Search

Evidence is increasing that long-term noninvasive ventilation (LTNIV) can improve outcomes in individuals with severe, hypercapnic COPD. Although the evidence remains unclear in some aspects, LTNIV seems to be able to improve patient-related and physiologic outcomes like dyspnea, FEV 1 and partial pressure of carbon dioxide (P co 2) and also to reduce rehospitalizations and mortality. Efficacy generally is associated with reduction in P co 2. To achieve this, an adequate interface (mask) is essential, as are appropriate ventilation settings that target the specific respiratory physiologic features of COPD. This will ensure comfort, synchrony, and adherence that will result in physiologic improvements. This article briefly reviews the newest evidence and current guidelines on LTNIV in severe COPD. It describes an actual patient who benefitted from the therapy. Finally, it provides strategies for initiating and optimizing this LTNIV in COPD, discussing high-pressure noninvasive ventilation, optimization of triggering, and control of inspiratory time. As demand increases, clinicians will need to be familiar with this therapy to reap its benefits, because inadequately adjusted LTNIV will not be tolerated or effective. [ABSTRACT FROM AUTHOR]

Children and young adults with congenital central hypoventilation syndrome (CCHS) are at risk of cognitive deficits. They experience autonomic dysfunction and chemoreceptor insensitivity measured during ventilatory and orthostatic challenges, but relationships between these features are undefined. Can a biomarker be identified from physiologic responses to ventilatory and orthostatic challenges that is related to neurocognitive outcomes in CCHS? This retrospective study included 25 children and young adults with CCHS tested over an inpatient stay. Relationships between physiologic measurements during hypercarbic and hypoxic ventilatory challenges, hypoxic ventilatory challenges, and orthostatic challenges and neurocognitive outcomes (by Wechsler intelligence indexes) were examined. Independent variable inclusion was determined by significant associations in Pearson's analyses. Multivariate linear regressions were used to assess relationships between measured physiologic responses to challenges and neurocognitive scores. Significant relationships were identified between areas of fluid intelligence and measures of oxygen saturation (SpO 2) and heart rate (HR) during challenges. Specifically, perceptual reasoning was related to HR (adjusted regression [β] coefficient, –0.68; 95% CI, 1.24 to –0.12; P =.02) during orthostasis. Working memory was related to change in HR (β, –1.33; 95% CI, –2.61 to –0.05; P =.042) during the hypoxic ventilatory challenge. Processing speed was related to HR (β, –1.19; 95% CI, –1.93 to –0.46; P =.003) during orthostasis, to baseline SpO 2 (hypercarbic and hypoxic β, 8.57 [95% CI, 1.63-15.51]; hypoxic β, 8.37 [95% CI, 3.65-13.11]; P =.002 for both) during the ventilatory challenges, and to intrachallenge SpO 2 (β, 5.89; 95% CI, 0.71-11.07; P =.028) during the hypoxic ventilatory challenge. In children and young adults with CCHS, SpO 2 and HR—or change in HR—at rest and as a response to hypoxia and orthostasis are related to cognitive outcomes in domains of known risk, particularly fluid reasoning. These findings can guide additional research on the usefulness of these as biomarkers in understanding the impact of daily physical stressors on neurodevelopment in this high-risk group. [ABSTRACT FROM AUTHOR]

Intravitreal bevacizumab (IVB), an anti-vascular endothelial growth factor (VEGF) antibody, is a widely adopted treatment for retinopathy of prematurity (ROP). Although animal studies have demonstrated that IVB inhibits alveologenesis in neonatal rat lung, the clinical influence of IVB on respiratory outcomes has not been studied. Does IVB affect the respiratory outcome in preterm infants with bronchopulmonary dysplasia? We retrospectively assessed very low birth weight (VLBW) preterm infants admitted to our neonatal ICU between January 2016 and June 2021. Furthermore, we evaluated the short-term respiratory outcomes after IVB therapy in VLBW preterm infants requiring ventilatory support at 36 weeks' postmenstrual age (PMA). One hundred seventy-four VLBW preterm infants with bronchopulmonary dysplasia were recruited. Eighty-eight infants showed ROP onset before being ventilator free, and 78 infants received a diagnosis of the most severe ROP before being ventilator free. Among them, 32 received a diagnosis with type 1 ROP and received IVB treatment. After adjusting for gestational age, birth body weight, and baseline respiratory status, we discovered that IVB is associated significantly with prolonged ventilatory support and a lower likelihood of becoming ventilator free (hazard ratio, 0.53; P =.03). IVB may have a short-term respiratory adverse effect in patients requiring ventilatory support at 36 weeks' PMA. Therefore, long-term follow-up for respiratory outcomes may be considered in VLBW infants who receive IVB treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Asthma exacerbations can be life-threatening, with 25,000 to 50,000 such patients per year requiring admission to an ICU in the United States. Appropriate triage of life-threatening asthma is dependent on both static assessment of airway function and dynamic assessment of response to therapy. Treatment strategies focus on achieving effective bronchodilation with inhaled β2-agonists, muscarinic antagonists, and magnesium sulphate while reducing inflammation with systemic corticosteroids. Correction of hypoxemia and hypercapnia, a key in managing life-threatening asthma, occasionally requires the incorporation of noninvasive mechanical ventilation to decrease the work of breathing. Endotracheal intubation and mechanical ventilation should not be delayed if clinical improvement is not achieved with conservative therapies. However, mechanical ventilation in these patients often requires controlled hypoventilation, adequate sedation, and occasional use of muscle relaxation to avoid dynamic hyperinflation, which can result in barotrauma or volutrauma. Sedation with ketamine or propofol is preferred because of their potential bronchodilation properties. In this review, we outline strategies for the assessment and management of patients with acute life-threatening asthma focusing on those requiring admission to the ICU. [ABSTRACT FROM AUTHOR]

The existing coverage criteria for home noninvasive ventilation (NIV) do not recognize the diversity of hypoventilation syndromes and advances in technologies. This document summarizes the work of the hypoventilation syndromes Technical Expert Panel working group. The most pressing current coverage barriers identified were: (1) overreliance on arterial blood gases (particularly during sleep); (2) need to perform testing on prescribed oxygen; (3) requiring a sleep study to rule out OSA as the cause of sustained hypoxemia; (4) need for spirometry; (5) need to show bilevel positive airway pressure (BPAP) without a backup rate failure to qualify for BPAP spontaneous/timed; and (6) qualifying hospitalized patients for home NIV therapy at the time of discharge. Critical evidence support for changes to current policies includes randomized controlled trial evidence and clinical practice guidelines. To decrease morbidity and mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: (1) given the significant technological advances, we advise acceptance of surrogate noninvasive end-tidal and transcutaneous Pco2 and venous blood gases in lieu of arterial blood gases; (2) not requiring Pco2 measures while on prescribed oxygen; (3) not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; (4) remove spirometry as a requirement; and (5) not requiring BPAP without a backup rate failure to approve BPAP spontaneous/timed. The overarching goal of the Technical Expert Panel is to establish pathways that improve clinicians' management capability to provide Medicare beneficiaries access to appropriate home NIV therapy. Adoption of these proposed suggestions would result in the right device, for the right type of patient with hypoventilation syndromes, at the right time. [ABSTRACT FROM AUTHOR]

Background: Noninvasive ventilation (NIV) is an effective form of treatment in obesity hypoventilation syndrome (OHS) with severe OSA. However, there is paucity of evidence in patients with OHS without severe OSA phenotype.Research Question: Is NIV effective in OHS without severe OSA phenotype?Study Design and Methods: In this multicenter, open-label parallel group clinical trial performed at 16 sites in Spain, we randomly assigned 98 stable ambulatory patients with untreated OHS and apnea-hypopnea index < 30 events/h (ie, no severe OSA) to NIV or lifestyle modification (control group) using simple randomization through an electronic database. The primary end point was hospitalization days per year. Secondary end points included other hospital resource utilization, incident cardiovascular events, mortality, respiratory functional tests, BP, quality of life, sleepiness, and other clinical symptoms. Both investigators and patients were aware of the treatment allocation; however, treating physicians from the routine care team were not aware of patients' enrollment in the clinical trial. The study was stopped early in its eighth year because of difficulty identifying patients with OHS without severe OSA. The analysis was performed according to intention-to-treat and per-protocol principles and by adherence subgroups.Results: Forty-nine patients in the NIV group and 49 in the control group were randomized, and 48 patients in each group were analyzed. During a median follow-up of 4.98 years (interquartile range, 2.98-6.62), the mean hospitalization days per year ± SD was 2.60 ± 5.31 in the control group and 2.71 ± 4.52 in the NIV group (adjusted rate ratio, 1.07; 95% CI, 0.44-2.59; P = .882). NIV therapy, in contrast with the control group, produced significant longitudinal improvement in Paco2, pH, bicarbonate, quality of life (Medical Outcome Survey Short Form 36 physical component), and daytime sleepiness. Moreover, per-protocol analysis showed a statistically significant difference for the time until the first ED visit favoring NIV. In the subgroup with high NIV adherence, the time until the first event of hospital admission, ED visit, and mortality was longer than in the low adherence subgroup. Adverse events were similar between arms.Interpretation: In stable ambulatory patients with OHS without severe OSA, NIV and lifestyle modification had similar long-term hospitalization days per year. A more intensive program aimed at improving NIV adherence may lead to better outcomes. Larger studies are necessary to better determine the long-term benefit of NIV in this subgroup of OHS.Trial Registry: ClinicalTrials.gov; No.: NCT01405976; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: Surgical patients with OSA are at increased risk for perioperative complications. Postoperative supplemental oxygen is commonly used, but it may contribute to respiratory depression in patients with OSA receiving opioids. The objective of the study is to investigate the effect of postoperative supplemental oxygen on arterial oxygen saturation (Sao2), sleep respiratory events, and CO2 level in patients with untreated OSA.Methods: Consented patients with an apnea hypopnea index (AHI) > 5 events per hour on a preoperative polysomnography were randomized (1:1) to oxygen (O2 group) or no oxygen (control group). The O2 group received oxygen at 3 L/min via nasal prongs for three postoperative nights. The primary outcomes were polysomnographic parameters measuring Sao2, sleep respiratory events, and Pco2 measured by transcutaneous CO2 monitor (PtcCO2) on nights 1 through 3. The intention-to-treat and per protocol analysis were completed.Results: There were 123 patients randomized (O2 group: n = 62; control group: n = 61). On night 3, the O2 vs control group had a higher average Sao2 (95.2% ± 3% vs 91.4% ± 4%, respectively; P < .001) and lower oxygen desaturation index (median, 2.3; 25th-75th percentile, 0.2-13.8 vs median, 18.5; 25th-75th percentile, 8.2-45.9 events per hour, respectively; P < .0001). The O2 group had a decreased AHI (median, 8.0; 25th-75th percentile, 2.1-19.9 vs median, 15.6; 25th-75th percentile, 9.5-45.8, respectively; P = .016), hypopnea index (P < .001), and central apnea index (P = .026) and a shortened longest apnea hypopnea duration (P = .002). Although time percentage with PtcCO2 ≥ 55 mm Hg ≥ 10% on postoperative night 1, 2, or 3 was found in 11.4% patients, there was no difference in PtcCO2 between the groups.Conclusions: Postoperative supplemental oxygen was found to improve oxygenation and decrease the AHI without increasing the duration of apnea-hypopnea event or PtcCO2 level. A small number of patients had significant CO2 retention while receiving supplemental oxygen.Trial Registry: ClinicalTrials.gov; No.: NCT01552304; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: Congenital Central Hypoventilation Syndrome (CCHS) is a rare neurocristopathy characterized by severe hypoventilation and autonomic dysregulation, with typical presentation in the neonatal period, and deficient cognitive skills in school-aged patients. We hypothesized that younger (preschool) children with CCHS would also show neurocognitive delay and that CCHS-related physiologic factors would impact neurocognitive test results.Methods: We studied developmental (Bayley) test results collected during routine clinical care in 31 children (mean age 25.0 ± 8.5 months; range, 6-40 months) with PHOX2B mutation-confirmed CCHS by comparing them with the normative reference mean from the Bayley standardization sample; we also examined associations between Bayley scores and CCHS disease-related factors.Results: Preschool patients with CCHS fell significantly below the normative mean of 100 on Bayley indices of mental (mean, 83.35 ± 24.75) and motor (mean, 73.33 ± 20.48) development (P < .001 for both). Significantly lower Bayley mental and motor scores were associated with severe breath-holding spells, prolonged sinus pauses, and need for 24 h/d artificial ventilation. Lower Bayley motor scores were also associated with seizures. Bayley scores differed among children with the three most common polyalanine repeat expansion mutation genotypes (mental, P = .001; motor, P = .006), being essentially normal in children with the 20/25 genotype but significantly lower in the other genotype groups (P < .05).Conclusions: These results confirm neurodevelopmental impairment of CCHS preschoolers, with severity related to physiologic compromise and PHOX2B genotype. These findings suggest that adverse effects begin early in the disease process, supporting the need for neurodevelopmental monitoring and intervention from early infancy. [ABSTRACT FROM AUTHOR]

The article investigates whether obese patients with raised bicarbonate exhibit signs of obesity-related hypoventilation (OHS). Topics discussed include the symptoms of OHS, the physiologic similarities and differences between patients with OHS and those with only a raised bicarbonate and the recommendations for diagnosing OHS patients and those with raised bicarbonate.

The article discusses a research study which compared capnometry-assisted hypoventilation (CATCH) training versus slow breathing and awareness training in improving asthma control. Data is provided comparing the pulmonary function, asthma symptoms, quality of life, bronchodilator use and airway hyperreactivity among patients in both interventions. Study results show the levels of respiratory impedance during treatment and distress during methacholine challenge between the two patient groups.

The article discusses a study on the impact of backup respiratory rate (BURR) settings on the efficacy of noninvasive positive pressure ventilation (NPPV) in patients with obesity hypoventilation syndrome (OHS). The patients involved were treated with noctural NPPV and underwent polysomnographic recordings and transcutaneous capnography with three BURR settings, namely, spontaneous (S) mode, low BURR and high BURR. The study found a link between the S mode and respiratory events.

The article deals with a study which compared noninvasive ventilation (NIV) and conservative measures in the treatment of obesity hypoventilation syndrome (OHS). Effects were compared on blood gas measurements, sleep quality, vigilance, and cardiovascular, metabolic, and inflammatory parameters. NIV treatment reportedly improved sleep and blood gas measurements dramatically, but did not affect inflammatory, metabolic, and cardiovascular markers.

The article examines whether oxygen therapy can worsen hypercapnia in patients with obesity-associated hypoventilation (OAH). According to the authors, the 24 outpatients who participated in the study inhaled 100 percent oxygen for 20 minutes on two separate days. They report that three subjects showed increased transcutaneous carbon dioxide tension which resulted in the termination of their participation in the study. They conclude that breathing 100 percent oxygen worsens hypercapnia among stable patients with OAH.

The article describes the physiologic characteristics of respiratory function in obesity, obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS). It discusses the clinical case of a 63-year-old obese man with sleep-disordered breathing. The effects of obesity on lung function are explained, along with the pathogenesis of OSA and the control of upper-airway muscle function while sleeping. In addition, the article also discusses the surgical approach for patients with sleep-disordered breathing.

The article discusses research on the long-term outcome of noninvasive positive pressure ventilation (NPPV) for obesity hypoventilation syndrome (OHS). The researchers analyzed 130 patients with OHS who started NPPV between January 1995 and December 2006. The findings support long term NPPV as an effective OHS treatment initiated in either acute or chronic setting.

The article discusses the postoperative complications related to the obesity hypoventilation syndrome (OHS) and hypercapnic obstructive sleep apnea (OSA). It references the study "Postoperative complications in patients with unrecognized obesity hypoventilation syndrome undergoing elective noncardiac surgery," by R. Kaw and colleagues. Topics include the symptoms of hypercapnia, its relations to the increased risks of postoperative respiratory failure, and apneahypopnea index (AHI).

The article presents a study that determines various manifestations of congenital central hypoventilation syndrome (CCHS). It investigates a Chinese family with paired-like homeobox 2B mutation-confirmed CCHS, with a clinical spectrum from newburn to adulthood. Results show that transmission of late-onset CCHS is autosomal-dominant. Genetic screening of family members with CCHS is suggested for early diagnosis and treatment.

The article discusses the study of daytime hypercapnia in obstructive sleep apnea syndrome (OSAS). The study investigates the prevalence of daytime hypercapnia in patients with OSAS, the association of daytime hypercapnia and obesity, and the obstructive airflow limitation. Accordingly, it examined 1,227 patients by using polysomnography. Furthermore, it is stated that the pathogenesis of daytime hypercapnia may be directly linked to sleep apnea in patient with OSAS.

The article offers information about obesity hypoventilation syndrome (OHS). OHS consists of a combination of obesity and chronic hypercapnia accompanied by sleep-disordered breathing. Patients inflicted with OHS have a lower quality of life with increased health-care expenses and are at a higher risk for the development of pulmonary hypertension and early mortality. Its treatment is associated with lower long-term morbidity and mortality.

The article presents information on sleep related hypoventilation or hypoxemiac syndromes. Sleep induced-hypoventilation is characterized by abnormal pulmonary gas exchange while sleeping. The sleeping posture, the state of sleeping, and the circadian rhythm driving sleep effect the respiratory mechanics leading to breathing problem in sleep induced-hypoventilation.

The article cites a study that aims to determine whether nocturnal polysomnography allows the detection of respiratory disturbances in patients suffering with obesity-hypoventilation syndrome (OHS) treated with nasal positive pressure ventilation (NPPV). OHS is commonly defined as a combination of obesity and arterial hypercapnia during wakefulness. The study found that the efficacy of NPPV requires an optimal interaction between a patient's ventilatory drive and the ventilator.

The article assesses the role of average volume-assured pressure support (AVAPS) as an additional mode for a bilevel pressure ventilation (BPV) device in obesity hypoventilation syndrome (OHS). It was found that BPV with the spontaneous/timed ventilation mode improved oxygenation and sleep quality in patients with OHS. It was also noted that AVAPS provided additional benefits on ventilation quality.

Background: Changes in PaCO2 have not been described during thoracoscopy under sedation-assisted local anesthesia. We hypothesized that hypoventilation might occur secondary to administration of sedatives and decreased ventilation in one lung. Aim: Prospectively measure cutaneous carbon dioxide tension (PcCO2) in addition to pulse oximetric saturation (SpO2) using a new combined digital sensor to examine the occurrence of hypoventilation during thoracoscopy under sedation-assisted local anesthesia. Setting: University hospital. Methods: Following validation studies, PcCO2 was prospectively measured in 16 consecutive patients undergoing thoracoscopy under sedation-assisted local anesthesia using a combined digital earlobe sensor measuring SpO2 (percentage) and PcCO2 (millimeters of mercury). All patients received supplemental oxygen. Routine BP monitoring and SpO2 was continued. Patients received IV hydrocodone, 5 mg, and intermittent boluses or IV midazolam and pethidine. Results: Mean baseline PcCO2 measurement was 39.1 ± 7.2 mm Hg (± SD) [range, 27.5 to 50.5 mm Hg], and peak measurement during the procedure was 52.3 ± 10.3 mm Hg (range, 37.2 to 77 mm Hg) [p < 0.001]. Median and mean changes in PcCO2 measurement from baseline were 13.0 mm Hg and 13.2 ± 5.3 mm Hg (range, 5.5 to 27.8 mm Hg), respectively. Mean fall in SpO2 during the procedure was 4.6 ± 3.2% (range, 1 to 14%). Conclusions: Thoracoscopy performed under sedation-assisted local anesthesia is associated with significant hypoventilation. Combined measurement of SpO2 and PcCO2 during thoracoscopy is a novel approach in the monitoring of ventilation, enhancing patient safety, and might allow to guide the administration of sedation in a better way. [ABSTRACT FROM AUTHOR]

Study objective: This two-part study was designed to determine the effect of supplemental oxygen on the detection of hypoventilation, evidenced by a decline in oxygen saturation (SpO2) with pulse oximetry. Design: Phase 1 was a prospective, patient-controlled, clinical trial. Phase 2 was a prospective, randomized, clinical trial. Setting: Phase 1 took place in the operating room. Phase 2 took place in the postanesthesia care unit (PACU). Patients: In phase 1, 45 patients underwent abdominal, gynecologic, urologic, and lower-extremity vascular operations. In phase 2, 288 patients were recovering from anesthesia. Interventions: In phase 1, modeling of deliberate hypoventilation entailed decreasing by 50% the minute ventilation of patients receiving general anesthesia. Patients breathing a fraction of inspired oxygen (FIO2) of 0.21 (n = 25) underwent hypoventilation for up to 5 min. Patients with an FIO2 of 0.25 (n = 10) or 0.30 (n = 10) underwent hypoventilation for 10 min. In phase 2, spontaneously breathing patients were randomized to breathe room air (n = 155) or to receive supplemental oxygen (n = 133) on arrival in the PACU. Measurements and results: In phase 1, end-tidal carbon dioxide and SpO2 were measured during deliberate hypoventilation. A decrease in SpO2 occurred only in patients who breathed room air. No decline occurred in patients with FIO2 levels of 0.25 and 0.30. In phase 2, SpO2 was recorded every min for up to 40 min in the PACU. Arterial desaturation (SpO2 < 90%) was fourfold higher in patients who breathed room air than in patients who breathed supplemental oxygen (9.0% vs 2.3%, p = 0.02). Conclusion: Hypoventilation can be detected reliably by pulse oximetry only when patients breathe room air. In patients with spontaneous ventilation, supplemental oxygen often masked the ability to detect abnormalities in respiratory function in the PACU. Without the need for capnography and arterial blood gas analysis, pulse oximetry is a useful tool to assess ventilatory abnormalities, but only in the absence of supplemental inspired oxygen. [ABSTRACT FROM AUTHOR]

The article deals with noninvasive ventilatory management of obesity hypoventilation syndrome (OHS). It references a study by O. Contal et al. on the impact of backup respiratory rates (BURR) on the efficacy of noninvasive ventilatory support in OHS published within the issue. The patients involved in the study were subjected to polysomnography (PSG) with bilevel positive airway pressure (PAP). The factors that may contribute to possible errors in the study' findings are discussed.

A letter to the editor and a reply are presented in response to the article "Noninvasive ventilation in mild obesity hypoventilation syndrome: a randomized controlled trial" in the March 2012 issue.

The article comments on a study by M. Wijesinghe and colleagues concerning the effects of oxygen supplementation on patients with obesity hypoventilation syndrome (OHS). According to the authors, OHS is a condition that combines obesity, sleep-disordered breathing and awake chronic hypercapnia. They reveal that in Wijesinghe's study, over 30 percent of patients with severe obesity have been found to be hypercapnic. They add that the study also showed that high concentrations of oxygen can make hypercapnia worse by decreasing minute ventilation.

The article presents the author's comments on the treatment of obesity hypoventilation syndrome (OHS). OHS is defined as a combination of obesity, awake chronic hypercapnia, and sleep-disordered breathing. Patients with OHS are at higher risk for pulmonary hypertension and early mortality. The author claims that the high burden of morbidity and mortality associated with this syndrome can be reduced with early recognition and treatment with positive air pressure therapy.

Patient was subsequently intubated and placed on mechanical ventilation with persistent hypoxemia despite increasing the positive end expiratory pressure (PEEP) to 10 cmH20 and fraction of inspired oxygen (FiO2) of 100%. Worsening hypoxemia in the face of increasing PEEP: a case of large pulmonary embolism in the setting of intracardiac shunt. Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report. [Extracted from the article]

Patients with OHS have higher rates of hospitalization and health care utilization, greater cardiorespiratory comorbidities, and higher mortality than eucapnic obese patients. Data collected included age, sex, serum bicarbonate, arterial blood gasses (ABG), diagnoses, and in-hospital complications and mortality. B CLINICAL IMPLICATIONS: b Adequately screening patients for OHS could affect both inpatient and outpatient treatment plans, and possibly reduce the complication and mortality rates associated with in-hospital stays. [Extracted from the article]

We present a case with the uncommon manifestation of complete AV block secondary to myxedema coma. His electrocardiogram (ECG) showed evidence of complete heart block. After the treatment with intravenous levothyroxine for 6 days patient was successfully extubated, and the ECG returned to normal sinus rhythm without any other treatment. [Extracted from the article]

A letter to the editor is presented in response to a article related to cardiovascular morbidity and obstructive sleep apnea (OSA) severity in obesity hypoventilation syndrome (OHS) patients published in July 2016 issue of the periodical.

Chart review revealed paraneoplastic Anti-Hu anti-body in the blood and cerebrospinal fluid (CSF) with a non-enhancing brainstem abnormality on magnetic resonance imaging. In the context of encephalitis and persistent apneas during sleep, a diagnosis of central sleep apnea (CSA) from Anti-Hu encephalitis (AHE) was made. The patient was begun on day time TC and nocturnal ACV with resolution of hypercarbia and apneas. [Extracted from the article]

Diagnostic of severe SA requires rapid CPAP treatment initialization and treatment maintenance to restore normal airflow during sleep and avoid severe complications. B CONCLUSIONS: b Conclusion: In the last year we made progresses in increasing CPAP initialization/adherence in SA patients. [Extracted from the article]

The damage depends highly on the brains response to changing serum concentration and can present with many symptoms. Therefore, Brain magnetic resonance imaging (MRI) was obtained; results showed early T2 hyperintense signal within the pons centrally in a pattern suggesting Osmotic Demyelination syndrome (ODS) (figures 1 & 2).Patient remained conscious and needed to be transferred to a long-term nursing facility after tracheostomy and percutaneous endoscopic gastrostomy. Astrocytes surround the brains capillaries with foot processes and contain the vital water channels that regulate cellular solutes and water across the blood-brain-barrier. [Extracted from the article]

The article discusses the medical diagnosis of a 57-year female patient presented with obesity, progressive mental deterioration and dyspnea after prolonged intensive care as a result of cerebral aneurysm rupture. An overview is given on the medical history of the patient, including arterial hypertension with appropriate treatment and former tobacco use. It explains the diagnosis of obesity hypoventilation syndrome, classically described as Pickwickian syndrome.

Comments on the article on pectus excavatum published in the June 2001 issue of the journal 'Chest.' Role of pectus excavatum as the cause of hypercapnic respiratory failure; Occurrence of scoliosis in patients with generalized neuromuscular weakness; Association of generalized weakness with spinal muscular atrophy type 1.