Hypoventilation

About: Hypoventilation is a research topic. Over the lifetime, 1772 publications have been published within this topic receiving 40799 citations. The topic is also known as: respiratory depression.

Pathophysiological basis of mechanical ventilation

Abstract: Mechanical ventilation is required if ventilatory insufficiency is present. This is typically indicated by hypercapnea. Hypoxemia occurs secondary to hypoventilation. Usually overload of the respiratory muscles (ventilatory pump) will be the underlying mechanism, for the most part caused by acute or chronic disease. In case of sole hypoxemia mechanical ventilation will only be indicated if the oxygen-content (equals oxygen saturation x haemoglobin x 1.39) drops below a critical threshold or if ventilatory pump failure is imminent on account of the underlying disease (eg. pneumonia). The background of our recommendations is to avoid potential damage caused by mechanical ventilation. Especially high inspiratory pressures and oxygen concentrations can be harmful to the lung. Therefore every case has to evaluated for individual target parameters of ventilation. The use of the oxygen-content instead of the arterial oxygen pressure as the target parameter will usually lead to a more careful ventilation. Cardiogenic pulmonary oedema is an exception to this rule since inspiratory positive pressure and PEEP will result in improved diffusion as well as reduction of preload and work of breathing. In recent years progress has been made on the field of ventilation access especially in severe and acute cases. Non-invasive ventilation is superior to invasive ventilation in patients with exacerbated COPD since it improves outcome effectively. This is being caused by a decline in ventilator associated pneumonias, most likely because non-invasive ventilation allows patients to clear their secretions by coughing, resulting in improved lung clearance. Controlled ventilation allows optimal unloading of the respiratory muscles which have been overloaded by the underlying disease. Application of a controlled ventilation mode in acute disease will usually require some kind of sedation. Assisted ventilation will result in improved gas exchange but only incomplete unloading of respiratory muscles and therefore delayed restitution. Permanent controlled ventilation under sedation for a prolonged period (days) requires intermittent periods of assisted- or spontaneous breathing in order to avoid atrophy of the respiratory muscles. This review summarizes background information on the nature of the derangement, the relation between oxygen supply and consumption under special consideration of respiratory muscle insufficiency and impact of different ventilation modes.

Bicyclic amides for enhancing glutamatergic synaptic responses

Abstract: This invention relates to compounds, pharmaceutical compositions and methods for use in the prevention and treatment of cerebral insufficiency, including enhancement of receptor functioning in synapses in brain networks responsible for basic and higher order behaviors. These brain networks, which are involved in regulation of breathing, and cognitive abilities related to memory impairment, such as is observed in a variety of dementias, in imbalances in neuronal activity between different brain regions, as is suggested in disorders such as Parkinson's disease, schizophrenia, respiratory depression, sleep apneas, attention deficit hyperactivity disorder and affective or mood disorders, and in disorders wherein a deficiency in neurotrophic factors is implicated, as well as in disorders of respiration such as overdose of an alcohol, an opiate, an opioid, a barbiturate, an anesthetic, or a nerve toxin, or where the respiratory depression results form a medical condition such as central sleep apnea, stroke-induced central sleep apnea, obstructive sleep apnea, congenital hypoventilation syndrome, obesity hypoventilation syndrome, sudden infant death syndrome, Rett syndrome, spinal cord injury, traumatic brain injury, Cheney-Stokes respiration, Ondines curse, Prader-Willi's syndrome and drowning, hi a particular aspect, the invention relates to bicyclic amide compounds useful for treatment of such conditions, and methods of using these compounds for such treatment.

Central congenital hypoventilation syndrome: changing face of a less mysterious but more complex genetic disorder.

Abstract: Central congenital hypoventilation syndrome (CCHS) is a disorder in which affected individuals fail to breathe during sleep despite progressive hypercapnia and hypoxia. Discovery of the genetic link between PHOX2B gene mutations and CCHS represents a breakthrough in the diagnosis of CCHS, identification of patients with late-onset central hyperventilation syndrome (LO-CHS), association of mutated alleles with disease severity, and clues to the pathophysiology responsible for the disorder. CCHS is a neurocristopathy, and affected individuals are more likely to have disorders of the autonomic nervous system, Hirschsprung disease, and neural crest tumors. Most CCHS patients harbor sporadic mutations, but identification of an affected individual should trigger evaluation of family members because inherited mutations are transmitted in an autosomal dominant fashion. Management of CCHS and LO-CHS is primarily directed at optimizing respiratory status, most often with nighttime mechanical ventilatory support and monitoring with polysomnography. Multidisciplinary care is also necessary to promote better outcomes and long-term survival.