A 57-year-old male hypertensive Caucasian patient on medical treatment for 1.5 months for non-organic-related AF was hospitalized in the ICU because of high-ventricular response AF (170 per minute). Biphasic CV with 100J was performed on the patient under medical treatment, and sinus rhythm was maintained. The patient had high-ventricular response AF (160 per minute) again after 2 days, biphasic CV with 200J was conducted again, and sinus rhythm was maintained. An apnea test (AT) was performed on the same night because frequent apneas were observed during sedation, and his body mass index (BMI) was 40.9kg/m2. The results were as follows: apnea-hypopnea index (AHI) of 71 per hour, desaturation period of 28 minutes, and minimum peripheral oxygen saturation (SpO2) of 68 %. The patient was discharged with nocturnal BiPAP—expiratory positive airway pressure of 8cm H2O and inspiratory positive airway pressure of 14cm H2O—and medical treatment. The patient was in sinus rhythm at the 1-month follow-up; thus, medication doses were decreased, AT was performed under BiPAP at the 6-month follow-up, and the results were as follows: AHI of 1 per hour, desaturation period of 1 minute, and minimum SpO2 of 87 %. The patient did not have AF within these 6 months. At the 12th month, the patient decided to undergo gastric bypass surgery. Up to the time of surgery, nocturnal BiPAP and medical treatment were continued. Within 6 months after the medical surgery, the patient lost 40kg and only medical treatment was continued. In the AT conducted in the 18th month (via spontaneous breathing), results in the range of AHI of 5 per hour, apnea index of 1 per hour, and minimum SpO2 of 93 % were observed; hence, bisoprolol fumarate was ended (Fig. ).
Case 7 involved an 8-year-old girl with a diagnosis of ventricular septal defect. She presented to the ICU as intubated after ventricular septal defect (VSD) closure. She was on 7.4mcg/kg/min dopamine, 8mcg/kg/hr dobutamine, and 0.08mcg/kg/min adrenalin support postoperatively. She received a 1mg/hr midazolam infusion for 14 hours and a 0.15mg/kg/hr tramadol infusion for 23 hours. After 24 hours, her pupils were dilated and an epidural hemorrhage and shift were detected in her cranial computational tomography (CT) scan, after which the epidural hemorrhage was extracted. Despite the lack of sedative administration for the first 96 postoperative hours, she was sedated and the conditions of her pupils did not change. A reverse flow was detected in her carotid Doppler scan but no intracerebral hemorrhage was detected in her cerebral angiogram. At 98 postoperative hours, she performed the standard apnea test and her ApneaLink™ recordings were made simultaneously. Due to the desaturation occurring at the end of the apnea test that lasted 4 minutes and 38 seconds, continuous positive airway pressure (CPAP) treatment was applied. Her PaCO2 value increased from 45 to 75mmHg and the ApneaLink™ showed that there was no respiratory effort present. This demonstrated that the presence of apnea can be seen and recorded by ApneaLink™ during the apnea test.