Respiratory pattern disturbances in ischemic cerebral vascular disease.

Abstract

Impedance pneumography was used to monitor respiratory rates and patterns in 49 patients with acute ischemic cerebral vascular disease. Nine patients had clinical evidence of bilateral ischemic cerebral disease. In one of these, normal respiratory pattern was present at all times; in five, there was intermittent Cheyne-Stokes respiration; in two, there were variants of Cheyne-Stokes pattern, and one patient eventually developed sustained tachypnea with probable hyperpnea. Twenty-eight patients had unilateral cerebral infarct. In five of these, normal respiratory pattern was present at all times; in 15, there was intermittent Cheyne-Stokes respiration; six had a variant of Cheyne-Stokes respiration; two had sustained tachypnea with probable hyperpnea. In 12 patients with brainstem infarcts, Cheyne-Stokes respiration was intermittently present in four, Cheyne-Stokes variant patterns were observed in two, and sustained tachypnea with probable hyperpnea developed in six. Abnormalities of respiratory patterns occurred more frequently during sleep, in the presence of a depressed sensorium, and in patients with severe neurological deficits. Respiratory alkalosis of variable degree was present in all patients with Cheyne-Stokes respiration or sustained tachypnea with probable hyperpnea. Cheyne-Stokes respiration was not always related to bilateral cerebral lesions. Intermittent Cheyne-Stokes respiration was not closely related to immediate prognosis. Sustained tachypnea with respiratory alkalosis was associated with the highest mortality rate among patients with respiratory pattern abnormalities.