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Case Report ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00937

Refractory Central Neurogenic Hyperventilation: A novel approach utilizing mechanical dead space

 Alexander Sweidan1,  Matthew M. Bower2*, Jeffrey R. Paullus2, Sara Stern-Nezer2,  Cyrus K. Dastur2,  Wengui Yu2 and  Leonid I. Groysman2
  • 1Campus Bio-Medico University, Italy
  • 2UCI Health, United States

This report describes the successful management of a case of central neurogenic hyperventilation (CNH) refractory to high dose sedation by increasing mechanical dead space. A 46-year-old male presented with a history of multiple neurological symptoms. Following an extensive evaluation, he was diagnosed with primary diffuse CNS lymphoma and started on high dose steroids. After an initial symptomatic improvement, the patient developed increasing respiratory distress and tachypnea. He was intubated and transferred to the neurointensive care unit (neuro ICU). While in the ICU the patient continued to be ventilator dependent with significant tachypnea and respiratory alkalosis resistant to fentanyl and propofol. This prompted an attempt to normalize the PaCO2 via an increase of the mechanical dead space. This approach successfully increased PaCO2 and bridged the patient until ongoing therapy for the underlying disease resolved the pervasive breathing pattern typical of CNH. Further investigation is warranted to evaluate this strategy, which upon review of the literature appears underused.

Keywords: Central neurogenic hyperventilation, neurocritical care, Critical Care, Ventilator management, Lymphoma, neuro-oncolgy, neurocritical care management

Received: 15 Mar 2019; Accepted: 12 Aug 2019.

Copyright: © 2019 Sweidan, Bower, Paullus, Stern-Nezer, Dastur, Yu and Groysman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Matthew M. Bower, UCI Health, Irvine, 92868, California, United States, bowerm1@uci.edu