Early recognition of myxedematous respiratory failure in the elderly

Guo, Fengjin; Xu, Tianming; Wang, Houli

doi:10.1016/j.ajem.2008.01.027

Cited by 12 publications

(6 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…those with PHO2XB mutations [57] who can be completely asymptomatic while awake, yet despite normal daytime PaCO2s, exhibit profound hypoventilation responses to sedation and narcotics once asleep. Others at risk include patients with obesity hypoventilation syndrome [58], chest wall deformities, polio sequelae, advanced COPD [59], and severe hypothyroidism [60]. Then there's always the possibility of an accidental narcotic overdose, although our currently piqued awareness regarding medication error has resulted in a wide range of preemptive processes being applied by most hospitals to prevent this.…”

Section: Resultsmentioning

confidence: 99%

Patterns of unexpected in-hospital deaths: a root cause analysis

Lynn¹,

2011

View full text Add to dashboard Cite

BackgroundRespiratory alarm monitoring and rapid response team alerts on hospital general floors are based on detection of simple numeric threshold breaches. Although some uncontrolled observation trials in select patient populations have been encouraging, randomized controlled trials suggest that this simplistic approach may not reduce the unexpected death rate in this complex environment. The purpose of this review is to examine the history and scientific basis for threshold alarms and to compare thresholds with the actual pathophysiologic patterns of evolving death which must be timely detected.MethodsThe Pubmed database was searched for articles relating to methods for triggering rapid response teams and respiratory alarms and these were contrasted with the fundamental timed pathophysiologic patterns of death which evolve due to sepsis, congestive heart failure, pulmonary embolism, hypoventilation, narcotic overdose, and sleep apnea.ResultsIn contrast to the simplicity of the numeric threshold breach method of generating alerts, the actual patterns of evolving death are complex and do not share common features until near death. On hospital general floors, unexpected clinical instability leading to death often progresses along three distinct patterns which can be designated as Types I, II and III. Type I is a pattern comprised of hyperventilation compensated respiratory failure typical of congestive heart failure and sepsis. Here, early hyperventilation and respiratory alkalosis can conceal the onset of instability. Type II is the pattern of classic CO2 narcosis. Type III occurs only during sleep and is a pattern of ventilation and SPO2 cycling caused by instability of ventilation and/or upper airway control followed by precipitous and fatal oxygen desaturation if arousal failure is induced by narcotics and/or sedation.ConclusionThe traditional threshold breach method of detecting instability on hospital wards was not scientifically derived; explaining the failure of threshold based monitoring and rapid response team activation in randomized trials. Furthermore, the thresholds themselves are arbitrary and capricious. There are three common fundamental pathophysiologic patterns of unexpected hospital death. These patterns are too complex for early detection by any unifying numeric threshold. New methods and technologies which detect and identify the actual patterns of evolving death should be investigated.

show abstract

Section: Resultsmentioning

confidence: 99%

Patterns of unexpected in-hospital deaths: a root cause analysis

Lynn¹,

2011

View full text Add to dashboard Cite

show abstract

“…OSAS occurs because of pharyngeal narrowing due to soft tissue infiltration by mucopolyssacharides . In elderly adults with hypoventilatory respiratory failure, if no obvious pulmonary, cardiac, or central nervous system disease explains the clinical manifestations, hypothyroidism should be included as a differential diagnosis even in the absence of a history of thyroid disease . This man presented several falls, and a diagnosis of encephalopathy associated with Hashimoto's thyroiditis was made.…”

Section: Discussionmentioning

confidence: 98%

Type 2 Respiratory Failure and Falls in Elderly Adults: Beware of the Thyroid!

Vargas

Tibullo

Carifi

et al. 2014

J American Geriatrics Society

View full text Add to dashboard Cite

“…These respiratory abnormalities respond to thyroid hormone replacement, as observed in our case. Although hypoventilatory respiratory failure does not tend to be associated with endocrine diseases, hypothyroidism should be included as a differential diagnosis in elderly patients if no obvious cardiopulmonary or central nervous system disease explains the clinical presentation because myxedema coma occurs in elderly populations, especially those older than 60 years of age …”

Section: Discussionmentioning

confidence: 99%

Myxedema coma accompanied by sick sinus syndrome and hypoventilation: A case report

Harada

Murakami

Tokumasu

et al. 2019

J of Gen and Family Med

View full text Add to dashboard Cite

Myxedema coma is an emergency presentation of hypothyroidism, and cardiopulmonary manifestations of the disease are related to a high mortality rate. We herein report a case of myxedema coma accompanied by sick sinus syndrome requiring temporary cardiac pacing and hypercapnic respiratory failure in an 87‐year‐old woman. This case is unique because both of the cardiac and pulmonary manifestations were reversible and successfully treated with thyroid hormone replacement. Our case indicates that early detection of the condition and administration of levothyroxine are essential to improve the life‐threatening condition and avoid invasive treatment such as permanent pacemaker implantation or intubation.

show abstract

Early recognition of myxedematous respiratory failure in the elderly

Cited by 12 publications

References 15 publications

Patterns of unexpected in-hospital deaths: a root cause analysis

Patterns of unexpected in-hospital deaths: a root cause analysis

Type 2 Respiratory Failure and Falls in Elderly Adults: Beware of the Thyroid!

Myxedema coma accompanied by sick sinus syndrome and hypoventilation: A case report

Contact Info

Product

Resources

About