Showing papers on "Hypoventilation published in 1987"
TL;DR: The long-term clinical course of six patients with congenital central hypoventilation syndrome is described, and with appropriate support, the parents were able to provide safe ventilatory care with low morbidity and no mortality.
Abstract: The long-term clinical course of six patients with congenital central hypoventilation syndrome is described. During the neonatal period, the patients had prolonged apneas and hypoventilation, in the absence of cardiac, pulmonary, or neuromuscular disease. After an initial period of respirator dependency, they became able to sustain normal gas exchange while awake. During sleep, however, profound hypoventilation developed, and tracheostomy and mechanical ventilation were required. Ventilatory responses to hypercapnia and hypoxia were depressed or absent and did not improve with time. One patient was able, at 2 years of age, to breathe spontaneously during sleep with only moderate hypoventilation. The others, now 4 to 14 years of age, still need ventilatory support during sleep. Complications, such as cardiac failure and hypoxic seizures, mostly occurred early in the course and resolved with correction of insufficient mechanical ventilation. Speech acquisition was possible with the use of a special stoma plug. All patients were managed at home, and with appropriate support, the parents were able to provide safe ventilatory care with low morbidity and no mortality.
116 citations
TL;DR: It is concluded that nocturnal NPV is an effective method of preventing sleep-induced reductions in alveolar ventilation and a practical method of long-term management of patients with nonobstructive chronic respiratory failure.
Abstract: The efficacy of negative pressure ventilation (NPV) in alleviating sleep-induced reductions in alveolar ventilation and in producing long-term clinical benefits was studied in 5 patients (54 +/- 8 yr of age; mean +/- SD) with chronic respiratory failure secondary to restrictive ventilatory impairment (VC, 40 +/- 14% predicted; TLC, 72 +/- 18% predicted; FEV1/FVC, 89 +/- 15%). In control sleep studies, arterial O2 saturation decreased from 81 +/- 6% during wakefulness to 79 +/- 1% during non-REM sleep and to 67 +/- 3% during REM sleep, and transcutaneous PCO2 increased from 80 +/- 16 mm Hg during wakefulness and non-REM sleep to 87 +/- 16 mm Hg during REM sleep. Nocturnal NPV in a cuirass ventilator improved baseline ventilation during wakefulness and prevented deterioration of alveolar ventilation during sleep. Upper airway obstruction during sleep induced by NPV was successfully managed with either a tricyclic medication or nasal CPAP. After 8 wk of nocturnal NPV, all patients felt considerably better. Daytime resting arterial PCO2 decreased from 56 +/- 2 to 46 +/- 3 mm Hg (p less than 0.05) and PO2 increased from 51 +/- 9 to 70 +/- 10 mm Hg (NS). Four patients have continued NPV at home on a regular basis and have returned to full-time employment. We conclude that nocturnal NPV is an effective method of preventing sleep-induced reductions in alveolar ventilation and a practical method of long-term management of patients with nonobstructive chronic respiratory failure.
72 citations
TL;DR: A case of DKA is reported in a young, otherwise healthy man whose treatment was complicated by severe hypokalemia and a hypoventilatory respiratory arrest without severe hypophosphatemia.
Abstract: THE OCCURRENCE of life-threatening hypokalemic hypoventilatory respiratory failure requiring intubation and respiratory support in diabetic ketoacidosis (DKA) is exceedingly rare. In none of the reported cases have serum phosphate levels been assessed within 12 hours of respiratory failure and in only one case have serial arterial blood gas measurements been performed to document hypoventilation. 1 The recent documentation of severe hypophosphatemia as a cause of hypoventilation and the fact that decrements in serum phosphate and serum potassium levels frequently parallel one another in DKA call into question the importance of hypokalemia to the respiratory response in DKA. We report a case of DKA in a young, otherwise healthy man whose treatment was complicated by severe hypokalemia and a hypoventilatory respiratory arrest without severe hypophosphatemia. We further discuss issues relating to the assessment and treatment of the hypokalemic patient with DKA at risk for ventilatory failure. Report of a Case
28 citations
TL;DR: A patient in whom intermittent assisted ventilation was applied successfully by using a nasal mask to provide positive pressure ventilatory support is presented.
16 citations
TL;DR: La principale cause est la bronchopneumopathie obstructive chronique mais il y a aussi de nombreuses autres causes: neuromusculaires, obesite, hypoventilation centrale et primitive, maladies du collagene, mal Diseases endocriniennes, metaboliques etc...
15 citations
TL;DR: DADLE decreases heart rate by increasing parasympathetic activity to the heart and induces hypoventilation by a different mechanism, and it is speculated that the opioid-induced ventilatory depression is due to either direct opioid action on central respiratory regulation or parASYmpathetic non-muscarinic or non-cholinergic mediating mechanisms.
12 citations
TL;DR: This paper describes ultrastructural abnormalities in the lung and other tissues in congenital copper deficiency and describes Hypoventilation, a feature of SIDS.
5 citations
TL;DR: There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period that include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonalveolar right-to-left shunting.
4 citations
TL;DR: A hypothesized pathophysiological mechanism is presented, and an approach to treatment emphasizing comprehensive inpatient management by the coordinated efforts of psychiatric, pediatric, and supportive disciplines is described.
Abstract: Obesity-Hypoventilation Syndrome, in which obesity is accompanied by respiratory hypoventilation and daytime somnolence, is a particularly complex and dangerous disorder. The authors review the literature describing Obesity-Hypoventilation (Pickwickian Syndrome) and describe the management and rehabilitation of a 7-year-old boy referred to their hospital unit with features of the syndrome. A hypothesized pathophysiological mechanism is presented, and the authors describe an approach to treatment emphasizing comprehensive inpatient management by the coordinated efforts of psychiatric, pediatric, and supportive disciplines.
3 citations
TL;DR: Auditory brainstem responses were studied in a child with congenital central alveolar hypoventilation showing marked depression of respiratory drive during sleep, and findings are discussed with respect to brainstem dysfunction associated with varied sleep apnea syndromes.
Abstract: Auditory brainstem responses (ABRs) were studied in a child with congenital central alveolar hypoventilation showing marked depression of respiratory drive during sleep. During wakefulness and normoventilation no ABR abnormalities were found, either at the age of 14 months or five years. ABR recordings during sleep at 14 months of age showed marked wave V latency and wave I to wave V interpeak latency prolongation of about 0.4 ms both for periods of hypoventilation and normoxic hypercapnia. ABR findings of this and other studies carried out in sleep apneas are discussed with respect to brainstem dysfunction associated with varied sleep apnea syndromes.
3 citations
TL;DR: Patients with amyotrophic lateral sclerosis usually die from respiratory problems such as hypoventilation, aspiration pneumonitis, other pneumonias and pulmonary embolism.
Abstract: Respiratory complications are very common in patients with amyotrophic lateral sclerosis (ALS), which in all cases involves the muscles of the rib cage and the diaphragm. Sometimes these muscles are the earliest ones involved and patients with ALS usually die from respiratory problems such as hypoventilation, aspiration pneumonitis, other pneumonias and pulmonary embolism.
TL;DR: In this paper, the elective neurosurgical patient should be extubated and upon emergence from anesthesia soon achieve the same or better neurologic status he exhibited preoperatively.
TL;DR: Patients with fetal alcohol syndrome who had upper airway obstruction, presumably predisposed by midfacial hypoplasia or micrognathia are described, with clinical findings implicated choanal stenosis as the immediate cause of obstruction in one infant, obstructive lymphoid tissue in the second, and a laryngeal web in the third.
Abstract: Sir .—Usowicz et al 1 described three patients with fetal alcohol syndrome who had upper airway obstruction, presumably predisposed by midfacial (including maxillary) hypoplasia or micrognathia. Documentation of alveolar hypoventilation due to airway compromise by means of arterial blood gas analysis at rest or during sleep was not obtained. The clinical findings implicated choanal stenosis as the immediate cause of obstruction in one infant, obstructive lymphoid tissue in the second, and a laryngeal web in the third. Readers of the above report should be reminded of another entity in which there is midfacial hypoplasia and which may be complicated by upper airway obstruction, namely, Down's syndrome. Rowland et al 2 reported a case of cor pulmonale due to chronic upper airway obstruction in a 5-year-old child with Down's syndrome. Tonsillectomy and adenoidectomy relieved the hypoventilation, with subsequent resolution of pulmonary hypertension. Levine and Simpser 3 described four infants with Down's