Cases reported "Hypoventilation"

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1/24. Malignant hyperinflation of the nondependent lung during chest surgery.

    Unilateral malignant hyperinflation of the lungs during positive pressure mechanical ventilation was described during aggressive respiratory therapy of unilateral lung disease or in situations of significant difference in compliance between the two lungs. We report a case of malignant hyperinflation of the nondependent lung during chest surgery. The differential diagnosis and treatment with differential lung ventilation are described.
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keywords = chest
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2/24. Central hypoventilation during quiet sleep in two infants.

    Expired ventilation (VE), tidal volume (VT), frequency (f), and alveolar PCO2 (PACO2) were examined in six normal infants at 41 to 52 weeks post-conceptional age and in two infants who were apneic at birth. Their response to breathing 5% carbon dioxide in air and to 100% oxygen in quiet sleep were compared to those in rapid eye movement (REM) sleep. VE in normal infants was 259 ml/kg/min in REM and 200.2 ml/kg/min in quiet sleep with the difference being due to decreased carbon dioxide production and to decreased dead space. VE increased 34.4 ml/kg/min/mm Hg of PCO2 elevation with 5% carbon dioxide breathing during REM and was not significantly different during quiet sleep. During oxygen breathing VE fell by 32.7% at 30 seconds before increasing again. In the affected infants, VE and PACO2 during REM at 1 and 4 months were normal. At 1 month, during quiet sleep, each infant became apneic and PACO2 rose 9 and 8 mm Hg/min respectively. At this time mechanical ventilation was begun. At 4 months, during quiet sleep, VE was 0.064 and 0.063 ml/kg/min at PACO2 of 66 mm Hg in each infant. The change was due entirely to a decrease in VT to 2.3 and 2.5 ml/kg. At this time 5% carbon dioxide breathing given during normal ventilation in REM produced an abrupt fall in VT to 2.0 and 2.2 ml/kg with no change in frequency. oxygen breathing during REM at one month had no effect but at 4 months produced apnea requiring mechanical ventilation after one minute. The findings suggest that the ventilatory response to carbon dioxide is (1) important in initiation of extrauterine ventilation and (2) in sustaining ventilation particularly in quiet sleep. It is not necessary in sustaining ventilation awake or in REM sleep and it represents a balance between the stimulatory and depressant effects of carbon dioxide on the central nervous system.
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ranking = 1313.8319121522
keywords = breathing
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3/24. Congenital central hypoventilation syndrome and Hirschsprung's disease in an extremely preterm infant.

    Congenital central hypoventilation syndrome with Hirschsprung's disease, also known as Haddad syndrome, is a rare disorder with a variable phenotypic severity. The underlying cause is thought to be an abnormality of neural crest development and/or migration. Surviving neonates can have generalized autonomic nervous system dysfunction. Recent reports have identified mutations in the PHOX2B gene in a significant number of patients with this disorder. diagnosis and management of this disorder in the setting of extreme prematurity is difficult as the manifestations of failure to maintain breathing effort and failure to establish feeds overlap with the complications of prematurity. We describe an infant who had congenital central hypoventilation syndrome with Hirschsprung's disease and was delivered at 26 weeks' gestational age and had total aganglionosis of the bowel, failure to wean from ventilation, and a mutation in the PHOX2B gene.
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ranking = 262.76638243045
keywords = breathing
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4/24. Independent lung ventilation in the management of traumatic bronchopleural fistula.

    Independent lung ventilation (ILV) is a technique for managing patients with unilateral lung disease or injury who have failed conventional mechanical ventilation. A 20-year-old man sustained severe ballistic injuries to the chest and abdomen. Damage control laparotomy controlled the patient's initial hemorrhage, however, an evolving cavitary pulmonary lesion subsequently developed into a high-volume bronchopleural fistula. Progressive atelectasis of the damaged lung resulted in profound hypoxemia and hypercarbia refractory to conventional mechanical ventilation. Synchronous ILV was initiated using a double-lumen endotracheal tube and two ventilators titrated to optimize the patient's oxygenation and ventilation and minimize ventilator-induced lung injury. Intensive ILV over the next 17 days resulted in recruitment of the atelectatic right lung, resolution of the bronchopleural fistula, and significant improvement in oxygenation and pulmonary compliance. This appears to be the longest reported use of ILV for traumatic lung injury.
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keywords = chest
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5/24. Chronic hypoventilation syndrome: treatment with non-invasive mechanical ventilation.

    Chronic hypoventilation syndrome can be caused by many disease states, although it is more commonly seen in neuromuscular disorders. Assessment of hypoventilation includes measurement of carbon dioxide level, respiratory muscle strength, pulmonary function testing, and any other system involved, such as cardiac dysfunction or sleep abnormalities. Often, chronic hypoventilation is initially diagnosed during an episode of acute respiratory failure. The use of noninvasive ventilation with positive pressure, negative pressure, or gravitational devices can be an effective treatment option for some patients, thus obviating the need for a tracheostomy. Noninvasive ventilatory equipment such as the nasal or oral masks, mouthpieces, bi-level positive airway pressure, chest cuirasses, ponchos, or the iron lung, and the rocking bed or pneumobelt can each ventilate a certain type of patient adequately. Each has specific indications, advantages, and disadvantages and must be individualized to the patient's needs.
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6/24. Obese hypoventilation syndrome of early childhood requiring ventilatory support.

    In December 1986 a 30-month-old female child with morbid obesity and respiratory failure was admitted to the Izaak Walton Killam Hospital for Children in Halifax. The etiology of the obesity was found to be dietary in origin after ruling out genetic, neurological and metabolic causes. This patient exhibited somnolence and cyanosis in association with hypercapnia and right ventricular overload. Her respiratory failure in the presence of a normal upper airway required ventilatory support, first with nasal endotracheal intubation, and then, tracheotomy. Weight reduction normalized her capillary blood gases and her somnolence disappeared. Subglottic stenosis hampered removal of the tracheotomy tube until 9 months after admission. The pathogenesis and management of obese hypoventilation syndrome are reviewed by the authors.
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ranking = 0.014549786660969
keywords = upper
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7/24. Management of chronic alveolar hypoventilation with nasal positive pressure breathing.

    Negative pressure ventilation is the most common method of providing assisted ventilation without a tracheostomy. Unfortunately, negative pressure devices have several disadvantages and are not well tolerated by all patients. We present a patient in whom intermittent assisted ventilation was applied successfully by using a nasal mask to provide positive pressure ventilatory support.
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ranking = 1051.0655297218
keywords = breathing
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8/24. Lung function in diaphragm pacing.

    electric stimulation of the diaphragm via the phrenic nerve to induce ventilation has recently been used for the long-term management of chronic ventilatory insufficiency. Since 1973 three patients with inadequate alveolar ventilation have been treated with diaphragm pacing at the Toronto Western Hospital. Two, who had quadriplegia due to lesions of the spinal cord in the upper cervical region and a severe restrictive ventilatory defect, were treated with continuous diaphragm pacing. The third patient required assisted nocturnal ventilation because of primary alveolar hypoventilation. All three patients tolerated the diaphragm pacing well, and pulmonary function tests showed satisfactory gas exchange with the patients breathing room air. This form of therapy seems to be a practical clinical method of managing chronic ventilatory failure in patients with lesions of the upper cervical cord or primary alveolar hypoventilation.
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ranking = 262.79548200377
keywords = breathing, upper
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9/24. Electrophrenic respiration: report of six cases.

    The development of electrophrenic respiration has permitted freedom from mechanical ventilation for patients who have irreversible respiratory failure in association with high-cervical spinal cord or brainstem lesions. There are three basic criteria for successful diaphragm pacing: (1) the need for long-term mechanical ventilatory assistance, (2) a functionally intact phrenic nerve-diaphragm axis, and (3) chest wall stability. Inability to achieve satisfactory pacing can be due to malfunction of equipment, instability of the chest wall, or inadequate neuromuscular responsiveness. These features of diaphragm pacing are exemplified in a series of six patients. Three achieved independence from mechanical ventilatory assistance with full-time phrenic pacing. In one patient, only limited electrophrenic respiration was achieved, and in another the method was entirely unsuccessful. Although functioning well, pacing systems were removed from the sixth patient because of infection. diaphragm pacing can be a valuable form of respiratory support for carefully selected patients.
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keywords = chest
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10/24. bronchogenic cyst causing a unilateral ventilation-perfusion defect on lung scan.

    A 37-year-old woman had pleuritic chest pain, dyspnea, and normal findings on chest roentgenogram. Lung scan showed markedly diminished perfusion to the right lung with a matched ventilatory defect. Further evaluation revealed a bronchogenic cyst. After resection, the lung scan was normal. To our knowledge, this is the first report of a bronchogenic cyst causing a reversible, unilateral ventilation-perfusion defect on lung scan.
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ranking = 0.4
keywords = chest
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