eMedicine Specialties > Pulmonology > Sleep-Related Disorders

Hypoventilation Syndromes: Follow-up

Author: Jazeela Fayyaz, DO, Senior Fellow, Department of Pulmonology, Lenox Hill Hospital
Coauthor(s): Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Contributor Information and Disclosures

Updated: Sep 18, 2009

Follow-up

Further Inpatient Care

  • Intensive care unit admission
    • If hypoventilation is severe and leads to respiratory failure, admission to an ICU may be required.
    • ICU admission allows for more specialized nursing and respiratory care.
    • Criteria for admission to the ICU are confusion, lethargy, respiratory muscle fatigue, worsening hypoxemia, hypercapnia, and respiratory acidosis with a pH of less than 7.3.
    • All patients requiring immediate tracheal intubation and mechanical ventilation also require ICU admission.
    • Most acute care facilities require that all patients being treated with noninvasive ventilation also be admitted to the ICU.

Further Outpatient Care

  • Home oxygen therapy
    • In the outpatient setting, continue oxygen therapy in patients who meet the specific criteria for long-term oxygen therapy.
    • The specific criteria for long-term oxygen therapy include a PaO2 less than 55 mm Hg, a PaO2 less than 59 mm Hg with evidence of polycythemia, or cor pulmonale.
    • Re-evaluate patients in 1-3 months after initiating therapy because some patients may improve and may not require long-term oxygen.
    • Again, use oxygen therapy with caution in patients with alveolar hypoventilation because some of these patients may experience worsening of hypercapnia.
  • Noninvasive ventilation
    • Noninvasive mechanical ventilation can be continued in the outpatient setting.
    • Bilevel positive-pressure ventilation can be used long-term to treat patients with hypoventilation syndromes.
    • Furthermore, patients with hypoventilation syndromes improve with nocturnal noninvasive mechanical ventilation only. Clinical studies have shown improvements in hypercapnia and hypoxia after treatment with nocturnal noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD) with associated hypoventilation, neuromuscular disorders, obesity hypoventilation syndrome, and kyphoscoliosis.

Deterrence/Prevention

  • Alcohol and many illicit substances are known respiratory depressants. Their use in patients with hypoventilation syndromes may lead to coma and death.21

Prognosis

  • The prognosis of patients with hypoventilation syndromes is variable and dependent on the underlying cause of hypoventilation and the severity of the underlying illness.

Miscellaneous

Medicolegal Pitfalls

  • Failure to correctly diagnose the cause of hypoventilation is a concern. Patients with hypoventilation should be thoroughly evaluated for an etiology. Many of the potential causes of hypoventilation are treatable. Efforts should be made to determine a diagnosis early in the course of the illness in order to facilitate prompt treatment and prevention of potential morbidity and mortality.
  • A diagnosis of lung disease should not be assumed because other organ system dysfunction may be the primary cause of hypoventilation.
  • Central and peripheral neurologic disorders and muscular disorders should be considered.
  • The effects of sedating drugs such as narcotics and benzodiazepines in causing or worsening hypoventilation should always be considered. In patients without an obvious source of hypoventilation, a drug screen should be performed.
  • Efforts should be taken to use oxygen therapy cautiously in patients with COPD and hypoventilation because higher fractions of inspired oxygen can worsen hypoventilation.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jackie A. Hayes, MD, FCCP, and Sat Sharma, MD, FRCPC, FACP, FCCP, DABSM, to the development and writing of this article.



More on Hypoventilation Syndromes

Overview: Hypoventilation Syndromes
Differential Diagnoses & Workup: Hypoventilation Syndromes
Treatment & Medication: Hypoventilation Syndromes
Follow-up: Hypoventilation Syndromes
References
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Further Reading

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Keywords

hypoventilation syndrome, primary alveolar hypoventilation, alveolar ventilation, VA, obesity hypoventilation syndrome, OHS, chronic obstructive pulmonary disease with hypercapnia, hypercapnia, chronic obstructive pulmonary disease, COPD, chronic lung disease, hypoxemia, hypoxia, respiratory system, respiratory failure, obstructive sleep apnea, sleep apnea, OSA, chest wall deformities, respiratory insufficiency, myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barre syndrome, Guillain-Barré syndrome, muscular dystrophy, kyphoscoliosis, dyspnea, central respiratory drive depression, pickwickian syndrome

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Contributor Information and Disclosures

Author

Jazeela Fayyaz, DO, Senior Fellow, Department of Pulmonology, Lenox Hill Hospital
Jazeela Fayyaz, DO is a member of the following medical societies: American College of Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: sepracor Ownership interest None

Medical Editor

Ryland P Byrd Jr, MD, Professor, Department of Internal Medicine, Division of Pulmonary Medicine and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University; Chief of Pulmonary Medicine, Medical Director of Respiratory Therapy, Intensive Care Unit, Program Director of Pulmonary Diseases and Critical Care Medicine Fellowship, James H Quillen Veterans Affairs Medical Center
Ryland P Byrd Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H, Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine
Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine
Disclosure: Keck School of Medicine, USC None None

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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