrator v podaljšani hrbtenjači in ponsu. Ta avtomatično generira bazalni ritem za krčenje dihalnih mišic, ki ga nato, glede na informacije iz kemoreceptorjev in mehanoreceptorjev ter drugih struktur, prilagaja spreminjajočim se presnovnim potrebam, mehaničnim razmeram ali vedenju. Uravnavanje ventilacije je primarno nezavedno in avtomatično, vendar lahko nanj do neke mere vplivamo tudi z voljo, kar je je mogoče med budnostjo, ko lahko z voljo celo preglasimo avtomatično uravnavanje ventilacije. Med spanjem  se dražljaji budnosti in volje  umaknejo, tako da je dihanje odvisno predvsem od avtomatskega uravnavanja. Uravnavanje dihanja se razvije zgodaj v fetalnem obdobju in še naprej dozoreva po rojstvu. Sistem za uravnavanje ventilacije pri dojenčkih, zlasti pri nedonošenčkih, je nezrel in sam po sebi nestabilen, kar povzroča nepravilno dihanje, pogoste apneje in periodično dihanje, zaradi česar so dojenčki bolj dovzetni za dihalno odpoved. V tem prispevku obravnavamo fiziološke osnove zrelega uravnavanja ventilacije pri odraslih in razlike pri dojenčkih.

Physiological Principles of Ventilatory Control from Infants to Adults

Breathing is a homeostatic mechanism that primarily counteracts environment- or organism-induced changes in pO2 and pCO2 in the organism, and involves exchange of gases with the environment (ventilation), transfer of gases across the alveolocapillary barrier (diffusion), transport of gases in blood, and cellular utilization or production of pO2 and pCO2, respectively. Breathing is regulated at all these levels, although breathing regulation is usually equated with the ventilatory control. Ventilation is controlled by a complex system involving a central respiratory rhythm/pattern generator and integrator in the medulla oblongata and pons, which automatically generates the basic rhythm for contraction of the respiratory muscles and then adjusts this rhythm according to changing metabolic needs, varying mechanical conditions, and a range of episodic non-ventilatory behaviours, according to the inputs from chemoreceptors, mechanoreceptors, and other structures. It is primarily involuntary and automatic and can be, to some degree, also influenced by voluntary inputs that are prominent during wakefulness and can even override automatic ventilatory control. During sleep, however, wakefulness stimuli and voluntary influences are withdrawn, so that ventilation depends predominantly on automatic control. Breathing regulation develops early in foetal life and continues to mature after birth. The infantile ventilatory control system, especially in preterm infants, is immature and inherently unstable, resulting in irregular breathing, frequent apnoeas, and periodic breathing, making infants more susceptible to respiratory failure. The article aims to review the physiological principles of mature ventilatory control in adults and the differences in infants.

Katja Pavšič, Fajko F. Bajrović