phenylephrine-hydrochloride and Hypoventilation

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a novel airway technique that utilizes high-flow humidified nasal oxygen. It can extend apnea time and maintain oxygen saturation. Here we report the use of THRIVE in a 35-year-old man who required emergent surgical tracheostomy for a clinically relevant compromised airway secondary to acute supraglottic and glottic pathology. Intravenous sedation resulted in hypoventilation close to apnea. THRIVE maintained oxygen saturation for 40 minutes until transient desaturation developed after complete airway obstruction.

Topics: Adult; Airway Management; Humans; Hypoventilation; Insufflation; Male; Nose; Tracheostomy

Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system.. We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment.. Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.

Topics: Aged; Female; Humans; Hypoventilation; Nose; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive

Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.

Topics: Acidosis, Respiratory; Adult; Age Factors; Aged; Body Mass Index; Carbon Dioxide; Female; Humans; Hypoventilation; Lung Diseases, Obstructive; Male; Middle Aged; Nose; Obesity; Oxygen; Oxygen Inhalation Therapy; Peak Expiratory Flow Rate; Polysomnography; Positive-Pressure Respiration; Respiratory Insufficiency; Sleep Apnea Syndromes

Topics: Adolescent; Female; Home Care Services; Humans; Hypoventilation; Infant; Masks; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

A group of 31 subjects were subjected to complete artificial obstruction of the nose for a period of one hour. Their ages ranged from 14 to 16 years. Prior to the experiment the subjects were found to be healthy. During the nasal obstruction there was a fall in pO2 and an increase in pCO2 due to the hindered ventilation.

Topics: Adolescent; Airway Obstruction; Carbon Dioxide; Humans; Hydrogen-Ion Concentration; Hypoventilation; Nose; Oxygen

Four healthy adults with normal nose were asked to pedal an ergometer for 3 min or more at a load of 25, 50, and 75 W/min, respectively. The same procedure was repeated on the same subjects whose nostrils were plugged. Air-flow and pressure difference between the mesopharynx and the nares, FO2 and FCO2, percutaneous-PO2 and ScO2 were recorded on a polygraph. At the start of the exercise, respiration deepened. Nasal resistance (Rn) decreased within 30 s and kept low while the exercise lasted. TcPO2 initially increased slightly for 1 min, then decreased. ScO2 also showed the same pattern, but of very slight range. At the end of the exercise Rn returned to pre-exercise level after slight rebound increase. Recovery of tcPO2 delayed for 30 s and its rebound increase lasted for more than 5 min. In case of nasal obstruction, such sequential changes of these parameters were of the same pattern as those in normal noses but were more evident. The results demonstrated that in case of moderate or severe nasal obstruction the exercise created hypoventilation despite a marked increase in the breathing activity if nasal breathing was continued.

Topics: Adult; Airway Obstruction; Airway Resistance; Humans; Hypoventilation; Nose; Physical Exertion; Respiration; Respiratory Function Tests

Topics: Catheterization; Equipment and Supplies; Humans; Hypoventilation; Masks; Methods; Nose; Oxygen Inhalation Therapy; Partial Pressure; Pulmonary Atelectasis; Tracheotomy