Choreoathetosis
Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin in Brain Injury and Pediatric Cardiac Surgery, 2019
The perioperative manifestations of neurologic injury in children with congenital heart disease may appear as seizures, delayed recovery of consciousness, focal infarcts, or movement disorders such as choreoathetosis. In contrast, the development of severe choreoathetosis in older children, carries a significantly worse prognosis. Pre-1985 patients were maintained at a significantly less alkalotic pH with less hypocarbia than either the persistent or comparison patients, and none of them developed choreoathetosis following deep hypothermic circulatory arrest. The incidence of choreoathetosis has been estimated between 1% and 12%. The concept of two different degrees of choreoathetosis, mild and severe, has been alluded to by several authors. Choreoathetosis continues to be reported regularly with no universally accepted single etiology. The electroencephalogram and Computed x-ray tomography scan were largely unhelpful. The electroencephalogram generally showed diffuse slowing.
Acute hypoxia and hyperventilation
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
Hypoxia is an insufficient supply of oxygen reaching the tissues. Acute hypoxia refers to effects experienced over a few seconds to a few hours; chronic effects of hypoxia predominate over days to weeks. There are four main forms of hypoxia: hypoxic, anaemic, ischaemic and histotoxic. In the aviation environment, main cause of acute hypoxia is insufficient alveolar oxygen as a result of reduced atmospheric pressure – Hypoxic hypoxia. Multiple types of hypoxia can coexist. Alveolar gas equation is used to calculate alveolar oxygen content. Alveolar water vapour pressure remains constant with ascent to altitude, and so becomes increasingly important component of alveolar content. Hypoxic ventilatory response is a reflex which increases ventilatory drive in an attempt to maintain oxygen levels. Hyperventilation is defined as breathing in excess of metabolic needs, eliminating more carbon dioxide than is produced, to produce hypocapnia.
Pulmonology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Appearance suggestive of blood gas disturbance: 1 Hypoxic: blue hands and tongue, i.e. central cyanosis, restless, confused, drowsy or unconscious. 2 CO 2 retention: warm hands, bounding pulse, dilated veins on hands and face, twitching of facial muscles, drowsy. 3 Hypocapnia: hyperventilation, paraesthesia around lips, dizzy.
Association between hypocapnia and ventilation during the first days of life and brain injury in asphyxiated newborns treated with hypothermia
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2019
Maria Agustina Lopez Laporte, Hui Wang, Priscille-Nice Sanon, Stephanie Barbosa Vargas, Julie Maluorni, Emmanouil Rampakakis, Pia Wintermark
Purpose: Therapeutic hypothermia is the standard treatment for asphyxiated newborns. Since hypocapnia is common in these newborns, the aim of this study was to assess the association among hypocapnia, ventilation, and brain injury. Methods: We conducted a retrospective cohort study of all asphyxiated newborns treated with hypothermia from 2008 to 2014. Partial pressure of carbon dioxide (pCO2), ventilatory status, and modes of ventilation were recorded during the first 4 days of life. Brain injury was evaluated using brain magnetic resonance imaging. Differences between intubated and nonintubated newborns and between the newborns who developed brain injury or not were assessed. Results: One hundred ninety-eight asphyxiated newborns were treated with hypothermia. During the first 2 days of life, intubated newborns had consistently lower pCO2 levels (respectively, 29.01 ± 8.55, p
High blood carbon dioxide variability and adverse outcomes in neonatal hypoxic ischemic encephalopathy
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2016
Gregory Hansen, Nasser Al Shafouri, Michael Narvey, Jeff K. Vallance, Ganesh Srinivasan
Objective: Hypocarbia during the first 12 h of life is associated with mortality and disability in neonatal hypoxic ischemic encephalopathy (HIE). Notable variation in arterial carbon dioxide tension (PaCO2) during the first 4 d of life is related to severe intraventricular hemorrhages in preterm infants. We examined the association between PaCO2 during 72 h of whole-body therapeutic hypothermia for neonatal HIE and 2-year neurodevelopmental outcomes. Methods: A retrospective review of 23 term neonates treated with whole-body hypothermia documented clinical, demographic and arterial blood gas data. Comparisons were made across good and severe neurodevelopmental outcome groups at 2 years of age. Results: Severe neurodevelopmental outcomes were documented in 8 of 23 toddlers. There were no significant differences between outcome groups with regard to the number of patients with hypocarbic means or measurements. There were also no significant differences with mean PaCO2, PaO2, pH, time-weighted cumulative hypocarbia, and PaCO2 range. The severe neurodevelopmental outcomes group had a significantly higher mean PaCO2 standard deviation (p = 0.04; 95% CI, −5.46 to −0.39). Conclusion: Severe neurodevelopmental outcomes were significantly associated with high PaCO2 variability over 72 h in whole-body-cooled HIE neonates. Mitigating these fluctuations may be a potential management strategy.
Characteristics of hyperthermia-induced hyperventilation in humans
Published in Temperature, 2016
Bun Tsuji, Keiji Hayashi, Narihiko Kondo, Takeshi Nishiyasu
In humans, hyperthermia leads to activation of a set of thermoregulatory responses that includes cutaneous vasodilation and sweating. Hyperthermia also increases ventilation in humans, as is observed in panting dogs, but the physiological significance and characteristics of the hyperventilatory response in humans remain unclear. The relative contribution of respiratory heat loss to total heat loss in a hot environment in humans is small, and this hyperventilation causes a concomitant reduction in arterial CO2 pressure (hypocapnia), which can cause cerebral hypoperfusion. Consequently, hyperventilation in humans may not contribute to the maintenance of physiological homeostasis (i.e., thermoregulation). To gain some insight into the physiological significance of hyperthermia-induced hyperventilation in humans, in this review, we discuss 1) the mechanisms underlying hyperthermia-induced hyperventilation, 2) the factors modulating this response, and 3) the physiological consequences of the response.
Related Knowledge Centers
- Alkalosis
- Cerebral Hypoxia
- Blood
- Hypercapnia
- Hyperventilation
- Vasoconstriction
- Respiratory Signs & Symptoms