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 concluded that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction and chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.
Abstract: Opioids are respiratory depressants and heroin/opioid overdose is a major contributor to the excess mortality of heroin addicts. The individual and situational variability of respiratory depression caused by intravenous heroin is poorly understood. This study used advanced respiratory monitoring to follow the time course and severity of acute opioid-induced respiratory depression. 10 patients (9/10 with chronic airflow obstruction) undergoing supervised injectable opioid treatment for heroin addiction received their usual prescribed dose of injectable opioid (diamorphine or methadone) (IOT), and their usual prescribed dose of oral opioid (methadone or sustained release oral morphine) after 30 minutes. The main outcome measures were pulse oximetry (SpO2%), end-tidal CO2% (ETCO2%) and neural respiratory drive (NRD) (quantified using parasternal intercostal muscle electromyography). Significant respiratory depression was defined as absence of inspiratory airflow >10s, SpO2% 10s and ETCO2% per breath >6.5%. Increases in ETCO2% indicated significant respiratory depression following IOT in 8/10 patients at 30 minutes. In contrast, SpO2% indicated significant respiratory depression in only 4/10 patients, with small absolute changes in SpO2% at 30 minutes. A decline in NRD from baseline to 30 minutes post IOT was also observed, but was not statistically significant. Baseline NRD and opioid-induced drop in SpO2% were inversely related. We conclude that significant acute respiratory depression is commonly induced by opioid drugs prescribed to treat opioid addiction. Hypoventilation is reliably detected by capnography, but not by SpO2% alone. Chronic suppression of NRD in the presence of underlying lung disease may be a risk factor for acute opioid-induced respiratory depression.
47 citations
TL;DR: The difficulty of achieving the diagnosis of ROHHAD syndrome and its overlap with other well-established disease entities are highlighted and the mortality and morbidity resulting from the high incidence of cardiorespiratory arrest may be prevented by early ventilatory support.
Abstract: A rare syndrome of rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) has been recently described. We report the first patient with this syndrome in Southeast Asia and review reported cases to date. Our patient was good health with normal development until the age of 2. He then developed hyperphagic obesity, hypersomnolence, seizures, alveolar hypoventilation, central hypothyroidism, sodium and water dysregulation, gastrointestinal dysmotility, strabismus, disordered temperature and irregular heart rate, altered sweating, delayed puberty, mental retardation and recurrent respiratory tract infections. The cardiomyopathy with heart failure and abnormal cerebral spinal fluid (CSF) neurotransmitter analysis present in our patient have not been reported previously. Tumours of the sympathetic nervous system are known to be associated with this syndrome but had not been found in our patient at the time of reporting. We highlight the difficulty of achieving the diagnosis of ROHHAD syndrome and its overlap with other well-established disease entities. The mortality and morbidity resulting from the high incidence of cardiorespiratory arrest may be prevented by early ventilatory support.
47 citations
TL;DR: The data suggest that the neuronal loss of the DCMN, VCMN, and SMN is associated with the presence of hypoventilation in MyD and may be an important feature of MyD.
Abstract: Article abstract-Respiratory insufficiency occurs frequently in patients with myotonic dystrophy (MyD). We have performed a quantitative study of neurons linked to respiratory function in the dorsal central medullary nucleus (DCMN), the ventral central medullary nucleus (VCMN), and the subtrigeminal medullary nucleus (SMN) in seven patients with MyD and eight age-matched controls. Alveolar hypoventilation of the central type occurred in three of the MyD patients but not in the remaining MyD patients or controls. The densities of neurons of the DCMN, the VCMN, and the SMN in MyD patients with hypoventilation were significantly lower than in MyD without hypoventilation and controls. These data suggest that the neuronal loss of the DCMN, VCMN, and SMN is associated with the presence of hypoventilation in MyD and may be an important feature of MyD. NEUROLOGY 1996;46: 228-231
47 citations
TL;DR: The hope is that, with growing recognition, discussion, and investigation into the overlap of ROHHAD with disorders outside congenital central hypoventilation syndrome, further advancement will be made.
Abstract: Purpose of review The focus of this review is to compare and contrast two orphan disorders of late-onset hypoventilation. Specifically, rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) and congenital central hypoventilation syndrome (CCHS) are distinct in presentation, pathophysiology, and etiology. Recent findings While limited new information is available, appreciation and understanding of rare disorders can be attained through case reports. Recent literature in ROHHAD has included case reports with new findings that may provide insight into pathophysiology involving possible aberrant immune process and dysregulation at the level of the orexinergic system. Summary The etiology of ROHHAD continues to be elusive. The hope is that, with growing recognition, discussion, and investigation into the overlap of ROHHAD with disorders outside congenital central hypoventilation syndrome, further advancement will be made.
47 citations
TL;DR: The clinical importance of recognizing the syndrome of general alveolar hypoventilation lies in its reversibility following adequate relief of the hypoxaemia and hypercapnia.
Abstract: Chronic alveolar hypoventilation has been considered in terms of its pathogenesis. Distinction has been made between general alveolar hypoventilation, which arises from failure of the ventilatory apparatus, and net alveolar hypoventilation which is secondary to bronchopulmonary disease. Examples are presented to ifiustrate the pathogenesis of general alveolar hypoventilation in various disorders of the ventilatory apparatus. The common end-points for all of these are arterial hypoxaemia and hypercapnia; these abnormalities in the blood gases are responsible for the cardiorespiratory failure of chronic alveolar hypoventilation. However, the clinical expression of these abnormal blood gases is modified by the pathogenetic background: in failure of the respiratory centre, the consequences of arterial hypoxaemia and hypercapnia are manifest in the purest forms, free of the complications of abnormal lungs or mechanics of breathing; in severe kyphoscoliosis, the compressed distorted lung restricts the pulmonary hypertension and cor pulmonale ; in obesity, the hypermetabolic and hypervolemic states provide a background of left ventricular, as well as right ventricular overload, for the consequences of arterial hypoxaemia and hypercapnia. The clinical importance of recognizing the syndrome of general alveolar hypoventilation lies in its reversibility following adequate relief of the hypoxaemia and hypercapnia.
47 citations