scispace - formally typeset
Search or ask a question

Showing papers on "Hypoventilation published in 1989"


Journal ArticleDOI
01 Nov 1989-Chest
TL;DR: It is confirmed that in patients with hypothyroidism diaphragmatic dysfunction occurs more frequently than has been suspected and might be of varying severity and this dysfunction reverses with adequate hormone replacement.

76 citations


Journal ArticleDOI
01 Oct 1989-Brain
TL;DR: It is shown that some patients with motor neuron disease, mainly those with symptoms due to respiratory muscle weakness in the absence of severe bulbar impairment, derive symptomatic benefit from supported ventilation.
Abstract: Although respiratory insufficiency is common in the advanced stages of motor neuron disease, some patients may develop distressing respiratory symptoms early in the course of the disease or even present with respiratory failure or arrest. We describe 14 patients with motor neuron disease who were considered for respiratory support; 11 received such support and all derived significant symptomatic improvement without distressing prolongation of life. Of the 8 patients with typical features of amyotrophic lateral sclerosis, 7 had predominant diaphragm weakness and 1 generalized respiratory muscle weakness; 7 received negative pressure ventilation by cuirass which improved both the quality of sleep and exercise tolerance. Three patients with predominantly bulbar disease had nocturnal apnoea or hypoventilation. Two received no support. One, who also developed diaphragm weakness, was treated by a cuirass, continuous positive airway pressure (CPAP), and later nocturnal intermittent positive pressure ventilation (IPPV). Three patients with progressive muscular atrophy had predominant diaphragm weakness or nocturnal apnoea. These patients received nocturnal CPAP, cuirass or IPPV with symptomatic benefit. This series shows that some patients with motor neuron disease, mainly those with symptoms due to respiratory muscle weakness in the absence of severe bulbar impairment, derive symptomatic benefit from supported ventilation.

71 citations


Journal ArticleDOI
18 Nov 1989-BMJ
TL;DR: Negative pressure respiratory support is a non-invasive yet effective treatment for respiratory failure and may avoid the need for intubation, reduce the pathophysiological consequences of positive airway pressure ventilation, and aid extubation.
Abstract: OBJECTIVE--To assess the efficacy of a newly developed system for applying continuous or intermittent negative (subatmospheric) extrathoracic pressure in respiratory failure. DESIGN--Uncontrolled clinical trials in infants deteriorating or failing to improve despite standard medical treatment. SETTING--Paediatric and neonatal intensive care units and paediatric wards. PATIENTS--88 Infants and young children aged 1 day to 2 years with respiratory failure due to bronchopulmonary dysplasia, the neonatal respiratory distress syndrome, bronchiolitis, myopathy, the congenital hypoventilation syndrome, pneumonitis, and postoperative phrenic nerve palsy. At the start of treatment 59 were receiving greater than or equal to 50% inspired oxygen and 40 positive airway pressure ventilation. INTERVENTION--Treatment was provided within purpose built Perspex chambers of appropriate size. The chamber incorporated safe and effective latex neck seals; facilities for access, monitoring, and observation; and a heater to control the ambient air temperature. MAIN OUTCOME MEASURES--Inspired oxygen concentration and carbon dioxide pressure before application of negative extrathoracic pressure and two and 48 hours afterwards; duration of treatment; and final outcome (discharge home or death). RESULTS--While arterial oxygen saturation was maintained at constant values 75 infants showed reductions in inspired oxygen concentrations (range 4-50%, median 15%) two hours after starting treatment and 74 showed reductions at 48 hours (2-79%, median 20%). Of 59 infants who had carbon dioxide pressure measured before and after starting negative extrathoracic pressure, 21 showed a reduction (range 0.6-8.9 kPa, median 2.0), 30 no change (+/- 0.5 kPa), and eight a rise (range 0.6-5.1 kPa, median 2.1). In 28 patients extubation was facilitated, 54 patients were discharged home, where six continued treatment, and 34 died. Treatments lasted for between two and 236 days (median 13 days). CONCLUSION--Negative pressure respiratory support is a non-invasive yet effective treatment for respiratory failure. It may avoid the need for intubation, reduce the pathophysiological consequences of positive airway pressure ventilation, and aid extubation.

60 citations


Journal ArticleDOI
TL;DR: NIPPV and SONI IPPV can improve the nocturnal ventilation of post-poliomyelitis patients with chronic alveolar hypoventilation and reduce unnecessary morbidity by early awareness and appropriate management.
Abstract: Post-poliomyelitis patients may develop insidious respiratory failure. Chronic alveolar hypoventilation symptoms are often misdiagnosed and the condition is frequently treated inappropriately by oxygen therapy. Physicians are often at a loss to offer assisted ventilation by noninvasive methods and tracheostomy and long-term tracheostomy intermittent positive pressure ventilation is often refused. We studied the use of two noninvasive positive airway pressure alternatives for the nocturnal ventilatory support of 31 post-poliomyelitis patients. These methods were intermittent positive pressure ventilation via nasal access (NIPPV) and via a strapless oral-nasal interface (SONI IPPV). The use of custom fabricated interfaces was also evaluated. Practical alternatives for assisted daytime ventilation included glossopharyngeal breathing, the pneumobelt ventilator and mouth intermittent positive pressure ventilation. Overnight sleep monitoring was performed on 10 patients breathing autonomously or with body ventilators then repeated on NIPPV and/or SONI IPPV. The mean sleep oxygen saturation (SaO2) increased from 87.5 +/- 9.1% on unassisted breathing or body ventilators to 96.2 +/- 2.0% (P less than 0.01) on NIPPV or SONI IPPV. Of 12 other patients with a mean vital capacity of 472 +/- 480 ml and no significant free time supine, 11 patients also maintained SaO2 greater than 94% during sleep supine on NIPPV and/or SONI IPPV. Twenty-one patients have been on nocturnal NIPPV for an average of 23 (3-70) months. Six have been on nocturnal SONI IPPV for an average of 35 (5-66) months. All patients' hypoventilation symptoms were relieved. In conclusion, NIPPV and SONI IPPV can improve the nocturnal ventilation of post-poliomyelitis patients with chronic alveolar hypoventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

54 citations


Journal ArticleDOI
TL;DR: It is concluded that asthma patients have variable resolution of airway obstruction during mechanical ventilation and that controlled hypoventilation can be a safe therapy for the patients with more severe obstruction.

43 citations


Journal ArticleDOI
01 Jan 1989-Chest
TL;DR: Bronchial challenge produces hypoxia in stable asthmatic patients, which might result from a combination of hypoventilation with alteration in alveolar ventilation/perfusion relationships.

34 citations


Journal Article
TL;DR: The majority of the symptoms of hypoventilation rapidly disappeared with nocturnal ventilation and the daytime PaO2 and PaCO2 improved significantly allowing the patients to perform more daily activities.
Abstract: 29 patients with chronic respiratory failure due to neuromuscular deficits and restrictive chest wall disorders were treated with nocturnal ventilation via nasal mask at home for at least one year. Home ventilation was provided by a volume cycled positive pressure ventilator attached to a nasal mask which was made to measure by modelling silicon paste onto the patient's face. This method was well tolerated. The majority of the symptoms of hypoventilation rapidly disappeared with nocturnal ventilation and the daytime PaO2 and PaCO2 improved significantly allowing the patients to perform more daily activities. Nocturnal nasal ventilation is efficient but needs strict supervision. The nasal mask can replace or postpone tracheostomy which, if needed, remains a possible and efficient method.

31 citations


Journal Article
TL;DR: In intensive care, HFJV and HFPPV offer some advantages over conventional ventilation with PEEP in the presence of acute respiratory failure with circulatory shock, acute ventricular failure, bronchopleural fistula with large airleak flows and tracheal lesions secondary to tracheostomy or prolonged intubation.
Abstract: High-frequency jet ventilation (HFJV) and high-frequency positive pressure ventilation (HFPPV) occupy a specific place in the wide range of ventilatory support techniques available for anesthesia and critical care. In anesthesia, HFJV and HFPPV have been proved to be superior to conventional ventilation in ENT surgery, laryngoscopies, laser surgery, bronchoscopies, surgery of the upper airways, surgical resection of aneurysms involving the thoracic descending aorta, vocal cord surgery, microsurgery for superficial temporal artery to middle cerebral artery anastomosis and lithotripsy. In intensive care, HFJV and HFPPV offer some advantages over conventional ventilation with PEEP in the presence of acute respiratory failure with circulatory shock, acute ventricular failure, bronchopleural fistula with large airleak flows and tracheal lesions secondary to tracheostomy or prolonged intubation. In many other clinical situations HFJV and HFPPV have produced results identical with those obtained with conventional ventilation. Chronic obstructive pulmonary disease and asthma are absolute contra-indications to both techniques because overdistension and/or hypoventilation occur in the presence of increased respiratory compliance and/or elevated bronchial resistance. In unilateral lung disease HFJV and HFPPV offer no advantage over conventional ventilation.

23 citations


Journal Article
TL;DR: Evaluating critically the various proposed mechanisms, showing the minor role played by some and defining the respective roles of the two principal mechanisms, i.e., CO2 unloading, and the complement activation-hypoxemia cascade.
Abstract: The dialysis patient treated intermittently on a three-times-weekly schedule is exposed during the short dialysis period (4 hours) to abrupt changes in the internal milieu. During the 44 hours of the interdialytic period, H+ ions accumulate slowly, causing respiratory-compensated (hyperventilation) metabolic acidosis in the patient at the start of dialysis. The arterial bicarbonate concentration (HCO3-) is between 17 and 23 mEq/L and a relatively low arterial carbon dioxide tension (PaCO2) of 33-36 mm Hg is observed. Four hours later, after exposure to a biocompatible (polyacrylonitrile) or bioincompatible membrane (cuprophane) and a bicarbonate or acetate dialysis bath, the patient reaches metabolic alkalosis after mild to moderate hypoventilation, with or without breathing irregularities. Defined another way, the dialysis patient is an acid accumulator for 44 hours, after which a 4-hour period of efficient retitration occurs that is accompanied by a variable degree of hypoxemia. The latter phenomenon has been the subject of numerous investigations during the past 10 years. As happens with complex biologic processes, the conclusions reached by the various investigators are conflicting, depending on their viewpoint and the variables they examined. Since Sherlock in 1977 showed that patients dialyzed with an acetate-containing dialysate became hypoxemic and attributed it to hypoventilation after carbon dioxide (CO2) losses through the dialyzer, a number of other mechanisms have been proposed, defended by some and questioned by others. The purpose of this short overview is to evaluate critically the various proposed mechanisms, showing the minor role played by some and defining the respective roles of the two principal mechanisms, i.e., CO2 unloading, and the complement activation-hypoxemia cascade.

20 citations


Journal ArticleDOI
TL;DR: PetO2 and FiO2 — PetO2 are sensitive and valuable indicators of adequate ventilation and appropriate oxygen supply and exceeded the sensitivity of end-tidal CO2.
Abstract: The effect of progressive hypoventilation on end-tidal gas concentrations and corresponding partial pressures in arterial blood was studied in anesthetized pigs. Oxygen, CO2, and nitrous oxide concentrations were measured continuously with fast infrared and paramagnetic sensors as ventilation was decreased gradually in 12.5% increments at 5-min intervals. Samples for blood gas determinations were obtained at 3 min after each respirator adjustment. An increasing difference between inspiratory and end-tidal oxygen concentrations (FIO2 — PetO2) was the most sensitive indicator of hypoventilation and exceeded the sensitivity of end-tidal CO2. Decreasing PetO2 was followed by a decrease in PaO2, but no detectable change in arterial oxygen saturation until the ventilation was decreased to 37% of the initial value. The rapidly decreasing alveolar oxygen was replaced by nitrous oxide, and a sudden drop in ventilation was characterized by a change in the end-tidal values of all the three gases and peaked waveforms. Thus, PetO2 and FiO2 — PetO2 are sensitive and valuable indicators of adequate ventilation and appropriate oxygen supply.

19 citations


Journal ArticleDOI
TL;DR: It is concluded that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis.
Abstract: • The effect of intravenous sedation on oxygen saturation and ventilation was studied in 11 patients undergoing peritoneoscopy. Oxygen saturation (mean ± SD) decreased from baseline (94.7% ± 1.7%) to nadir (78.6% ± 10.7%) after sedation. Respiratory depression was evident in these patients by concomitant decreases in minute ventilation and tidal volume. Baseline to nadir arterial blood gas changes in eight patients were consistent with hypoventilation and also suggested a superimposed ventilation perfusion mismatch. Mean respiratory rate did not significantly change during peritoneoscopy. Peritoneal gas insufflation stimulated increased ventilation and oxygen saturation, but no further changes in Pco 2 or pH. We conclude that serious arterial oxygen desaturation and possibly some ventilation perfusion mismatch occur after sedation with intravenously administered meperidine-diazepam for peritoneoscopy with resultant hypoxemia, hypercarbia, and acidosis. ( Arch Intern Med . 1989;149:1029-1032)

Journal ArticleDOI
TL;DR: The value of radical surgery is currently assessed, performed early in the course of the disease, which may stabilize and prolong independent walking and the effect of delaying the onset of scoliosis.
Abstract: In the absence of any effective drug treatment, physical methods of management are still the mainstay of treatment. Our current practice in Duchenne muscular dystrophy is to provide lightweight knee-ankle-foot orthoses at the time of loss of ambulation. This prolongs independent walking for an average of two years, and has the effect of delaying the onset of scoliosis, particularly if the boy remains ambulant during the pubertal growth spurt. We are currently assessing the value of radical surgery, performed early in the course of the disease, which may stabilize and prolong independent walking. In non-ambulant patients instrumentation of the spine, using mainly the Luque technique, has revolutionised the treatment of progressive scoliosis. Ventilator support produces clinical improvement in late cases with symptomatic hypoventilation. Its place in the management of asymptomatic patients with nocturnal hypoventilation still needs evaluation, as does the role of early prophylactic respiratory support. We have reviewed the clinical drug trials over the past 10 years. There has been an overall improvement in their quality control.

Journal ArticleDOI
TL;DR: The case of a 7 year old girl who developed central hypoventilation following pertussis and who was treated by negative pressure ventilation using a new portable tank respirator is reported.
Abstract: We report the case of a 7 year old girl who developed central hypoventilation following pertussis and who was treated by negative pressure ventilation using a new portable tank respirator. We believe this is the first reported case of central hypoventilation following pertussis successfully treated by intermittent negative pressure ventilation.

Journal ArticleDOI
TL;DR: The system pressure relief valve of the Dräger AV-E anesthesia ventilators is powered by connecting tubing from the ventilator, and the tubing became kinked when the anesthesia machine was moved, resulting in an iatrogenically induced valve malfunction and increasing minimum and peak pressures in the patient circuit.

Journal ArticleDOI
TL;DR: It is questionable whether the clinical value of the drug is outweighed by its toxicity, and the indications for use of this hypnotic drug may vary between doctors since an 8- fold variation was seen in drug prescription between Swedish counties in 1987.
Abstract: Cases of hexapropymate poisoning requiring intensive care in an urban region of Sweden (420,000 inhabitants) were collected over 2.5 years (1985 to 1987). Only patients with serum hexapropymate concentrations above 5.5 mg/L (30 μmol/L) and with a negative history for intake of tricyclic antidepressants, phenothiazines, barbiturates, antihistaminic drugs and opiates were included. Clinical data about 8 intoxication events in 6 patients were evaluated retrospectively. Initial symptoms included coma, hypotension, hypothermia, and hypoventilation. Maximum coma depth (Glasgow coma score) was 3 to 5 in 5 out of 8 events. On 7 occasions assisted ventilation was required (for 12 hours or more in 5 events). There was no relationship between serum concentrations of hexapropymate and severity of clinical symptoms. All patients survived. Detailed analysis of the drug elimination in one patient showed a terminal elimination half life of 21 hours, which is longer than previously reported (5 hours). The indications for use of this hypnotic drug may vary between doctors since an 8- fold variation was seen in drug prescription between Swedish counties in 1987. Poisoning with hexapropymate is a serious condition which may require symptomatic treatment in the intensive care unit. The clinical picture is similar to that seen in patients with burbiturate intoxication. There is no role for active forced elimination of the drug. It is questionable whether the clinical value of the drug is outweighed by its toxicity.


Journal Article
TL;DR: It is concluded that CNPV and IPPV through a nose mask significantly improve hypoventilation and quality of life in some patients with chronic respiratory failure.
Abstract: Chest negative pressure ventilation (CNPV) and intermittent positive pressure ventilation (IPPV) through a nose mask were used for ventilatory support of 4 patients with chronic respiratory failure due to old tuberculosis (2 patients), chronic pulmonary emphysema, and kyphoscoliosis (VC, 0.91 +/- 0.16 L; %VC 31.2 +/- 3.2; FEV1.0, 0.62 +/- 0.19 L). These ventilatory supports were used for relief of chronic arterial CO2 retention, weaning from the mechanical ventilation, therapy for the acute exacerbation on the chronic respiratory failure, and the relief of the respiratory muscle fatigue. After CNPV and IPPV through a nose mask, PaCO2 showed a significant fall from 75.7 +/- 14.8 Torr to 60.2 +/- 12.3 Torr (p less than 0.01). All patients showed improvement of clinical symptoms. Two patients have continued CNPV at home on a regular basis. We conclude that CNPV and IPPV through a nose mask significantly improve hypoventilation and quality of life in some patients with chronic respiratory failure.

Book ChapterDOI
01 Jan 1989
TL;DR: This study examined the effect of hypoventilation immediately following trauma on cerebral energy metabolism in patients with fluid percussion brain injury and found that it had an impact on energy metabolism.
Abstract: There is evidence to suggest that severe head injury can cause disturbances of cerebral energy metabolism which can result in tissue acidosis and decreased energy production [2]. One objective of this study was to determine if fluid percussion brain injury affects cerebral energy metabolism. Additionally, since post-traumatic respiratory distress is a major complicating factor in head injury [5], another goal was to analyze the effect of hypoventilation immediately following trauma on cerebral energy metabolism.