Disordered breathing in severe cerebral illness – Towards a conceptual framework

Summ, Oliver; Hassanpour, Nahid; Mathys, Christian; Groß, Martin

doi:10.1016/j.resp.2022.103869

Cited by 6 publications

(3 citation statements)

References 60 publications

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“…2 ), a constellation possibly caused by lesions in both pontine key regions of respiratory control. Considering the current model of a rhythmogenic network of several pontine and medullary nuclei [ 17 ], a dysfunction of the rhythmogenic network in the brain stem has to be assumed in our patient. From a neuroanatomical point of view, it can thus be hypothesized that the pontine alterations of the MRI-signal in our patient represent white matter lesions which cause the polygraphically recorded impairment of the respiratory rhythm.…”

Section: Discussionmentioning

confidence: 99%

Central Bradypnea and Ataxic Breathing in Myotonic Dystrophy Type 1 – A Clinical Case Report

Summ

Mathys

Grimm

et al. 2023

JND

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Background: The occurrence of obstructive and central sleep apnea syndromes, ventilator pump failure and reduced hypercapnic ventilatory drive in myotonic dystrophy type 1 (DM1) is well established, and there are indications for an impairment of the hypoxic ventilator drive, too. Yet, it is still unknown, to which extent the respiratory rhythm is affected by DM1, thus if a central bradypnea, cluster breathing or ataxic (“Biot's”) breathing can occur. Additionally, the causes of the impairment of the central respiratory drive in DM1 are not known. Case Presentation: We present the case of a tracheotomized female patient with DM 1 with central bradypnea and ataxic breathing. A 57-year-old woman with DM1 was admitted to our Neurointensive Care Unit (NICU) due to refractory tracheobronchial retention of secretions resulting from aspiration of saliva. Due to a combination of chronic hypercapnic respiratory failure, severe central bradypnea with a minimal breathing frequency of 3 per minute and ataxic breathing a pressure-controlled home ventilation was initiated. Conclusions: In our patient central bradypnea and ataxic breathing possibly were respiratory sequale of DM1, that may have been caused by pontine white matter lesions affecting the pontine respiratory nuclei. From a clinical viewpoint, polygraphy is a suitable tool to objectify disorders of the respiratory rhythm in DM1 even in tracheotomized patients. Clinical studies combining respiratory diagnostics as polygraphy, transcutaneous capnometry and blood gas analysis with brain magnetic resonance imaging (MRI) are required to better understand disorders of respiratory regulation in DM1, and to identify their anatomical correlates.

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Section: Discussionmentioning

confidence: 99%

Central Bradypnea and Ataxic Breathing in Myotonic Dystrophy Type 1 – A Clinical Case Report

Summ

Mathys

Grimm

et al. 2023

JND

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“…The main task of the apnea test is to reliably detect a potentially preserved respiratory drive of the patient. Breathing patterns in patients with severe brain damage, which are triggered by the patient when PaCO 2 rises, appear as Biot or Cheyne-Stokes respiration (18,19), similar to an agonal or sigh respiration ("gasping"). In Biot respiration, deep and vigorous breaths are interrupted by pauses; in Cheyne-Stokes respiration, a crescendo-decrescendo pattern of depth of breaths and additionally regularly changing intervals between breaths occur.…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of a modified apnea-test without disconnection from the ventilator in brain death candidates

Lambeck,

Bardutzky,

Strecker

et al. 2023

Preprint

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Background: The apnea test (AT) is the central clinical component in the diagnosis of brain death (BD) and normally entails disconnecting the patient from the ventilator followed by tracheal oxygen sufflation to ensure adequate oxygenation. Most international guidelines state that a lack of spontaneous breathing must be demonstrated when PaCO2 ≥ 60mmHg to rate the test as positive. However, the loss of positive end-expiratory pressure (PEEP) that is associated with disconnection from the ventilator may cause rapid desaturation, frequently leading to cardiopulmonary instability (especially in ARDS-patients) and generally putting patients at risk. This prospective study therefore aimed to investigate whether a modified version of the AT (mAT) in which the patient remained connected to the ventilator, is potentially less harmful yet remains a valid test. Methods: mAT was performed in all 140 BD candidates registered between January 2019 and December 2022: After 10 min of pre-oxygenation, (i) PEEP was increased by 2mbar, (ii) ventilation mode was switched to CPAP and (iii) apnea back-up mode was turned off (flow trigger 10l/min). mAT was considered positive when spontaneous breathing occurred upon increasing PaCO2 to ≥ 60 mmHg (baseline 35–45 mmHg). Clinical complications during/after mAT were documented. Results mAT was possible in 139/140 patients and had a median duration of 15 min (IQR 13–19). Severe complications did not occur. In n = 51 patients, the post-mAT PaO2 was lower than that during pre-mAT, while it was equal or higher in n = 88 cases. In ARDS-patients, apneic oxygenation during mAT improved PaO2. In n = 123 cases, there was a transient post-mAT drop in blood pressure, in n = 12 to a MAP < 60 mmHg. Conclusions The mAT is a safe and gentle means for identifying patients in whom the central respiratory drive has not failed.

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“…Der atmungstherapeutische Behandlungsbedarf begründet sich durch Symptome wie der Dysphagie, der Husteninsuffizienz, der Parese der Atemmuskulatur, obstruktiven und zentralen Apnoen und Hypopnoen, dem erworbenen zentralen Hypoventilatonssyndrom sowie der Sekretretention [29,30]. ▶Tab.…”

Section: Besonderheiten Neurologischer Erkrankungen Mit Beeinträchtig...unclassified

Der Atmungstherapeut in der Neurologie – Ein Blick auf das Berufsbild und ein Ausblick in die Zukunft

Hornemann¹,

Marquardt

Sugg

et al. 2022

Fortschr Neurol Psychiatr

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ZusammenfassungDie Qualifikation des Atmungstherapeuten wird von Pflegekräften und Therapeuten durch eine ca. 1,5jährige qualifizierende Weiterbildung erworben. Die Leistungen der Atmungstherapeuten in Bezug auf neurologische Erkrankungen umfassen die Diagnostik und die Therapie von Störungen der Atmung, des Hustens und des Schluckens sowie das Sekretmanagement. Der Bedarf an Atmungstherapeuten in der Neurologie steigt stetig, und sie werden insbesondere in der neurologisch-neurochirurgischen Frührehabilitation eingesetzt. Die 2021 eingeführte Zertifizierung von „Zentren für Beatmungsentwöhnung in der neurologisch-neurochirurgischen Frührehabilitation“ durch die Deutsche Gesellschaft für Neurorehabilitation umfasst den Einsatz von Atmungstherapeuten als Zertifizierungskriterium. Atmungstherapeuten arbeiten in neurologischen Organisationseinheiten der Versorgung von Schwer- und Schwerstkranken an einer wichtigen interdisziplinären Schnittstelle zwischen ärztlichem, pflegerischem und therapeutischem Team. Sie können die Schulung von Teams, Patienten, Angehörigen und persönlichen Assistenten übernehmen und die Etablierung von Versorgungsstrukturen für neurologisch schwer- und schwerstkranke Patienten unterstützen. Die Tätigkeit in neurologischen Einrichtungen erfordert angesichts der Komplexität der dort behandelten Krankheitsbilder allerdings eine spezifische Qualifizierung der dort tätigen Atmungstherapeuten. Die Professionalisierung des Berufsbilds kann durch den Abgleich der Curricula zwischen den verschiedenen Bildungsanbietern, die Einführung von Zusatzqualifikationen wie „Neurologie und Neurorehabilitation“, die Gründung einer eigenständigen Fachgesellschaft und die Akademisierung gefördert werden.

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Disordered breathing in severe cerebral illness – Towards a conceptual framework

Cited by 6 publications

References 60 publications

Central Bradypnea and Ataxic Breathing in Myotonic Dystrophy Type 1 – A Clinical Case Report

Central Bradypnea and Ataxic Breathing in Myotonic Dystrophy Type 1 – A Clinical Case Report

Prospective evaluation of a modified apnea-test without disconnection from the ventilator in brain death candidates

Der Atmungstherapeut in der Neurologie – Ein Blick auf das Berufsbild und ein Ausblick in die Zukunft

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