[Disturbed respiratory cycle accompanying hypoxic-ischemic encephalopathy].
We report the case of a 2-year-old boy who experienced total asphyxia at 4 months of age, and suffered abnormalities at specific phases of the respiratory cycle. The patient was bedridden due to severe tetraplegia and showed little response to external stimuli. He has been tube-fed since the initial asphyxia and a tracheotomy was performed after recurrent hypoxic episodes as a result of the respiratory dysfunction. Upon examination, his respiratory pattern was characterized by arrest during the inspiratory phase with a possible over-riding secondary inspiration. The respiratory pause at the inspiratory phase was markedly prolonged during an episode of pulmonary infection, resulting in recurrent cyanosis that necessitated artificial ventilation. The "second" inspiration typically occurred during the mid- or late-inspiratory phases, with this pattern often shown to be variable after epileptic seizures. The characteristic breathing of this patient suggested that difficulty in forming a normal respiratory cycle, other than during periods of hypoventilation or apnoea, could be a significant respiratory dysfunction following asphyxiation. Strategies for the management of such patients should be carefully designed after close observation of breathing patterns within the respiratory cycle, and with consideration for the influence of epileptic seizures and other inputs from somatic afferents.
Saito
Yoshiaki
Y
Department of Pediatrics and Pediatric Neurology, Yokohama Ryoiku Medical Center, Yokohama, Kanagawa. saitoyo@fb3.so-net.ne.jp
Masuko
Kaori
K
Kaneko
Kaori
K
Saito
Kazuyo
K
Chikumaru
Yuri
Y
Iwamoto
Hiroko
H
Matsui
Akira
A
Kimura
Seiji
S
D001921:Brain / Q000473:pathology; D002675:Child, Preschool; D004569:Electroencephalography; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D012119:Respiration; D012120:Respiration Disorders / Q000503:physiopathology*