DOCSLIB.ORG

Respiratory Function and Acid-Base Status in Accidental Hypothermia Assessed by Arterial Blood Gas Analysis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Respiratory Function and Acid-Base Status in Accidental Hypothermia Assessed by Arterial Blood Gas Analysis Original Article Respiratory Function and Acid-base Status in Accidental Hypothermia Assessed by Arterial Blood Gas Analysis Michio OKADAand Fumiaki NISHIMURA To study the respiratory function and acid-base status in hypothermia, we retrospectively reviewed data of arterial blood gas analysis obtained from 63 patients with accidental hypothermia on admission. Twenty- nine showed acidemia and 16 showed alkalemia. The following results were obtained from 57 patients in whom blood gas analysis was performed in room air. PaCO2was 46 mmHgor more in 2 and 34 mmHgor less in 46. Most of the patients exhibiting acidemia had metabolic acidosis except 2 with severe pneumonia or subdural hematoma. PaCO2was low even in the patients with alkalemia. PaO2 was 60 mmHgor less in 8, of whom7 had pneumonia, and 70 mmHgor more in most of the patients without pneumonia. Wefound that patients with accidental hypothermia generally showed a respiratory function proportionate to their decreased metabolism or hyperventilation, and most of the patients with acidemia exhibited metabolic acidosis. Key words: Metabolic acidosis, Respiratory acidosis Accidental hypothermia is not an uncommon In an attempt to clarify the respiratory function and condition and is often associated with acidosis and acid-base status in patients with accidental hypo- can result in a high mortality (1-7). Although the thermia, a retrospective study of the arterial blood initial respiratory response to hypothermia is one of gas analysis data of patients with accidental stimulation, the respiration begins to become hypothermia, including many without pneumonia shallow and the rate decreases as the core or circulatory failure, was carried out. temperature drops to below approximately 32°C (8). PATIENTS AND METHODS However, in the hypothermic state, metabolism also decreases, and an 8°C drop in body temperature Wereviewed retrospectively the data of arterial causes a 50%decrease in the production of carbon blood gas analysis, which had been performed dioxide (9, 10). Thus, to manage patients with immediately after admission in 63 of the 74 patients accidental hypothermia, it is important to know with accidental hypothermia whowere admitted to whether this reduction in respiratory function is Tokyo Metropolitan Charity Hospital. Wemoni- proportional to the decreased rate of metabolism, tored the core body temperature with a thermometer or not. As it is difficult to assess the effects of placed in the rectum, and defined hypothermia as hypothermia on the respiratory function in man this a core body temperature of 34.0°C or lower. The issue is still controversial; the changes that occur hypothermia occurred by exposure to cold weather during induced hypothermia under general as a result of alcohol intoxication or weakness anesthesia largely reflect the mechanical ventilation, secondary to underlying diseases. Although the and in patients with accidental hypothermia, the duration of exposure to cold weather could not be findings are often complicated by changes produced determined in most of the patients, it was estimated by coexisting pneumonia, or circulatory failure (1). to range from a few hours to a few days. Manyof From the Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo Received for publication September 4, 1989; Accepted for publication July 27, 1990 This work originated from the Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan Reprint requests should be addressed to Michio Okada, MD,Second Department of Internal Medicine, School of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka 181, Japan 500 Jpn J Med Vol 29, No 5 (September, October 1990) Blood Gas in Accidental Hypothermia the patients were alcoholics and/or poorly nourished A 7i .. vagrants. Their mean age was 52 years. Although more detailed clinical data from these 74 patients can be found in a previous study (7), the important 7.2- . à"à" : "à""à" data concerning the underlying causes of hypo- thermia in 63 patients in this study is included here. Q7.aà" à" Thirty-one patients were under the influence of alcohol, 18 had pneumonia or pulmonary tuber- 6.8 culosis, 4 had head injuries, 3 had diabetic 6.6 ketoacidosis and 2 had drug intoxication. Ta 26 28 30 32 34 The arterial blood gas analysis was carried out Q BODY TEMPERATURECc) by percutaneous puncture of the brachial or femoral b 60r arteries. At the time of blood gas analysis, 3 patients had 50 been treated by assisted respiration and 3 patients by oxygen administration. In the remaining 57 patients, the blood gas analysis was performed in I3°- à" ,à" "'*{ room air. PaO2, PaCO2 and pH were determined with a blood gas analyzer (M 175, Corning), and 20à"'à">." ' à"'" corrected for body temperature according to the 10- 8 Kelman and Nunn formula: ty« - -, _-i , pHt = pH37-0.015(t-37) 24 26 28 30 32 34 PO2t = PO2eA(t"37) BODY TEMPERATURECc) PCO t = PCO e10-044^37^ Fig. 1-A. Arterial pH and body temperature (A = 0.012+0.062 [i-e-^ioo-o. sat^ on admission in 63 patients. B. PaCO2and body temperature on admission in 57 patients in whom where pHt, PCO2t, and PO2t = pH, PCO2 and blood gas analysis was performed in roomair. PO2 corrected for body temperature (t), and t = body temperature at which the arterial blood gas temperature. Of 8 patients in whomthe hypothermia analysis was performed. The electrode temperature appeared to have contributed largely to death, 6 was maintained at 37°C. showed acidemia, but none had alkalemia. For statistical comparisons, the unpaired t test Weinvestigated PaCO2,PaO2, and the relation was employed, p <0.05 was considered significant. between PaCO2 and pH in 57 patients after ex- cluding the 6 who had been treated by assisted RESULTS respiration (3 patients) or oxygen administration (3 The body temperature of the 63 patients on patients) by the time of blood gas analysis. There admission ranged from 24.1°C to 33.8°C (mean, was no apparent association between PaCO2and 29.8°C). Pneumonia was observed in 18 patients. body temperature (Fig. 1-B). PaCO2 was 46 mmHg Assisted respiration was required immediately after or more in 2 patients, 34.1-45.9 mmHgin 9, and admission before blood gas analysis in 3 patients: 34 mmHgor less in 46 patients. One patient with this was due to severe pneumoniain one patient, to a PaCO2of 60.3 mmHghad severe pneumonia, a cessation of breathing following ventricular fibrilla- pH of7.08 and a PaO2 of 16.8 mmHg. The same tion in another, and to ataxic respiration induced patient was also suffering from drug intoxication. by intracranial hemorrhage in the third. No patients Another patient with a PaCO2 of 48.3 mmHgwas required assisted respiration due to impaired in a deep comaon admission, and died from acute respiratory function caused by the hypothermia. subdural hematomaon the day. There were no The arterial pHwas less than 7.36 in 29 patients records about his respiratory status on admission. and more than 7.44 in 16 (Fig. 1-A). There appeared Evaluation of the relation between pH and to be no definite association between pH and body PaCO2indicated base deficit in all the patients with Jpn J Med Vol 29, No 5 (September, October 1990) 501 Okada and Nishimura acidemia (Fig. 2). PaCO2 was also decreased in patients with a normal pH showed a decreased most of them. Only the 2 above-mentioned patients PaCO2 and base deficit. exhibited an increase in PaCO2. Seven patients were Anemia with a hemoglobin value of 10 g/dl or within the range of acute base deficit suggesting in- less was observed in 13 patients on admission (Fig. adequate compensationfor metabolic acidosis by 2). All of these patients revealed a pH of 7.36 or hyperventilation. PaCO2and pHin 3 patients with moreand were in a state of acute or chronic diabetic keto-acidosis was 10.1, 14.9 and ll.6 hypocapnia. In 10 patients with a PaO2 level of 70 mmHg, and 6.88, 6.92 and 6.86, respectively. All mmHgor less, the extent of decrease in PaO2was 3 patients were between acute and chronic base not associated with the severity of metabolic acidosis deficit. In all the patients with alkalemia, PaCO2 (Fig. 2). The base excess was -17.2±8.3 was decreased. About half of them with alkalemia (mean± lSD) in 20 patients with a systolic blood showed a normal base excess, and the remaining half pressure of 80 mmHg or less and -7.86±6.8 were in a state of base deficit. None of them ex- (mean ± 1SD) in 37 patients with that of more than hibited an abnormal base excess. Most of the 80 mmHg; more severe metabolic acidosis was Paco2 .^ BASE EXCESS EXTRACELL. mm"9\ ri^^^^^^^^*\ BASE EXCESS 150" ^/C^ +5 +10\+20\+30 mmol/l 140- a/\\° \ \+15\+25\ 130" &F-*\ \ \\\\\ -120" <^\10 \ \ \a\\\ no- T 4 \ \°\ \\VvAoA \ \ \.\\YVt^\V\ 5°- -25 \ ^V" \ °\r^\<#\V\\\ -£å å v\PLASMAHXDRQGENCARBONATE XlNQRM^L _/\ \ \\\ ° \ / à"«? / \ *å \ \ I à"* \/ l\/ \ \ \ '5" \ \/ à"o V \ \ \ -30 V ^ /\ \ \ \ ! \o #6.9 7.0 ^7.1 d/\: 7.2 7.3 |7.4?V\\ 7.5 7.6 7.7 PLASMA pH ACIDEMIA NORMAL ALKALEMIA i i i t Fig. 2. Acid-base balance in 57 patients with accidental hypothermia. Closed symbols = Twenty patients with a systolic blood pressure of 80 mmHgor less, Boxes = Thirteen patients who had anemia with a hemoglobin value of 10 g/dl or less, * = Ten patients with a PaO2 level of 70 mmHgor less. 502 Jpn J Med Vol 29, No 5 (September, October 199G) Blood Gas in Accidental Hypothermia patient. He died from severe pneumonia. (p<0.001)observed in (Fig.the patients2). with a lower blood pressure DISCUSSION Nodefinite association was found between PaO2 and body temperature (Fig.
Load more

Recommended publications
  • Seizures in Childhood Cerebral Malaria
    SEIZURES IN CHILDHOOD CEREBRAL MALARIA A thesis submitted to the University of London for the degree of Doctor of Medicine June 2001 Jane Margaret Stewart Crawley MB BS, MRCP A \ Bfii ¥ V ProQuest Number: U642344 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest U642344 Published by ProQuest LLC(2015). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ABSTRACT Every year, more than one million children in sub-Saharan Africa die or are disabled as a result of cerebral malaria. Seizures complicate a high proportion of cases, and are associated with an increased risk of death and neurological sequelae. This thesis examines the role of seizures in the pathogenesis of childhood cerebral malaria. The clinical and electrophysiological data presented suggest that seizures may contribute to the pathogenesis of coma in children with cerebral malaria. Approximately one quarter of the patients studied had recovered consciousness within 6 hours of prolonged or multiple seizures, or had seizures with extremely subtle clinical manifestations. EEG recording also demonstrated that electrical seizure activity arose consistently from the posterior temporo-parietal region, a “watershed” area of the brain that is particularly vulnerable to hypoxia.
    [Show full text]
  • Current Clinical Approach to Patients with Disorders of Consciousness
    CURRENTREVIEW CLINICAL APPROA CARTICLEH TO PATIENTS WITH DISORDERS OF CONSCIOUSNESS Current clinical approach to patients with disorders of consciousness ROBSON LUIS OLIVEIRA DE AMORIM1, MARCIA MITIE NAGUMO2*, WELLINGSON SILVA PAIVA3, ALMIR FERREIRA DE ANDRADE3, MANOEL JACOBSEN TEIXEIRA4 1PhD – Assistant Physician of the Neurosurgical Emergency Unit, Division of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil 2Nurse – MSc Student at the Neurosurgical Emergency Unit, Division of Neurosurgery, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil 3Habilitation (BR: Livre-docência) – Professor of the Neurosurgical Emergency Unit, Division of Neurosurgery, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil 4Habilitation (BR: Livre-docência) – Full Professor of the Division of Neurosurgery, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil SUMMARY Study conducted at Hospital das Clínicas, In clinical practice, hospital admission of patients with altered level of conscious- Faculdade de Medicina, Universidade de ness, sleepy or in a non-responsive state is extremely common. This clinical con- São Paulo (FMUSP), São Paulo, SP, Brazil dition requires an effective investigation and early treatment. Performing a fo- Article received: 1/28/2015 cused and objective evaluation is critical, with quality history taking and Accepted for publication: 5/4/2015 physical examination capable to locate the lesion and define conducts. Imaging *Correspondence: and laboratory exams have played an increasingly important role in supporting Address: Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César clinical research. In this review, the main types of changes in consciousness are São Paulo, SP – Brazil discussed as well as the essential points that should be evaluated in the clinical Postal code: 05403-000 [email protected] management of these patients.
    [Show full text]
  • Quantification of Periodic Breathing in Premature Infants
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by College of William & Mary: W&M Publish W&M ScholarWorks Arts & Sciences Articles Arts and Sciences 2015 Quantification of periodic breathing in premature infants Mary A. Mohr College of William and Mary John B. Delos College of William and Mary Karen D. Fairchild Manisha Patel Robert A. Sinkin Follow this and additional works at: https://scholarworks.wm.edu/aspubs Recommended Citation Mohr, M. A., Fairchild, K. D., Patel, M., Sinkin, R. A., Clark, M. T., Moorman, J. R., ... & Delos, J. B. (2015). Quantification of periodic breathing in premature infants. Physiological measurement, 36(7), 1415. This Article is brought to you for free and open access by the Arts and Sciences at W&M ScholarWorks. It has been accepted for inclusion in Arts & Sciences Articles by an authorized administrator of W&M ScholarWorks. For more information, please contact [email protected]. IOP Physiological Measurement Physiol. Meas. Institute of Physics and Engineering in Medicine Physiological Measurement Physiol. Meas. 36 (2015) 1415–1427 doi:10.1088/0967-3334/36/7/1415 36 2015 © 2015 Institute of Physics and Engineering in Medicine Quantification of periodic breathing in premature infants PMEA Mary A Mohr1, Karen D Fairchild2, Manisha Patel2, 1415 Robert A Sinkin2, Matthew T Clark3, J Randall Moorman3,4,5, Douglas E Lake3,6, John Kattwinkel2, John B Delos1 1 Department of Physics, College of William and Mary, Williamsburg, VA 23187-8795, USA 2 M A Mohr et al Department
    [Show full text]
  • TREATMENT OPTIONS for OBSTRUCTIVE SLEEP APNOEA *Winfried J
    TREATMENT OPTIONS FOR OBSTRUCTIVE SLEEP APNOEA *Winfried J. Randerath,1 Armin Steffen2 1. Institute of Pneumology, University Witten/Herdecke, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany 2. Department of Otorhinolaryngology, ENT Sleep laboratory, UKSH, University of Lübeck, Lübeck, Germany *Correspondence to [email protected] Disclosure: No potential conflict of interest. ABSTRACT Due to its prevalence, symptoms such as daytime sleepiness, increased risk of accidents, cardiovascular consequences, and the reduced prognosis, obstructive sleep apnoea (OSA) is highly relevant for individual patients and societies. Weight reduction should be recommended in general for obese OSA patients. Continuous positive airway pressure (CPAP) has proven to normalise respiratory disturbances and clinical findings and improve comorbidities and outcome. Although CPAP is not associated with serious side-effects, a relevant number of patients report discomfort, which may limit treatment adherence. Therefore, there is a huge interest in alternative conservative and surgical treatment options. The highest level of evidence can be described for mandibular advancement devices which can be recommended especially in patients with mild-to-moderate OSA, and in patients who fail to accept CPAP despite sophisticated attempts to optimise device, interface, and education. Hypoglossal nerve stimulation might be an interesting option in individual patients. Tonsillectomy is indicated in both children and adults with occluding tonsil hypertrophy. In addition, maxillomandibular osteotomy has been shown to sufficiently treat OSA in the short and long-term. Other surgical options including hyoid suspension, genioglossus advancement, and multilevel surgery might be used in carefully selected, individual cases if other options have failed.
    [Show full text]
  • Clinical Manifestations of Severe Enterovirus 71 Infection and Early
    Yang et al. BMC Infectious Diseases (2017) 17:153 DOI 10.1186/s12879-017-2228-9 RESEARCHARTICLE Open Access Clinical manifestations of severe enterovirus 71 infection and early assessment in a Southern China population Si-da Yang1*, Pei-qing Li1†, Yi-min Li2*, Wei Li3†, Wen-ying Lai4†, Cui-ping Zhu1, Jian-ping Tao1, Li Deng1, Hong-sheng Liu1, Wen-cheng Ma1, Jia-ming Lu1, Yan Hong1, Yu-ting Liang1, Jun Shen1, Dan-dan Hu1, Yuan-yuan Gao1, Yi Zhou1, Min-xiong Situ1 and Yan-ling Chen3 Abstract Background: Enterovirus 71 (EV-A71) shows a potential of rapid death, but the natural history of the infection is poorly known. This study aimed to examine the natural history of EV-A71 infection. Methods: This was a prospective longitudinal observational study performed between January 1st and October 31st, 2012, at three hospitals in Guangdong, China. Subjects with positive EV-A71 RNA laboratory test results were included. Disease progression was documented with MRI, autopsies, and follow-up. Symptoms/signs with potential association with risk of death were analyzed. Results: Among the 288 patients, neurologic symptoms and signs were observed (emotional movement disorders, dyskinesia, involuntary movements, autonomic dysfunction, and disturbance of consciousness). Some of them occurred as initial symptoms. Myoclonic jerks/tremors were observed among >50% of the patients; nearly 40% of patients presented fatigue and 25% were with vomiting. Twenty-eight patients (9.7%) presented poor peripheral perfusion within 53.4 ± 26.1 h; 23 patients (8.0%) presented pulmonary edema and/or hemorrhage within 62.9 ± 28. 6 h. Seventeen (5.9%) patients were in a coma.
    [Show full text]
  • Neuropulmonology 101
    NEUROPULMONOLOGY 101 William M. Coplin, MD, FCCM Resppyiratory Patterns in Coma Cheyne – Stokes respiration: bilateral hemispheral dysfunction Or congestive heart failure Central reflex hyperpnea: midbrain dysfunction causing neurogenic ppyulmonary edema Rarely see true central neurogenic hyperventilation with this lesion; central hyperventilation is common with increased ICP Resppyiratory Patterns in Coma Apneustic respiration (inspiratory cramp lasting up to 30 sec): pontine lesion Cluster breathing (Biot breathing): pontine lesion Ataxic respiration: pontomedullary junction lesion Increased Intracranial Pressure Hyperventilation (PaCO2 < 35 mmHg) works by decreasing blood flow and should be reserved for emerggyency treatment and only for brief periods. Major determinant of arteriolar caliber is the extracellular pH, not actually the PaCO2, but this is the parameter we can control. Classification of Neurogenic Respiratory Failure Oxygenation failure (low PaO2) primary difficulty with gas transport usually reflects pulmonary parenchymal disease, V/Q mismatch, or shunting Primary neurologic cause is neurogenic pulmonary edema. Neurogenic Pulmonary Edema A state of increased lung water (interstitial and sometimes alveolar): as a consequence of acute nervous system disease in the absence of ‐ cardiac disorders (CHF), ‐ pulmonary disorders (ARDS), or ‐ hypervolemia Causes of Neurogenic Pulmonary Edema Rare Common medullary tumors SAH multiple sclerosis spinal cord infarction head trauma Gu illain‐Barré sy ndrome intracerebral miscellaneous conditions causing hemorrhage intracranial hypertension seizures or status many case reports of other epilepticus conditions Classification of Neurogenic Respiratory Failure Ventilatory failure (inadequate minute ventilation [VE] for the volume of CO2 produced): In central resppyiratory failure, the brainstem response to CO2 is inadequate, and the PaCO2 begins to rise early. In neuromuscular ventilatory failure, the tidal volume begins to fall, and the PaCO2 is initially normal (or low).
    [Show full text]
  • Quantitative Analysis of Periodic Breathing and Very Long Apnea in Preterm Infants
    W&M ScholarWorks Dissertations, Theses, and Masters Projects Theses, Dissertations, & Master Projects 2016 Quantitative Analysis of Periodic Breathing and Very Long Apnea in Preterm Infants. Mary A. Mohr College of William and Mary Follow this and additional works at: https://scholarworks.wm.edu/etd Part of the Physics Commons Recommended Citation Mohr, Mary A., "Quantitative Analysis of Periodic Breathing and Very Long Apnea in Preterm Infants." (2016). Dissertations, Theses, and Masters Projects. Paper 1593092111. https://dx.doi.org/doi:10.21220/m2-njkk-9v07 This Dissertation is brought to you for free and open access by the Theses, Dissertations, & Master Projects at W&M ScholarWorks. It has been accepted for inclusion in Dissertations, Theses, and Masters Projects by an authorized administrator of W&M ScholarWorks. For more information, please contact [email protected]. Quantitative Analysis of Periodic Breathing and Very Long Apnea in Preterm Infants Mary A. Mohr Grand Island, New York Master of Science, The College of William and Mary, 2012 Bachelor of Science, University at Buffalo, 2010 Associate in Science, Niagara County Community College, 2008 A Dissertation presented to the Graduate Faculty of the College of William and Mary in Candidacy for the Degree of Doctor of Philosophy Department of Physics The College of William and Mary January, 2016 APPROVAL PAGE This Dissertation is submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy M ary A. Mohr Approved by the Comm«ee,<duly, -=015 ^Committee
    [Show full text]
  • Correlation Between Sleep Apnea and Methadone Therapy
    https://doi.org/10.5272/jimab.2021272.3817 Journal of IMAB Journal of IMAB - Annual Proceeding (Scientific Papers). 2021 Apr-Jun;27(2) ISSN: 1312-773X https://www.journal-imab-bg.org Original article CORRELATION BETWEEN SLEEP APNEA AND METHADONE THERAPY Christiana Madjova1, Simeon Chokanov1, Mario Milkov2 1) Department of Conservative Dentistry and Oral Pathology, Faculty of Den- tal Medicine, Medical University – Varna 2) Department of Dental Materials Science, and Propaedeutics of Prosthetic Dental Medicine, Faculty of Dental Medicine, Medical University – Varna, Bul- garia. SUMMARY Addiction is a brain disorder that creates mental and/ Introduction: Methadone therapy is the mainstay of or physical dependence. It tortures millions of people around treatment of addict patients. The most common side effects the world, which costs society a great deal in terms of medi- are: dizziness, drowsiness, vomiting, sweating, dry mouth and cal and social problems, and immeasurable suffering for constipation. The more serious complications that can be loved ones and for themselves [5]. Addiction is most com- observed are: sleep apnea, àbnormal heart rhythms, respira- monly observed for opioid drugs. The patients we examined tory problems, euphoria, disorientation, anxiety, seizures and were addicted to heroin. There are different modes of its ad- more. ministration: from smoking, sniffing to oral and intravenous Purpose: The purpose of this study is to determine heroin intake [5]. Drug addicts have the highest the correlation between methadone maintenance treatment psychoactive effect through intravenous administration, and sleep apnea in addict patients. which is also the most dangerous. Materials and methods: The subject of the study are Drugs are chemicals that affect a person’s physical, 81 methadone-treated drug-dependent patients, mean age 39 mental and social functions by changing them in various ± 9,07 years.
    [Show full text]
  • Acquired Central Hypoventilation Following Listeria
    Thorax Online First, published on January 13, 2017 as 10.1136/thoraxjnl-2016-208786 Chest clinic CASE BASED DISCUSSION Thorax: first published as 10.1136/thoraxjnl-2016-208786 on 13 January 2017. Downloaded from Acquired central hypoventilation following Listeria monocytogenes rhombencephalitis Sandrine H Launois,1,2 Natalia Siyanko,2 Marie Joyeux-Faure,1,2 Renaud Tamisier,1,2 Jean-Louis Pepin1,2 1HP2 Unit, Inserm U1042, INTRODUCTION events/hour, oxygen desaturation index of 64 Grenoble Alpes University, Acquired central hypoventilation syndrome (CHS) events/hour, time spent under 90% oxygen satur- Grenoble, France 2Department of Physiology and is a rare cause of respiratory failure. We report a ation of 287 min or 82% of total sleep time) with Sleep, Grenoble University case of acquired CHS, diagnosed several years after persistent daytime alveolar hypoventilation Hospital, Grenoble, France Listeria monocytogenes (LM) rhombencephalitis. (PaCO2=7.64 kPa, PaO2=9.61 kPa). The AHI was 34 events/hour during non-rapid eye movement Correspondence to (REM) sleep and 41 events/hour during REM Dr Sandrine H Launois, CASE REPORT Département Physiologie In 1993, a 46-year-old woman presented to our sleep. Prolonged periods of shallow breathing with Algologie Somnologie, Unité Sleep Clinic with poor sleep, nocturnal choking sustained hypoxaemia were noted in non-REM as de Somnologie et Fonction episodes and daytime fatigue. She denied habitual well as REM sleep (transcutaneous CO2 measure- Respiratoire, Hôpital ment was not available). Ataxic breathing alternated Universitaire Saint Antoine, snoring and hypersomnolence. Her medical history 184 rue du Faubourg Saint was unremarkable except for severe LM rhomben- with central apnoeas and hypopneas lasting up to Antoine, Paris 75012, France; cephalitis in 1977.
    [Show full text]
  • US-90314-Quiz-Respiratory.Pdf
    Respiratory 14Mar2009 Respiratory #1 – Histology 1) Which of the following belongs to the respiratory portion of the air passage, not the conduction portion? a) Bronchioles b) Bronchi c) Trachea d) Larynx e) Pharynx 2.1) Which of the following respiratory cell types create mucus? a) Brush cells b) Basal cells c) Ciliated cells d) Olfactory cells e) Goblet cells 2.2) What type of cells line the vestibular chamber of the nasal cavity? a) Bipolar olfactory neurons b) Pseudostratified columnar c) Ciliated tall columnar d) Stratified squamous e) Small granular cells 3) What type of epithelial cell characterizes the larynx and respiratory tract? a) Unciliated pseudostratified squamous b) Ciliated pseudostratified squamous c) Unciliated pseudostratified columnar d) Ciliated pseudostratified columnar e) Brush cells and goblet cells 4.1) What type of tracheal cells function as receptor cells as their basal surface is in synaptic contact with afferent nerve endings? a) Ciliated cells b) Mucous cells c) Brush cells d) Small granule cells e) Basal cells 4.2) The C-shaped cartilaginous layer is a unique feature of which of the following? a) Bronchioles b) Bronchi c) Trachea d) Larynx e) Pharynx 5) Disappearance of what histological layer signifies a change from the bronchi to the bronchioles? a) Mucosa b) Muscularis c) Submucousal d) Cartilage plates e) Adventitia DO NOT DISTRIBUTE - 1 - Respiratory 14Mar2009 6) Which of the following best describes the epithelial layer of the small bronchioles? a) Simple cuboid epithelium with Clara cells b) Pseudostratified
    [Show full text]
  • A Peculiar Type of Dyspnea: Kussmaul, Cheyne-Stokes, and Biot Respirations
    A Peculiar Type of Dyspnea: Kussmaul, Cheyne-Stokes, and Biot Respirations Volume 3, Issue 1, E22 John W Stanifer, MD, MSc ISSN:1946-3316 Fellow, Duke University Hospital Abstract: Observations concerning respiratory rates and patterns date back to the time of Hippocrates and Galen, and there are many descriptive terms such as ataxic, agonal, and clustered. Among these terms are three well-known but often misunderstood and misused eponymous respiratory signs: Kussmaul respiration, Cheyne-Stokes respiration, and Biot respiration. In the 21st Century, in which roentgenograms and laboratory tests often serve as surrogates for physical examination, respiratory patterns – though frequently present – are often overlooked. Herein, to rejuvenate clinical interest and clarify misconceptions concerning their application and utility, we present clear descriptions of three useful clinical signs: Kussmaul respiration, Cheyne-Stokes respiration, and Biot respiration. Keywords: Kussmaul, Cheyne-Stokes, Biot, dyspnea Introduction misunderstood, eponymous respiratory patterns: Kussmaul respiration, Cheyne- The most regularly overlooked and ignored Stokes respiration, and Biot respiration. vital sign in the clinic and wards today is the respiratory rate, and it has nearly become the Kussmaul Respiration standard to simply document twenty breaths per minute as the rate when we think of the A Peculiar Type of Dyspnea: In this patient as breathing normally (Figure 1). In type of dyspnea there is not the least the 21st century, when physicians frequently suggestion as is so common in all spend more time in front of a computer than other types that the passage of air to at the bedside, it would be uncommon to or from the lung has to combat merely observe a patient’s respiratory obstruction in its path; to the pattern for many minutes; however, contrary it passes in and out with the important clinical information can be missed greatest of ease.
    [Show full text]
  • 7 X 10.5 Long Title.P65
    Cambridge University Press 978-0-521-14648-7 - Case Studies in Sleep Neurology: Common and Uncommon Presentations Edited by Antonio Culebras Excerpt More information Part I Sleep-related breathing disorders © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-0-521-14648-7 - Case Studies in Sleep Neurology: Common and Uncommon Presentations Edited by Antonio Culebras Excerpt More information Case 1 Opioid-induced central sleep apnea Kamal Nasser and Sheldon Kapen Clinical history and examination A 42-year-old man presented for evaluation of frequent breathing pauses during sleep, which had been witnessed by his wife for 5 years along with intermittent mild snoring. He also reported excessive daytime sleepiness (EDS), but his Epworth Sleepiness Scale score was only 6/24 (see Appendix). He would wake up unrefreshed in the morning with a dry mouth. He also reported having had difficulties initiating and maintaining sleep for 10 years. He was treated with multiple medications with incomplete resolution of his insomnia. He was taking temazepam 7.5 mg to help him to maintain sleep. He had been going to bed between 1 and 4 am and waking up between 12 and 2 pm. His sleep latency was less than 5 minutes and his average sleep time was 8–9 hours per night, but he reported three to four nocturnal awakenings with no known triggers. He had problems returning to sleep after these awakenings and usually spent his time reading. He would take one unintentional nap per day of around 60–90 minutes’ duration and felt refreshed upon awakening.
    [Show full text]