Disorders of ventilatory control
- Douglas C Johnson, MD
Douglas C Johnson, MD
- Associate Professor, Department of Medicine
- Tufts University School of Medicine
- Section Editor
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Deputy Editors
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
- April F Eichler, MD, MPH
April F Eichler, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Neurology and Sleep Medicine
- Assistant Professor of Neurology
- Harvard Medical School
The respiratory system is dependent upon a complex system of ventilatory control to ensure appropriate and adequate ventilation in order to supply oxygen, remove carbon dioxide, and maintain acid-base homeostasis. Respiratory centers in the brain integrate input from neural and chemical receptors and provide neuronal drive to the respiratory muscles, which maintain upper airway patency and drive the thoracic bellows to determine the level of ventilation.
The abnormalities of ventilatory control that result from a variety of disorders, including chronic obstructive pulmonary disease (COPD), asthma, Ondine's curse, carotid body resection, Cheyne-Stokes respiration, myxedema, starvation, and neuromuscular disease, will be reviewed here. In addition, the effects of several pharmacologic agents on ventilation and ventilatory control will be reviewed. The physiologic aspects of ventilatory control and the evaluation of patients with disorders of ventilation are discussed separately. (See "Control of ventilation".)
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Development of hypercapnia in patients with chronic obstructive pulmonary disease (COPD) generally is associated with more severe disease, but is inconsistent among patients with similar degrees of airflow obstruction. Thus, patients with similar spirometric values can exhibit the "blue bloater" profile of hypercapnia (CO2 retention, with an elevated arterial carbon dioxide tension [PaCO2]) and hypoxemia or the "pink puffer" profile with eucapnia and relatively normal oxygen levels [1,2]. Those in the first group have reduced respiratory drive whereas the latter have increased drive.
The pattern of breathing in patients with chronic CO2 retention is characterized by a low tidal volume and high frequency, usually ≥22 breaths/minute. This respiratory pattern in combination with impaired matching of ventilation and perfusion leads to increased dead space ventilation and diminished alveolar ventilation, which contributes to CO2 retention .
Some hypercapnic, hypoxemic patients with COPD develop increased CO2 retention when O2 is administered. Such patients usually have both blunted hypercapnic and hypoxic drives . Other factors contributing to CO2 retention during O2 breathing include worsening of ventilation-perfusion distribution secondary to relief of compensatory pulmonary vasoconstriction , and unloading of CO2 due to the Haldane effect . (See "The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure".)
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- CHRONIC OBSTRUCTIVE PULMONARY DISEASE
- ONDINE'S CURSE
- Congenital central hypoventilation syndrome
- Late-onset central hypoventilation syndrome
- Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD)
- CAROTID BODY RESECTION
- CHEYNE-STOKES RESPIRATION
- NEUROMUSCULAR DISEASE
- DRUGS AFFECTING VENTILATORY DRIVE
- Central nervous system depressants
- SUMMARY AND RECOMMENDATIONS