Manic-like presentation with an organic aetiology

2020 ◽  
pp. 1-4
Author(s):  
K. Kennedy ◽  
C. Corby ◽  
E. Noctor
Keyword(s):  
Respiratory Failure ◽  
Mental State ◽  
Bipolar Affective Disorder ◽  
Blood Gas Analysis ◽  
Sudden Onset ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Secondary Mania

A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnoea (OSA) and no prior psychiatric history presented repeatedly over 6 months with mental and behavioural changes. Laboratory tests, chest X-ray and sleep study diagnosed an infective exacerbation of COPD, type II respiratory failure and OSA. Differential diagnoses included delirium, primary mania in bipolar affective disorder or organic pathology causing secondary mania. Oxygen, steroids, bronchodilators, antibiotics and non-invasive ventilation were administered to treat his infection and respiratory failure. However, blood gas analysis showed persistent hypoxia and hypercarbia, aggravating his ongoing mental state disturbance that required security supervision and sedation with antipsychotics and benzodiazepines. Sudden onset of classic manic symptoms and multiple presentations suggested secondary mania, driven by chronic hypoxia in end-stage COPD and OSA. The challenge was establishing a balance between mental state control and treatment of physical illness.

Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽  
2021 ◽  
pp. 1-8
Author(s):  
Clemens F. Hinke ◽  
Rudolf A. Jörres ◽  
Peter Alter ◽  
Robert Bals ◽  
Florian Bornitz ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Predictive Value ◽  
Hemoglobin Concentration ◽  
Blood Gas Analysis ◽  
Study Data ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Acute Exacerbations ◽  
All Cause Mortality

<b><i>Background:</i></b> Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). <b><i>Objectives:</i></b> We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). <b><i>Methods:</i></b> In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO<sub>2</sub>, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. <b><i>Results:</i></b> During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (<i>p</i> &#x3c; 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV<sub>1</sub> % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (<i>p</i> = 0.006) was superior to that of Hb or SpO<sub>2</sub> and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; <i>p</i> = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; <i>p</i> = 0.001) as covariates. <b><i>Conclusion:</i></b> The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

scholarly journals SINDROM PICKWICKIAN-SINDROM HIPOVENTILASI PADA OBESITAS: LAPORAN KASUS DENGAN PENDEKATAN DIAGNOSIS KLINIS

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Ni Luh Putu Dirasandhi Semedi Putri ◽  
Desak Ketut Indrasari Utami ◽  
I Gusti Ngurah Budiarsa ◽  
Sri Yenni Trisnawati
Keyword(s):  
Morbid Obesity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Blood Gas ◽  
Obesity Hypoventilation Syndrome ◽  
The Past ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

   OBESITY HYPOVENTILATION SYNDROME–THE PICKWICKIAN SYNDROME A CLINICALLY DIAGNOSTIC APPROACH CASE REPORTABSTRACTA 36-year-old man complained about snoring in the past 3 years with a very loud snoring interspersed with choking. This recurs throughout the night, thus, he often experiences excessive drowsiness during the day. He also experienced generalized tonic-clonic seizure in the past six months during sleeping at night or immediately after wake up in the morning. It happened three to four times a week. In the past one month he also experienced a morning headache. He was classified as morbid obesity and had 47.2 cm wide of neck circumference. STOP-BANG score and Snoring Severity Score (SSS) indicated high risk of Obstructive Sleep Apnea. Apnea Hypopnea Index (AHI) was 55.5. The Epworth Sleepiness Scale (ESS) score was 15 indicated to have an excessive sleepiness during the day. Blood gas analysis showed a hypercapnia and chronic hypoventilation condition characterized by the increasing of pCO2 and HCO3- with normal pH. A complete blood count examination showed polycythemia. The patient was diagnosed as Obesity Hypoventilation Syndrome (OHS) based on obesity, OSA, and chronic hypoventilation. With a limited gold standard diagnostic tools, such as polysomnography (PSG), a clinical approach using sleep tools and blood gas analysis to detect early stage OHS still can be made.Keywords: Chronic hypoventilation, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneaABSTRAKSeorang laki-laki 36 tahun dikeluhkan selalu mendengkur sejak 3 tahun dengan suara dengkuran yang sangat keras diselingi tersedak. Hal ini berulang sepanjang malam hingga pasien sering mengantuk berlebihan di siang hari. Pasien juga mengalami bangkitan umum tonik klonik sejak enam bulan, saat sedang tidur malam hari atau segera setelah terbangun di pagi hari. Sejak 1 bulan, pasien mengeluh sakit kepala saat bangun pagi. Pasien tergolong morbid obesity dan lingkar leher 47,2cm. Skor STOP-BANG dan skor Snoring Severity Score (SSS) menunjukkan risiko tinggi obstructive sleep apneu (OSA), serta Apnea Hypopnea Index (AHI) adalah 55,5. Skor Epworth Sleepiness Scale (ESS) 15 menunjukkan mengantuk berlebihan di siang hari. Pemeriksaan analisis gas darah didapatkan kondisi hiperkapnia dan hipoventilasi kronik berupa peningkatan pCO2 dan HCO3- dengan pH darah cenderung normal. Pemeriksaan darah lengkap menunjukkan polisitemia. Pasien didiagnosis sebagai Sindrom Hipoventilasi pada Obesitas (SHO) karena adanya obesitas, OSA, dan hipoventilasi kronik. Meskipun memiliki keterbatasan alat diagnostik baku emas seperti polisomnografi (PSG), namun pendekatan klinis beserta sleep tools dan analisis gas darah dapat digunakan untuk mendeteksi dini SHO.Kata kunci: Hipoventilasi kronik, morbid obesity, Obesity Hypoventilation Syndrome, obstructive sleep apneu  

Hemodynamic responses to controlled 100% oxygen breathing in emphysema

1965 ◽  
Vol 20 (2) ◽  
pp. 215-220 ◽  
Author(s):  
John H. Holt ◽  
Ben V. Branscomb
Keyword(s):  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Dilution Method ◽  
Chronic Obstructive ◽  
Hemodynamic Responses ◽  
Arterial Blood Gas ◽  
Controlled Ventilation ◽  
Oxygen Breathing ◽  
Oxygen Inhalation ◽  
Arterial Blood

Cardiopulmonary hemodynamic responses to breathing 100% oxygen for 20 min were studied in 13 patients with moderate to severe chronic obstructive emphysema under conditions of controlled ventilation. A technique for regulating the level of ventilation in the unanesthetized subject is described. Cardiac output was measured by the indicator-dilution method. Arterial blood gas analysis and pH were performed in each phase of the study. A slight but statistically significant decrease in cardiac index occurred. There was a highly significant reduction in pulmonary arterial pressure and pulmonary vascular resistance. No change in heart rate, pulmonary wedge pressure, or aortic pressure occurred. It is concluded that oxygen breathing caused a release, in part at least, of a pulmonary vasoconstrictive element in these patients. pulmonary circulation; oxygen in pulmonary hypertension; hypoxia and pulmonary vasoconstriction; controlled ventilation during oxygen inhalation Submitted on May 27, 1964

Acute respiratory failure and acute respiratory distress syndrome

2018 ◽  
Author(s):  
Luciano Gattinon ◽  
Eleonora Carlesso
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Partial Pressure ◽  
Distress Syndrome ◽  
Gas Analysis ◽  
Chronic Obstructive ◽  
Low Oxygen ◽  
Arterial Blood

Respiratory failure (RF) is defined as the acute or chronic impairment of respiratory system function to maintain normal oxygen and CO2 values when breathing room air. ‘Oxygenation failure’ occurs when O2 partial pressure (PaO2) value is lower than the normal predicted values for age and altitude and may be due to ventilation/perfusion mismatch or low oxygen concentration in the inspired air. In contrast, ‘ventilatory failure’ primarily involves CO2 elimination, with arterial CO2 partial pressure (PaCO2) higher than 45 mmHg. The most common causes are exacerbation of chronic obstructive pulmonary disease (COPD), asthma, and neuromuscular fatigue, leading to dyspnoea, tachypnoea, tachycardia, use of accessory muscles of respiration, and altered consciousness. History and arterial blood gas analysis is the easiest way to assess the nature of acute RF and treatment should solve the baseline pathology. In severe cases mechanical ventilation is necessary as a ‘buying time’ therapy. The acute hypoxemic RF arising from widespread diffuse injury to the alveolar-capillary membrane is termed Acute Respiratory Distress Syndrome (ARDS), which is the clinical and radiographic manifestation of acute pulmonary inflammatory states.

scholarly journals Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure

2020 ◽  
Author(s):  
Capan Konca ◽  
Mehmet Tekin ◽  
Fatih Uckardes ◽  
Samet Benli ◽  
Ahmet Kucuk
Keyword(s):  
Carbon Dioxide ◽  
Respiratory Failure ◽  
Pediatric Patients ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mechanically Ventilated ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

AbstractIn the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

scholarly journals Respiratory failure: technical means for diagnosis and respiratory support

Doklady BGUIR ◽  
2020 ◽  
Vol 18 (8) ◽  
pp. 29-36
Author(s):  
Е. I. Davidovskaya ◽  
A. S. Dubrovski ◽  
О. В. Zelmanski
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Obstructive Sleep Apnea ◽  
Respiratory Failure ◽  
Pulse Oximetry ◽  
Respiratory Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome ◽  
Cpap Devices

The necessity of early diagnosis of respiratory diseases, especially in the context of the COVID-19 pandemic, by means of pulse oximetric screening and monitoring has been substantiated. The expediency of using portable pulse oximeters by therapists and general practitioners has been shown. The main respiratory diseases accompanied by respiratory failure, which can be detected in time by pulse oximetry, are the chronic obstructive pulmonary disease and the obstructive sleep apnea-hypopnea syndrome. Early detection of these diseases is an important task because of the mild symptoms of these diseases in the early stages, and as a result, the prevalence of late diagnosis. Special attention is given to the pulse oximetry for COVID-19 detection, as this infection is also accompanied by respiratory failure. The use of oxygen concentrators and auto CPAP devices for the treatment of respiratory failure as well as rehabilitation has been argued. The effectiveness of the appointment of long-term oxygen therapy using oxygen concentrators for patients with chronic obstructive pulmonary disease, CPAP therapy using automatic CPAP devices for patients with obstructive sleep apnea-hypopnea syndrome with mandatory pulse oximetry monitoring has been confirmed. The analysis of 120 cases of treatment of moderate and severe COVID-19 cases complicated by the pneumonia has been carried out. The efficiency of the use of oxygen concentrators for supplying oxygen to patients at a flow rate not more than 5 l/min has been proven. It has been found that no more than 10 % of patients needed an oxygen flow rate more than 5 l/min. At the same time, the possibility of using CPAP devices for non-invasive ventilation of lungs using full-face masks has been shown. The expediency of using oxygen concentrators and CPAP devices for the rehabilitation of patients after COVID-19 has been noted.

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