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.

Non-invasive ventilation for acute exacerbations of COPD: a new standard of care

Abstract: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent cause of admission to hospital and the intensive care unit (ICU). During these episodes a major deterioration in gas exchange is accompanied by a worsening in the clinical condition of the patient, characterised by a rapid and shallow breathing pattern, severe dyspnoea, right ventricular failure, and encephalopathy. The pathophysiological pathway of all these features is the inability of the respiratory system to maintain adequate alveolar ventilation in the presence of major abnormalities in respiratory mechanics. Hypercapnia, acidosis, and hypoxaemia all ensue, leading to clinical deterioration in cardiovascular and neurological functions. What triggers the abnormal breathing pattern of the patient is still unclear. Although it has been suggested that rapid shallow breathing may afford a protection against the development of respiratory muscle fatigue, this notion has been challenged by studies of weaning off mechanical ventilation where the occurrence of acute respiratory failure can be closely monitored and analysed.1 2 The key element during decompensation seems to be the shortening of the inspiratory time, inducing both a decrease in tidal volume and an increase in respiratory frequency. Because this is associated with, or is secondary to, excessive respiratory loads, treatment should be directed at reducing the loads imposed on the respiratory muscles. Unfortunately, the ability of medical treatment to reverse severe respiratory failure in these patients is limited. When hypoventilation becomes so severe that several organ dysfunctions occur, there is no choice other than to provide “artificial” ventilation to avoid a fatal outcome. The traditional way has been to use endotracheal intubation as a means of access to the lower airways and to deliver ventilation to the patient's lungs. A more recent approach, called non-invasive ventilation (NIV), has profoundly changed the management and outcome of these patients.3 4 Three …

Upper airway occlusion induced by diaphragm pacing for primary alveolar hypoventilation: implications for the pathogenesis of obstructive sleep apnea.

Abstract: This report describes a patient with primary alveolar hypoventilation who, after 2 yr of successful treatment with nocturnal oxygen, developed severe hypoxemia and hypercapnia during sleep, morning headaches, and daytime fatigue. Sleep studies demonstrated prolonged periods of hypoventilation and apnea without evidence of upper airway occlusion. Therefore, a phrenic nerve stimulator was implanted to allow pacing of the diaphragm during sleep. However, diaphragm pacing was accompanied by paradoxical movement of the rib cage and upper airway occlusion during sleep, and was unsuccessful in maintaining adequate ventilation. Therefore, the patient underwent a tracheostomy after which diaphragm pacing maintained adequate nocturnal ventilation; however, paradoxical movement of the rib cage persisted. The induction of upper airway occlusion as a result of diaphragm pacing, in contrast to the absence of occlusion during spontaneous breathing, highlights the importance of the normal temporal coordination of inspiratory activation of the upper airway muscles and diaphragm. The findings have important implications for the pathogenesis of obstructive sleep apneas in general.

Abnormalities of breathing control and airway maintenance in infants and children as a cause of cor pulmonale.

Abstract: Respiratory control abnormalities may result in cor pulmonale. This report summarizes the clinical history, diagnostic evaluation, treatment, and outcome of 16 infants and children presenting with cor pulmonale subsequently found to be due to sleep-dependent hypoventilation. Eleven patients had cardiomegaly and electrocardiographic evidence of right ventricular hypertrophy (RVH) while 5 had only severe RVH or biventricular hypertrophy (BVH). Four infants with central hypoventilation syndrome (CHS)—absence of sleep-related ventilatory drive—had severe sleep-dependent asphyxia and resultant acute respiratory failure; all were ultimately treated with phrenic nerve pacing. One patient with alveolar hypoventilation syndrome (AHS)—a partial deficit in ventilatory drive during sleep—presented with severe pulmonary hypertension and ultimately died despite symptomatic relief with respiratory stimulants. Eleven patients presented with obstructive sleep apnea (OSA) and sleep-dependent asphyxia secondary to intermittent complete or to prolonged partial upper airway obstruction. Localized airway obstruction due to an anomalous innominate artery in 1 child was corrected by arteriopexy. Four children underwent adenotonsillectomy (TA none presently has evidence of cor pulmonale. In summary, early recognition and appropriate treatment of respiratory control disorders will improve sleep ventilation, eliminate asphyxia during sleep, and prevent the development of cor pulmonale.

Ventilatory failure and right-to-left shunt in newborn infants with respiratory distress

Abstract: Infants with severe respiratory distress were investigated by analysis of gases in arterial and venous blood during the breathing of pure oxygen. The results indicated that the infants suffered from a reduced alveolar ventilation and from right-to-left shunt. Possible mechanisms for these disorders are discussed.

Comorbidities and Mortality in Hypercapnic Obese under Domiciliary Noninvasive Ventilation

Abstract: Background The higher mortality rate in untreated patients with obesity-associated hypoventilation is a strong rationale for long-term noninvasive ventilation (NIV). The impacts of comorbidities, medications and NIV compliance on survival of these patients remain largely unexplored.