Topic
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.
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TL;DR: It is demonstrated that hypoventilation improves systemic oxygenation in patients after bidirectional superior cavopulmonary connection, and is likely the likely mechanism for this effect, which decreases cerebral vascular resistance, thus increasing cerebral, superior vena caval, and pulmonary blood flow.
82 citations
TL;DR: The latest edition of The International Classification of Sleep Disorders: Diagnostic and Coding Manual subsumes a broad range of disorders under the heading "Sleep Related Hypoventilation/Hypoxemic Syndromes" which are quite common, such as COPD with worsening gas exchange during sleep.
82 citations
TL;DR: Simulations demonstrated that remifentanil concentrations well tolerated in the steady state will cause a clinically significant hypoventilation following bolus administration, confirming the acute risk of bolus Administration of fast-acting opioids in spontaneously breathing patients.
Abstract: Background: The C 50 of remifentanil for ventilatory depression has been previously determined using inspired carbon dioxide and stimulated ventilation, which may not describe the clinically relevant situation in which ventilatory depression occurs in the absence of inspired carbon dioxide. The authors applied indirect effect modeling to non-steady state PaCO 2 data in the absence of inspired carbon dioxide during and after administration of remifentanil. Metbods: Ten volunteers underwent determination of carbon dioxide responsiveness using a rebreathing design, and a model was fit to the end-expiratory carbon dioxide and minute ventilation. Afterwards, the volunteers received remifentanil in a stepwise ascending pattern using a computer-controlled infusion pump until significant ventilatory depression occurred (end-tidal carbon dioxide [PeCO 2 ] > 65 mmHg and/or imminent apnea). Thereafter, the concentration was reduced to 1 ng/ml. Remifentanil pharmacokinetics and PaCO 2 were determined from frequent arterial blood samples. An indirect response model was used to describe the PaCO 2 time course as a function of remifentanil concentration. Results: The time course of hypercarbia after administration of remifentanil was well described by the following pharmacodynamic parameters: F (gain of the carbon dioxide response), 4.30; k e0 carbon dioxide, 0.92 min -1 ; baseline PaCO 2 , 42.4 mmHg; baseline minute ventilation, 7.06 1/min; k e1,CO2, 0.08 min -1 ; C 50 for ventilatory depression, 0.92 ng/ml; Hill coefficient, 1.25. Conclusion: Remifentanil is a potent ventilatory depressant. Simulations demonstrated that remifentanil concentrations well tolerated in the steady state will cause a clinically significant hypoventilation following bolus administration, confirming the acute risk of bolus administration of fast-acting opioids in spontaneously breathing patients.
81 citations
TL;DR: Respiratory symptoms developed relatively early in patients with acid maltase deficiency and inflammatory disorders but parallelled the development of limb weakness in limb girdle, myotonic and congenital syndromes.
Abstract: Eighty-four patients with primary disorders of muscle were referred for assessment of respiratory insufficiency between 1978 and 1991. The eventual diagnoses were: 'limb girdle syndromes' (18 patients), adult onset acid maltase deficiency (14), dystrophia myotonica (13), inflammatory disorders (10), congenital myopathies (nine), rigid spine syndromes (five), dystrophies (Duchenne (six), facioscapulohumeral (four), Becker (one)) and miscellaneous (four). Presentations were often insidious, with progressive nocturnal hypoventilation culminating in respiratory failure or arrest, recurrent respiratory tract infections, or obstructive sleep apnoea. Respiratory symptoms developed relatively early in patients with acid maltase deficiency and inflammatory disorders but parallelled the development of limb weakness in limb girdle, myotonic and congenital syndromes. Sixty-six patients received respiratory support for a median of 5 years (1-34 years) using various techniques of negative and positive pressure ventilation. Fourteen patients received short-term support for an episode of respiratory failure before being weaned, 51 required nocturnal domiciliary ventilation and one was dependent on continuous domiciliary support. Tracheostomy was performed in 32 patients and used for domiciliary nocturnal ventilation in 25. Twenty-eight patients have subsequently died.
80 citations
TL;DR: Sleep studies should be performed on post-polio patients with excessive daytime sleepiness and respiratory complaints, including individuals already on respiratory assistance such as rocking beds who have features of respiratory failure who can be treated effectively with long-term nasal mechanical ventilation.
80 citations