Respiratory Stimulation with Intravenous Doxapram in Respiratory Failure

Moser, Kenneth Μ.; Luchsinger, Peter C.; Adamson, James S.; McMahon, Samuel M.; Schlueter, Donald P.; Spivack, Martin L.; Weg, John G.

doi:10.1056/nejm197303012880901

Cited by 76 publications

(16 citation statements)

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“…These side effects have been said to be short lived because of the short half-life of doxapram in the plasma. However, more serious and troublesome side effects may occasionally occur and one patient has been reported as having a frank psychosis with hallucinations during doxapram infusion (6). Of twenty patients treated here with doxapram infusion the following four developed severe and violent restlessness, confusion or hallucinations at low doses.…”

Section: Introductionmentioning

confidence: 89%

“…It has been used for stimulating respiration and producing arousal in the immediate post-operative period, to hasten recovery, and to prevent pulmonary complications by simulating a sigh (2,3), to permit adequate oxygenation in acute respiratory failure in chronic bronchitis (4)(5)(6)(7) and in the treatment of barbiturate overdosage (8).…”

Section: Introductionmentioning

confidence: 99%

“…Previous reports have stressed the safety and absence of serious side effects of the drug; perineal warmth (5,6,9), tremor (3,9), nausea, light headedness (9), sweating, headache, twitching, restlessness (6) and confusion (4) have been described. These side effects have been said to be short lived because of the short half-life of doxapram in the plasma.…”

Section: Introductionmentioning

confidence: 99%

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Side effects of doxapram infusion

Baxter

1976

Europ. J. Intensive Care Med

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Side effects of doxapram infusion

Baxter

1976

Europ. J. Intensive Care Med

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“…For the individual patient at this stage, however, their disease progression and further damage from the exacerbation (with or without smoking) will lead them to more frequent admissions and episodes of HRF in the future 5. Each admission carries the risk of death, which before the advent of NIPPV and the use of central nervous system stimulants such as doxapram, carried a very high mortality in the first 48 hours 6. Since NIPPV, the mortality is much lower acutely and lives are saved, but readmissions of the same patients can become more and more frequent, with high hospital bed use 7,8…”

Section: Introductionmentioning

confidence: 99%

The successful treatment of hypercapnic respiratory failure with oral modafinil

Parnell¹,

Quirke²,

Farmer³

et al. 2014

COPD

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Hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease and is usually treated by nasal ventilation. Not all patients requiring such ventilation can tolerate it, with anxiety and phobia influencing their reaction, along with treatment failure. We report the case histories of six patients with hypercapnic respiratory failure who were at risk of death due to refusal of nasal ventilation or its failure despite ongoing treatment. We report their improvement with oral modafinil 200 mg tablets used as a respiratory stimulant, which led to discharge, improved arterial blood gases, and offset further admissions with hypercapnic respiratory failure. This drug is licensed for narcolepsy and is said to stimulate the respiratory system via the central nervous system. Its use in respiratory failure is an unlicensed indication, and there are no case reports or studies of such use in the literature. Its respiratory stimulant effects appear better than those with protriptyline, which was a drug previously used until its production was discontinued. Our findings suggest that a study of modafinil in hypercapnic respiratory failure would be warranted, especially for patients with treatment failure or intolerance to nasal ventilation. This may offer a way of shortening hospital stay, improving outcome and quality of life, and reducing death and readmissions.

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“…The prospective study was not designed to test the hypothesis that only patients with [H + ] >55 nmol/l should receive respiratory support, and noted, firstly, that clinical judgement led to doxapram being given at lower levels of [H + ] in 10 of 37 episodes in which it was used and secondly that, on retrospective analysis, [H + ] >53 nmol/l (pH <7.28) was a better predictor of mortality 2. The only placebo controlled trial of doxapram for respiratory failure in COPD demonstrated improvement in blood gas parameters in patients with a mean arterial [H + ] of 46 nmol/l (pH 7.34),4 and recent controlled trials of non-invasive ventilation have also shown benefit in subject groups with a mean [H + ] below 55 nmol/l 56 There is a risk that strict application of the BTS guidelines may result in treatment being delayed or withheld from patients with respiratory failure and worsening acidosis on controlled oxygen therapy whose [H + ] has not risen to 55 nmol/l, when there is no definitive evidence that such patients cannot benefit from doxapram or ventilatory support.…”

mentioning

confidence: 99%

COPD guidelines

Whittle

PEARSON²

1999

Thorax

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The case history is described of a young woman who presented with primary pulmonary hypertension and non-specific inflammatory signs. The patient received prolonged immunosuppressive treatment with low dose methotrexate and prednisone without any vasodilator agent. After one year the pulmonary artery pressure fell from a mean value of 47 mm Hg to 30 mm Hg and there was a corresponding clinical response. This case suggests that, in patients with pulmonary hypertension of unknown origin, immunopathogenetic factors should be sought in order to consider the utility of immunosuppressive therapy. (Thorax 1999;54:372-374) Keywords: pulmonary hypertension; methotrexate; transforming growth factor Primary pulmonary hypertension (PPH) is a rare disease of unknown origin that should be suspected in any young patient who presents with unexplained eVort dyspnoea and electrocardiographic signs of right ventricular hypertrophy in the apparent absence of any underlying cause.1 Pulmonary hypertension clinically and histologically similar to PPH has been described in association with connective tissue diseases and other immunological disorders, also in the absence of any parenchymal lung involvement.2 Primary forms usually show a rapidly progressive course despite treatment, with a mean survival of 2.5 years. 3We describe a patient with PPH who, after treatment with immunosuppressive therapy, showed a clinical improvement. Case reportA 25 year old woman was admitted in December 1994 because of the recent onset (less than six months) of rest dyspnoea (NYHA class III), cough, cyanosis, hypotension (80/60 mm Hg), tachycardia (120-130 bpm), and congestive heart failure. She had a five year history of recurrent mild temperature elevation, asthenia, myalgia, arthralgia, transient diVuse lymphoadenomegaly, neutrophil leukocytosis, and persistent elevation of acute phase reactants, despite anti-inflammatory therapy. Tests for antinuclear (ANA and ENA) and antiphospholipid antibodies, rheumatoid factor, ANCA and other autoantibodies, HIV and other infectious agents were always negative. The patient had never been pregnant nor used appetite suppressants or any other drug potentially able to induce pulmonary hypertension. 1There were no signs suggestive of connective tissue disease.Laboratory tests gave the following results: erythrocyte sedimentation rate, 29 mm/h; fibrinogen, 5.32 g/l (normal 2.0-4.0 g/l); antithrombin III 1.42 IU/ml (normal 0.8-1.2); positive indirect antiglobulin test; serum IgE, 1.817 kU/l (normal <200) with negative RAST; serum IgG, 19.30 g/l (normal 8.0-15.0 g/l); serum IgA, 0.32 g/l (normal 1.00-4.90 g/l); ferritin, 1808 ng/l (normal 4-233 ng/l); positivity for HLA-DR4 antigen; moderate increase in peripheral blood CD8+ lymphocytes. Other routine tests were negative or normal.Lung scans with 99m-technetium labelled albumin macroaggregates and 133-xenon gas and deep vein Doppler ultrasonography of the lower extremities were normal. The electrocardiogram, which had been normal six months earlier, showed sig...

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Respiratory Stimulation with Intravenous Doxapram in Respiratory Failure

Cited by 76 publications

References 12 publications

Side effects of doxapram infusion

Side effects of doxapram infusion

The successful treatment of hypercapnic respiratory failure with oral modafinil

COPD guidelines

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