Real-time dynamic carbon dioxide administration: a novel treatment strategy for stabilization of periodic breathing with potential application to central sleep apnea.

Abstract

OBJECTIVES:

This study targeted carbon dioxide (CO(2)) oscillations seen in oscillatory ventilation with dynamic pre-emptive CO(2) administration.

BACKGROUND:

Oscillations in end-tidal CO(2) (et-CO(2)) drive the ventilatory oscillations of periodic breathing (PB) and central sleep apnea in heart failure (HF).

METHODS:

Seven healthy volunteers simulated PB, while undergoing dynamic CO(2) administration delivered by an automated algorithm at different concentrations and phases within the PB cycle. The algorithm was then tested in 7 patients with HF and PB.

RESULTS:

In voluntary PB, the greatest reduction (74%, p < 0.0001) in et-CO(2) oscillations was achieved when dynamic CO(2) was delivered at hyperventilation; when delivered at the opposite phase, the amplitude of et-CO(2) oscillations increased (35%, p = 0.001). In HF patients, oscillations in et-CO(2) were reduced by 43% and ventilatory oscillations by 68% (both p < 0.05). During dynamic CO(2) administration, mean et-CO(2) and ventilation levels remained unchanged. Static CO(2) (2%, constant flow) administration also attenuated spontaneous PB in HF patients (p = 0.02) but increased mean et-CO(2) (p = 0.03) and ventilation (by 45%, p = 0.03).

CONCLUSIONS:

Dynamic CO(2) administration, delivered at an appropriate time during PB, can almost eliminate oscillations in et-CO(2) and ventilation. This dynamic approach might be developed to treat central sleep apnea, as well as minimizing undesirable increases in et-CO(2) and ventilation.

• Authors: Alberto Giannoni, Resham Baruah, Keith Willson, Yoseph Mebrate, Jamil Mayet, Michele Emdin, Alun D Hughes, Charlotte H Manisty, Darrel P Francis
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 56 Issue 22 Pg. 1832-7 (Nov 23 2010) ISSN: 1558-3597 [Electronic] United States
• PMID: 21087712 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Carbon Dioxide

Topics

• Adult
• Aged
• Carbon Dioxide (administration & dosage)
• Female
• Heart Failure (complications)
• Humans
• Male
• Respiratory Rate
• Sleep Apnea, Central (etiology, therapy)