- A Deeper Curse: A Hirschsprung Patient's Evaluation Unmasks a Rare Association with Congenital Central Hypoventilation Syndrome and Neuroblastoma. [Case Reports]
- We present a rare case of a 2-year-old male patient referred for primary evaluation of constipation and ultimately treatment of Hirschsprung disease (HSCR) whose preoperative workup incidentally revealed a posterior paraspinal mass. Following the biopsy of the mass, the patient exhibited hypoventilation and hypoxia requiring a delayed extubation, raising suspicion for congenital central hypoventi…
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- StatPearls: Mechanical Ventilation [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Although mechanical ventilation can be a complex and seemingly elusive topic, expectations are that physicians and healthcare professionals who deal with critically ill patients have a basic familiarity with the management of a patient on a ventilator. Additionally, providers must also understand how applying mechanical ventilation affects patient physiology and response to disease states. The fo…
- Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study. [Randomized Controlled Trial]Respir Physiol Neurobiol. 2023 Feb; 308:103987.RP
- Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on ex…
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- Hypoventilation in the PACU is associated with hypoventilation in the surgical ward: Post-hoc analysis of a randomized clinical trial. [Randomized Controlled Trial]J Clin Anesth. 2023 Feb; 84:110989.JC
- CONCLUSIONS: In adults recovering from abdominal surgery, events of hypoventilation during the first postoperative hour are associated with similar events during the rest of the first 48 postoperative hours, with positive predictive value approaching 100%. Sixty-one patients had ward hypoventilation that was not preceded by hypoventilation in PACU.
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- Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial. [Randomized Controlled Trial]
- Current guidelines recommend that patients with obesity hypoventilation syndrome (OHS) are electively admitted for inpatient initiation of home non-invasive ventilation (NIV). We hypothesised that outpatient NIV setup would be more cost-effective.
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- Noninvasive ventilation in New Zealand: a national prevalence survey. [Journal Article]Intern Med J. 2022 Nov 03 [Online ahead of print]IM
- CONCLUSIONS: Home-based NIV provision has doubled since the previous survey, reflecting increased burden from OHS and obstructive pathologies and a disproportionate disease burden among Māori and Pacific populations. The large regional variations are concerning and highlight the urgent requirement for national service specifications, education and equipment provision. Further research is needed to address access equity.
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- APAP, BPAP, CPAP, and New Modes of Positive Airway Pressure Therapy. [Review]
- Positive airway pressure (PAP) is the primary treatment of sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. Just as clinicians use pharmacological mechanism of action and pharmacokinetic data to optimize medication therapy for an individual, understanding how PAP works and choosing the right mode and device are critical to optim…
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- A Newborn Infant with Congenital Central Hypoventilation Syndrome and Pupillary Abnormalities: A Literature Review. [Case Reports]
- We present a neonate with early onset apnea and bradycardia in the absence of primary cardiorespiratory and central nervous system disorders that eventually required chronic ventilator support starting at 6 hours of life. Molecular testing of paired-like homeobox 2b (PHOX2B) gene mutation confirmed the diagnosis of congenital central hypoventilation syndrome (CCHS). CCHS is a rare genetic disorde…
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- Modified hypoxic challenge testing in children needing nocturnal ventilation: An observational study. [Journal Article]Pediatr Pulmonol. 2023 01; 58(1):88-97.PP
- CONCLUSIONS: Evaluating response to patients' usual ventilation through "fitness-to-fly" assessment aids decision making when considering whether children who receive nocturnal ventilation can travel by air, since for some using a ventilator reduces or avoids the need for supplemental oxygen.
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- VOLUMETRIC CAPNOGRAPHY FOR RESPIRATORY MONITORING OF PATIENTS DURING ROUTINE COLONOSCOPY WITH ROOM-AIR AND CARBON DIOXIDE INSUFFLATION. [Journal Article]Arq Gastroenterol. 2022 Jul-Sep; 59(3):383-389.AG
- CONCLUSIONS: In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
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- StatPearls: Oropharyngeal Airway [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Acute respiratory failure is caused by a wide range of etiologies. Progression to cardiopulmonary arrest and ultimately death is likely in the absence of effective and timely airway management. Therefore, one of the primary goals of airway management is to provide adequate ventilation and oxygenation to avoid or halt the progression to cardiopulmonary arrest. Effective and timely airway manageme…
- Hypoventilation and sleep hypercapnia in a case of congenital variant-like Rett syndrome. [Case Reports]
- CONCLUSIONS: Thus, we suggest screening patients with congenital-like Rett syndrome through transcutaneous bedtime carbon dioxide and oxygen monitoring. Moreover, assisted control mode was a breakthrough to achieve adequate ventilation in our case.
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- Sleep dysregulation in sympathetic-mediated diseases: implications for disease progression. [Review]Sleep. 2022 11 09; 45(11)S
- The autonomic nervous system (ANS) plays an important role in the coordination of several physiological functions including sleep/wake process. Significant changes in ANS activity occur during wake-to-sleep transition maintaining the adequate cardiorespiratory regulation and brain activity. Since sleep is a complex homeostatic function, partly regulated by the ANS, it is not surprising that sleep…
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- The clinical use of impulse oscillometry in neuromuscular diseases. [Journal Article]Respir Med. 2022 Aug-Sep; 200:106931.RM
- CONCLUSIONS: Clinically reported dysphagia, a decreased capability of coughing, and shortness of breath in patients with NMD make Rrs increase in general, but Xrs parameters, which mainly express rib cage elasticity, turn more negative. In patients with NMD, IOS monitoring may help in evaluating the regression in respiratory functions, however, future studies are needed to understand more.
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- The Influence of Obesity Hypoventilation Syndrome on the Outcomes of Patients With Diabetic Ketoacidosis. [Journal Article]
- CONCLUSIONS: OHS is an independent risk factor for mortality in DKA, irrespective of the degree of obesity. Further prospective studies are recommended to study the effects of different treatment modalities of OHS such as identification of the need for early non-invasive ventilation or for early invasive mechanical ventilation to improve outcomes in DKA patients.
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- Immediate and long-term effects of manual chest compression and decompression maneuver on patients receiving invasive mechanical ventilation. [Journal Article]
- It has been reported that the manual chest compression and decompression (MCCD) maneuver can increase lung volume in patients receiving invasive mechanical ventilation (IMV), but some important questions related to this maneuver require answers: how long the effects of MCCD on lung volume remain, and whether there are effects on other respiratory and hemodynamic variables.
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- StatPearls: Respiratory Acidosis [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Respiratory acidosis is a state in which there is usually a failure of ventilation and an accumulation of carbon dioxide. The primary disturbance of elevated arterial PCO2 is the decreased ratio of arterial bicarbonate to arterial PCO2, which leads to a lowering of the pH. In the presence of alveolar hypoventilation, 2 features commonly are seen are respiratory acidosis and hypercapnia. To compen…
- StatPearls: Central Sleep Apnea [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Central sleep apnea (CSA) is characterized by transient diminution or cessation of the respiratory rhythm generator located within the pontomedullary region of the brain. In general, CSA represents an array of sleep-disordered breathing (SDB) conditions due to the brief absence of ventilatory output during sleep. CSA manifests as a cyclical phenomenon/pattern during sleep; periods of apnea or hyp…
- Diagnostic and Therapeutic Approach to Children and Adolescents with Obstructive Sleep Apnea Syndrome (OSA): Recommendations in Emilia-Romagna Region, Italy. [Review]
- Obstructive sleep apnoea syndrome (OSA) in paediatrics is a rather frequent pathology caused by pathophysiological alterations leading to partial and prolonged obstruction (hypoventilation) and/or intermittent partial (hypopnoea) or complete (apnoea) obstruction of the upper airways. Paediatric OSA is characterised by daytime and night-time symptoms. Unfortunately, there are few data on shared di…
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- Metabolic Alkalosis Pathogenesis, Diagnosis, and Treatment: Core Curriculum 2022. [Review]
- Metabolic alkalosis is a widespread acid-base disturbance, especially in hospitalized patients. It is characterized by the primary elevation of serum bicarbonate and arterial pH, along with a compensatory increase in Pco2 consequent to adaptive hypoventilation. The pathogenesis of metabolic alkalosis involves either a loss of fixed acid or a net accumulation of bicarbonate within the extracellula…
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- StatPearls: Stroke Anticoagulation [BOOK]StatPearls. StatPearls Publishing: Treasure Island (FL)BOOK
- Stroke is one of the leading causes of death and long-term disability worldwide.[1][2] As medical management advances, the incidence and mortality rate of stroke declines, with most strokes presenting as ischemic strokes vs. hemorrhagic strokes. As such, the focus of this article will be on ischemic strokes. Various etiologies lead to ischemic stroke, including both modifiable and non-modifiable …
- The Phenomenology of Anti-NMDA Receptor Encephalitis: A Comparison with "Primary Mental Confusion" in Late 19th Century French Psychiatry. [Review]Front Biosci (Landmark Ed). 2022 04 01; 27(4):116.FB
- CONCLUSIONS: From the results, it is suggested that the phenomenological features understood as indicative of anti-NMDA receptor encephalitis include: (1) antecedent common cold-like symptoms (31.9%) in the prodromal phase, (2) delirium or acute confusional state (65.9%), (3) symptoms considered to be sudden personality changes (40.4%) in the psychotic phase, (4) central hypoventilation (14.9%) in the unresponsive phase, (5) motor disturbances (57.4%), and (6) autonomic symptoms, mainly without fluctuations (48.9%), in the hyperkinetic phase. These features were found to be similar to "primary mental confusion" (confusion mentale primitive) in French psychiatry in the late 19th century. We believe that classical psychiatry can contribute considerably to the interpretation of biological research results.
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- Non-invasive ventilation using a novel ventilator and non-vented full-face mask for patients with respiratory failure during the COVID-19 pandemic: Report of three cases. [Case Reports]
- The Japanese government's latest manual on COVID-19 management mentions non-invasive ventilation (NIV). Before this version, we experienced three cases in which COVID-19 was a concern. Each case had one of the following conditions: obesity hypoventilation syndrome, amyotrophic lateral sclerosis, acute heart failure with acute kidney injury with hypercapnia. The guidelines indicate that patients w…
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- [When should and when should not use oxygen in neuromuscular diseases?] [Journal Article]Medicina (B Aires). 2022; 82(2):244-248.M
- Although the references warn about the adverse effects of adding O2 without ventilatory assistance in patients with neuromuscular diseases (NMD), patients are still to be admitted to intensive care units with severe hypercapnia and CO2 narcosis. It seems that the problem is rediscovered as the years and generations go by. Unfortunately, many patients and their network of formal and informal careg…
- Clinical implications of opioid-induced ventilatory impairment. [Journal Article]Anaesth Intensive Care. 2022 Mar; 50(1-2):52-67.AI
- Opioid-induced ventilatory impairment is the primary mechanism of harm from opioid use. Opioids suppress the activity of the central respiratory centres and are sedating, leading to impairment of alveolar ventilation.Respiratory physiological changes induced with acute opioid use include depression of the hypercapnic ventilatory response and hypoxic ventilatory response. In chronic opioid use a c…
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- Ward-Based Noninvasive Ventilation for Acute Hypercapnic Respiratory Failure Unrelated to Chronic Obstructive Pulmonary Disease. [Multicenter Study]
- CONCLUSIONS: Pre-NIV pH and age have been identified as important predictors of surviving ward-based NIV treatment. Moreover, these data support the use of NIV in ward-based settings for obesity-related AHRF patients with pre-NIV pH thresholds down to 7.15. However, future controlled trials are required to confirm the effectiveness of NIV use outside critical care settings for obesity-related AHRF.
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- Assessment and Treatment of Nocturia in Neurological Disease in a Primary Care Setting: Systematic Review and Nominal Group Technique Consensus. [Review]Eur Urol Focus. 2022 Jan; 8(1):33-41.EU
- CONCLUSIONS: Nocturia in neurological disease is complex and lacks a robust evidence base, with very little research done in the primary care context. Guidance should be pragmatic, with reduction of risk a key requirement, until a multidisciplinary evidence base can be developed.
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- Bilevel positive airway pressure ventilation for non-COPD acute hypercapnic respiratory failure patients: A systematic review and meta-analysis. [Review]
- The effectiveness of bi-level positive airway pressure (BiPAP) in patients with acute hypercapnic respiratory failure (AHRF) due to etiologies other than chronic obstructive pulmonary disease (COPD) is unclear. To systematically review the evidence regarding the effectiveness of BiPAP in non-COPD patients with AHRF. The Cochrane Library, MEDLINE, EMBASE, and CINAHL Plus were searched according to…
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- Burden of primary influenza and respiratory syncytial virus pneumonia in hospitalised adults: insights from a 2-year multi-centre cohort study (2017-2018). [Journal Article]Intern Med J. 2021 Oct 11 [Online ahead of print]IM
- CONCLUSIONS: The increased knowledge of influenza-A/B and RSV pneumonia burden may contribute to a better management of patients with viral CAP.
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- Congenital central hypoventilation syndrome: a life-threatening cause of neonatal apnoea. [Case Reports]BMJ Case Rep. 2021 Sep 20; 14(9)BC
- Congenital central hypoventilation syndrome (CCHS) is an uncommon genetic disease characterised by an autonomic nervous system dysfunction that affects ventilatory homeostasis. Involvement of other systems is also described, mainly cardiovascular, gastrointestinal and central nervous systems. We describe a rare case of CCHS diagnosed in a term newborn who presented with persistent apnoea in the f…
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