Central respiratory failure during acute organophosphate poisoning
Name:
Publisher version
Document Type
Journal ArticlePublication Date
2013-11-01Keywords
Acute DiseaseAnimals
Humans
Nerve Net
Organophosphate Poisoning
Organophosphorus Compounds
Respiratory Center
Respiratory Insufficiency
Circulatory and Respiratory Physiology
Emergency MedicineMedical PhysiologyMedical ToxicologyNeurologyRespiratory SystemRespiratory Tract DiseasesToxicology
Metadata
Show full item recordAbstract
Organophosphate (OP) pesticide poisoning is a global health problem with over 250,000 deaths per year. OPs affect neuronal signaling through acetylcholine (Ach) neurotransmission via inhibition of acetylcholinesterase (AChE), leading to accumulation of Ach at the synaptic cleft and excessive stimulation at post-synaptic receptors. Mortality due to OP agents is attributed to respiratory dysfunction, including central apnea. Cholinergic circuits are integral to many aspects of the central control of respiration, however it is unclear which mechanisms predominate during acute OP intoxication. A more complete understanding of the cholinergic aspects of both respiratory control as well as neural modification of pulmonary function is needed to better understand OP-induced respiratory dysfunction. In this article, we review the physiologic mechanisms of acute OP exposure in the context of the known cholinergic contributions to the central control of respiration. We also discuss the potential central cholinergic contributions to the known peripheral physiologic effects of OP intoxication.Source
Respir Physiol Neurobiol. 2013 Nov 1;189(2):403-10. doi: 10.1016/j.resp.2013.07.022. Epub 2013 Aug 7. Link to article on publisher's siteDOI
10.1016/j.resp.2013.07.022Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30259PubMed ID
23933009Related Resources
Link to Article in PubMedScopus Count
Related items
Showing items related by title, author, creator and subject.
-
The clinical approach to lung disease in patients with cystic fibrosisThere is strong evidence that early, aggressive therapy of lung disease leads to improved quality and quantity of life for patients with cystic fibrosis (CF). The treatment of pulmonary disease associated with CF is multifactorial, encompassing prophylaxis, aggressive treatment of infection, use of antiinflammatory agents, and treatment of severe complications. Chest physiotherapy on a regular basis, perhaps using new modalities that allow patient autonomy, is also crucial. This review covers the pathogenesis of CF lung disease and current approaches to therapy, highlighting guidelines recently published by the Cystic Fibrosis Foundation. Clinicians caring for patients with CF should maximize current therapies with the goal of preserving lung function until the time a more definitive curative or controller medication is developed. Empowering patients in the process of providing their own care is a key to achieving this goal.
-
Evaluation of Noninvasive Respiratory Volume Monitoring in the PACU of a Low Resource Kenyan HospitalThis research aims to evaluate the use of the noninvasive respiratory volume monitor (RVM) compared to the standard of care (SOC) in the Post-Anesthesia Care Unit (PACU) of Kijabe Hospital, Kenya. The RVM provides real-time measurements for quantitative monitoring of non-intubated patients. Our evaluation was focused on the incidence of postoperative opioid-induced respiratory depression (OIRD). The RVM cohort (N = 50) received quantitative OIRD assessment via the RVM, which included respiratory rate, minute ventilation, and tidal volume. The SOC cohort (N = 46) received qualitative OIRD assessment via patient monitoring with oxygenation measurements (SpO2) and physical examination. All diagnosed cases of OIRD were in the RVM cohort (9/50). In the RVM cohort, participants stayed longer in the PACU and required more frequent airway maneuvers and supplemental oxygen, compared to SOC (all p < 0.05). The SOC cohort may have had fewer diagnoses of OIRD due to the challenging task of distinguishing hypoventilation versus OIRD in the absence of quantitative data. To account for the higher OIRD risk with general anesthesia (GA), a subgroup analysis was performed for only participants who underwent GA, which showed similar results. The use of RVM for respiratory monitoring of OIRD may allow for more proactive care.
-
Management of a Patient with an Encapsulated Parapneumonic Empyema Complicated by the Intraoperative Development of an Acute Bronchopleural Fistula and ARDSWe report the use of independent lung ventilation (ILV) in a patient with severe underlying parenchymal disease who developed bronchopleural fistula (BPF) after thoracotomy and decortication of an empyema with subsequent development of acute respiratory distress syndrome (ARDS). While a great majority of patients with either ARDS or BPF can be successfully managed with conventional ventilation strategies, the additional management challenges presented by BPF in the setting of ARDS and sepsis often necessitate the utilization of alternative ventilation strategies such as ILV, high frequency ventilation (HFV), and extracorporeal support.
