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.

Detection of hypoventilation

Abstract: This chapter aims to consider and discuss different methods of monitoring ventilation in patients with obesity hypoventilation syndrome (OHS) in both an inpatient and outpatient clinical settings. Monitoring ventilation is essential to ensure patient safety, as well as effectiveness and efficiency of treatment. OHS is associated with increased mortality, impaired quality of life, and increased healthcare utilization. Therefore, ensuring the effectiveness of treatment with continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) is imperative for achieving good patient outcomes while providing high value health care. Ventilation can be monitored by measuring symptoms, carbon dioxide, bicarbonate levels, pulse oximetry, and ventilator data downwards. It is likely that a combination of these methods will aid clinicians in determining optimal care.

Respiratory assessment in centronuclear myopathies.

Abstract: The centronuclear myopathies (CNMs) are a group of inherited neuromuscular disorders classified as congenital myopathies. While several causative genes have been identified, some patients do not harbor any of the currently known mutations. These diverse disorders have common histological features, which include a high proportion of centrally-nucleated muscle fibers, and clinical attributes of muscle weakness and respiratory insufficiency. Respiratory problems in CNMs may manifest initially during sleep, but daytime symptoms, ineffective airway clearance, and hypoventilation predominate as more severe respiratory muscle dysfunction evolves. Respiratory muscle capacity can be evaluated using a variety of clinical tests selected with consideration for the age and baseline motor function of the patient. Similar clinical tests of respiratory function can also be incorporated into preclinical CNM canine models to offer insight for clinical trials. Since respiratory problems account for significant morbidity in patients, routine assessments of respiratory muscle function are discussed.

Evaluating the evidence: is phrenic nerve stimulation a safe and effective tool for decreasing ventilator dependence in patients with high cervical spinal cord injuries and central hypoventilation?

Abstract: Case reports, case series and case control studies have looked at the use of phrenic nerve stimulators in the setting of high spinal cord injuries and central hypoventilation syndromes dating back to the 1980s. We evaluated the evidence related to this topic by performing a systematic review of the published literature. Search terms “phrenic nerve stimulation,” “phrenic nerve and spinal cord injury,” and “phrenic nerve and central hypoventilation” were entered into standard search engines in a systematic fashion. Articles were reviewed by two study authors and graded independently for class of evidence according to published guidelines. The published evidence was reviewed, and the overall body of evidence was evaluated using the grading of recommendations, assesment, development and evaluations (GRADE) criteria Balshem et al. (J Clin Epidemiol 64:401–406, 2011). Our initial search yielded 420 articles. There were no class I, II, or III studies. There were 18 relevant class IV articles. There were no discrepancies among article ratings (i.e., kappa = 1). A meta-analysis could not be performed due to the low quality of the available evidence. The overall quality of the body of evidence was evaluated using GRADE criteria and fell within the “very poor” category. The quality of the published literature for phrenic nerve stimulation is poor. Our review of the literature suggests that phrenic nerve stimulation is a safe and effective option for decreasing ventilator dependence in high spinal cord injuries and central hypoventilation; however, we are left with critical questions that provide crucial directions for future studies.

Controlled ventilation with intermittent positive-pressure breathing in the management of acute ventilatory failure associated with chronic obstructive pulmonary disease.

Abstract: Excerpt Controlled mechanical ventilation may be employed for ventilatory support in patients with respiratory failure when assisted ventilation fails. The purpose of controlled ventilation is to r...

Pulmonary hypertension and chronic hypoventilation in ROHHAD syndrome treated with average-volume assured pressure support

Abstract: Introduction: Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is an exceptionally rare clinical entity with significant morbidity and high mortality with challenging-to-treat hypoventilation. Case presentation: An 11-year-old morbidly obese Chinese female presented with a putative diagnosis of ROHHAD associated with a left psoas ganglioneuroma. Initial polysomnography showed severe obstructive sleep apnea and hypoventilation. She was not adherent to prescribed non-invasive positive pressure ventilation (NIPPV). Echocardiography demonstrated evidence of pulmonary hypertension, likely secondary to chronic hypoventilation. With behavioral modification and trial of average volume-assured pressure support (AVAPS), adherence improved with eventual improvement of her pulmonary hypertension. Conclusion: AVAPS may improve ventilation and NIPPV adherence in central hypoventilation disorders such as ROHHAD, reducing risk of morbidity and mortality. Key words: Pulmonary hypertension; Hypoventilation; Positive pressure ventilation; sleep Apnea; Obstructive; Polysomnography; ROHHAD