Hyperventilation Syndrome Research Articles

Hyperventilation: a practical guide

The term 'hyperventilation' is incorrectly applied by most physicians to a range of vague and imprecise clinical presentations. It is often used in cases of breathlessness when no clear respiratory disorder has been diagnosed, when the patient repeatedly reports complaints that do not fit any precise diagnostic category, and when there are abnormalities of respiratory pattern. Almost invariably, it is used to imply that there is an ill-defined underlying psychiatric cause for the symptoms. This is not necessarily correct. The precise physiological definition of hyperventilation is breathing in excess of metabolic requirements. It invariably implies arterial hypocapnia (reduced arterial partial pressure of carbon dioxide, PaCO 2), which can be documented by arterial or end-tidal measurements. Hyperventilation is a clinical finding and not a disease. It implies increased respiratory drive, which can have many causes and is thus no different from other abnormal biochemical measures for which the cause must be sought. The term ‘hyperventilation syndrome’ was first used to describe patients with a combination of organic and psychiatric symptoms, but has since been used in so many different contexts that it has no universally agreed meaning. In the author's opinion, it should not be used.

Artificial ventilation for basic life support leads to hyperventilation in first aid providers

The ‘Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care — International Consensus on Science’ recommend an artificial ventilation volume of 10 ml/kg bodyweight (equivalent to a tidal volume of 700–1000 ml) without the use of supplemental oxygen in adults with respiratory arrest. For first aid providers using the mouth-to-mouth or mouth-to-nose-ventilation technique, respectively, a ventilation volume of approximately 9.6 l/min results. Additionally, a deep breath is recommended before each ventilation to increase the end-expiratory oxygen concentration of the air exhaled by the first aid provider. To investigate the effects of these recommendations in healthy volunteers, test persons were asked to ventilate an artificial lung model for a period of up to 10 min. The tidal volume was set at 800 ml at a breathing rate of 12/min. End-tidal carbon dioxide, oxygen saturation (measured by pulse oximetry), and heart rate were measured continuously. Capillary blood gas samples were collected and non-invasive blood pressure readings were recorded prior to the start of ventilation and immediately after the end of the measuring period. The data reveal a statistically significant and clinically relevant decrease in end-tidal carbon dioxide pressure ( P<0.001, median decrease 14 mmHg), and the occurrence of hyperventilation-associated symptoms such as paraesthesia, dizziness, and carpopedal spasms in more than 75% of the participants. Clinically and statistically significant hyperventilation results in first aid providers performing artificial ventilation according to the guidelines. This artificial ventilation is associated with a significant decrease in capillary and end-tidal carbon dioxide pressure as well as with multiple symptoms of an acute hyperventilation syndrome. Ventilation performed according to these guidelines may cause injury to the health of the first aid provider. Rescuers ventilating the victim should be replaced at regular intervals and the recommendation to take a deep breath before each ventilation should not be upheld in order to minimise the risk of hyperventilation.

Subjective and neurological manifestations of hyperventilation states of different intensity

Detailed analysis of the subjective sensations of 135 healthy subjects during 20- to -30 min voluntary hyperventilation was performed. The hyperventilation levels (V EI = 20 l/min, V EII = 30 l/min, V EIII = 40 l/min) were chosen so that manifestations of paroxysms of hyperventilation syndrome (HVS) of different severity were simulated. Regular features in the time course of development of HVS symptoms were revealed: (1) specific peripheral subjective sensations and symptoms changed consistently, being peculiar sensory equivalents (correlates) of hyperventilation-related changes in gaseous metabolism and acid-base balance; (2) sensations and symptoms of central origin developed in waves, with considerable individual variations in manifestation and emotional hue and were closely correlated with changes in systemic hemodynamics and brain circulation disorders.

The association between febrile convulsion in children and chronic hyperventilation in parents

Background Febrile convulsion and chronic hyperventilation syndrome (spasmophilia) are suspected to share the same root of pathophysiology, a genetic trait abnormality related to ion channel that could cause neuronal hyperexcitability.Objective To determine the prevalence ratio of parents with chronic hyperventilation syndrome between two groups of children with and without febrile convulsion.Methods A cross-sectional design study was used, with a tertiary hospital setting (Kariadi Hospital). Participants were selected consecutively based on eligibility criteria. Febrile convulsion was diagnosed based on a modified Livingstone criteria. Chronic hyperventilation syndrome in parents was determined using the clinical diagnostic test of spasmophilia (88.4% sensitivity and 6 1.6% specificity). Statistical calculations were conducted with two by two table analysis and within the 95% confidence interval.Results Sixty-two children (mean age 18 months) who met the eligibility criteria were included. The parents' mean ages were 33 years (father) and 29 years (mother). The prevalence ratio of father, mother and both parents with chronic hyperventilation between the febrile convulsion group and the non-febrile convulsion group were 2.56 (95% CI 0.53 to 12.31), 6.19 (95% CI 1.70 to 22.6) and 18.7 (95% CI3.07 to 113.9), respectively.Conclusion Febrile convulsion can be anticipated in children of parents who suffer from chronic hyperventilation syndrome.

Functional symptoms confused with allergic disorders in children and adolescents.

The diagnosis of a functional respiratory disorder is sometimes difficult and time-consuming, because the symptoms often resemble those of organic diseases. The most common entities are hyperventilation syndrome, psychogenic cough, sighing dyspnea, and vocal cord dysfunction. Typical signs are heavy breathing or dyspnea, cough or sneezing, various breathing sounds, tightness of the throat or chest, pain, and fear. Criteria for differentiation include the lack of nocturnal symptoms, the sudden occurrence, no typical trigger factors, the variable duration, a quick regression, and that symptoms do not respond to adequate pharmacotherapy and finally normal results of diagnostic work-up. Therapeutic options comprise psychological intervention (by reassurance, relaxation techniques, and behaviour therapy) and physiotherapy (e.g. breathing therapy, voice training). Intensive efforts should be made to diagnose functional symptoms at an early stage because this will prevent stigmatization and fixation of symptoms and disease, and also prevent children from undergoing unnecessary and potentially harmful therapies.

Physiological mechanisms of respiratory phenomena in anxiety and depressive disorders

An analysis is presented of the current views on the functional respiratory disorders associated with depressive and panic disorders. The following subjects are discussed: the phenomenology of the problem, modern diagnostic methods, the role of hypocapnia in the symptomatological development of panic disorders, the relative contributions of psychogenic and biological factors in developing respiratory disorders, and the distinctions between dyspnea and the hyperventilation syndrome.

Breast biopsy for mammographically detected non-palpable lesions using a vacuum-assisted biopsy device (Mammotome) and an upright-type stereotactic mammography unit.

It is planned to start screening mammography throughout Japan in the near future. However, a minimally invasive biopsy procedure for mammographically detected non-palpable breast lesions is not available in almost all Japanese hospitals. It is crucial to develop a useful minimally invasive biopsy method which can be applied without difficulty. Eighty-nine biopsies for 88 mammographically detected non-palpable breast lesions, consisting of 70 lesions with microcalcifications alone, eight masses without calcifications and 10 with both masses and microcalcifications, were performed using the combination of a vacuum-assisted biopsy device (Mammotome) and an upright-type stereotactic mammography unit. Microcalcifications were confirmed radiographically in the tissue obtained from 78 biopsies among 81 biopsies for the lesions with microcalcifications (96.3%). All the lesions without calcifications were considered to be biopsied successfully. Five patients complained of nausea or fainted during the localization or biopsy procedure and an additional patient suffered from hyperventilation syndrome. Five cases experienced mild subcutaneous bleeding in the breasts. The biopsy technique using the combination of a vacuum-assisted biopsy device and an upright-type stereotactic mammography unit is a cost-effective, safe and very useful method for mammographically detected non-palpable breast lesions. It is expected to be a standard method of biopsy for such lesions in many developed countries other than the USA. However, it is important to make the patients relaxed during the biopsy to prevent mental strain.

Separation of systemic physiologic and specific cerebral drug effects in pharmacologic magnetic resonance imaging (phMRI)

Hyperventilation is considered an important factor in the production of a variety of somatic symptoms. This complex of symptoms is called the Hyperventilation Syndrome (HVS). Recognition of symptoms during the hyperventilation provocation test (HVPT) is a widely used criterion for diagnosing HVS. The validity of this criterion is tested in the present study.Twenty-three patients suspected of HVS performed a HVPT (hyperventilation during 3 min) and a mental load task (Stroop Color Word Test; CWT). It appeared that about the same number of patients (61%) recognized symptoms during the HVPT as during the CWT (52%), despite severe hypocapnia in the first test and normocapnia in the second. Reporting of symptoms was significantly related to psychological state and trait measures (SCL-90 and STAI scores) and unrelated to the degree of hypocapnia. These data have far reaching consequences, as they not only undermine the validity of the HVPT, but also question the tenability of the concept of HVS.

Diagnostic yield and development of a neurocardiovascular investigation unit for older adults in a district hospital.

Dizziness, syncope, and falls are common occurrences in elderly people. Neurocardiovascular investigation units aim to detect those patients who fall due to disturbances of blood pressure control or cardiac conduction. Specialist units have a high diagnostic yield in the investigation of these problems. Does this translate to less specialized centers? We report on the diagnostic findings of a district general hospital neurocardiovascular investigation unit. A total of 120 consecutive patients over the age of 65 presenting to a single geriatrician were assessed. After a full history and physical examination, patients underwent neurocardiovascular investigation: blood pressure and heart rate response to active stand, carotid sinus massage, and 30-minute head-up tilt. The 120 patients assessed had a mean age of 78 years (range 66-94 years); in this group, 85 were women. Of these patients, 23% presented with falls, 14% with blackouts, and 30% with dizziness. The remaining 33% had overlap of symptoms. Neurocardiovascular investigations produced a diagnosis in 57% of the patients: 22% had cardioinhibitory carotid sinus syndrome (CSS): 15% had vasodepressor CSS; 29% had orthostatic hypotension; and 3% had vasovagal syncope. Thirteen percent had more than one neurocardiovascular abnormality, and 18% had benign positional vertigo. Five patients had postural instability causing falls. Hyperventilation syndrome, aortic stenosis, dysrhythmia, cervical spondylosis, and epilepsy each accounted for one case. Seventeen percent of the subjects remained undiagnosed after integrated neurocardiovascular assessment. Management of falls requires access to neurocardiovascular assessment. It is feasible to provide such a service in the district general hospital setting, with a comparable diagnostic yield to tertiary referral centers.

Non-hodgkin’s lymphoma of the uterus and cns

We report a case of a non-Hodgkin’s lymphoma of the uterus and central nervous system in an 8-year-old female. The neurologic signs included blurred vision, neck stiffness, and walking difficulties but no abdominal problems. She deteriorated further, and repeated lumbar punctures revealed the presence of malignant cells in the cerebrospinal fluid. A repeated ultrasound scan of the abdomen demonstrated a markedly enlarged uterus. Biopsy revealed B-cell non-Hodgkin’s lymphoma. Treatment according to the Berlin-Frankfurt-Münster protocol was initiated, but she developed hyperventilation syndrome and required mechanical ventilation. Her condition improved after 1 week but then deteriorated again, and despite additional chemotherapy she developed myelosuppression and septicemia with multiresistant Klebsiella pneumoniae and eventually died 13 months after her first admission to the hospital. No clinical or laboratory signs of relapse were evident at the time of death.

Orthostatic increase of respiratory gas exchange in hyperventilation syndrome

BACKGROUNDHyperventilation syndrome (HVS) is a common disorder which is difficult to diagnose because of somatic symptoms and its episodic nature. In previous studies respiratory alkalosis in arterial blood was often...

Central hyperventilation related to administration of topiramate

Topiramate is a recently released antiepileptic agent used in the treatment of patients with refractory seizure disorders. In addition to its antiepileptogenic activities, it results in inhibition of carbonic anhydrase isoenzymes II and IV, which are present in the central nervous system. A 15-year-old female who presented with hyperpnea and primary respiratory alkalosis is reported. Other possible etiologies of the central hyperventilation syndrome were excluded. The problem resolved within 24 hours after discontinuing topiramate.

A Cooperative and Educational Approach to a Patient with Hyperventilation Syndrome and Conversion Disorder

A Cooperative and Educational Approach to a Patient with Hyperventilation Syndrome and Conversion Disorder

A Preliminary Study into the Effectiveness of Multi-Convergent Therapy in the Treatment of Heterogeneous Patients with Chronic Fatigue Syndrome

ABSTRACTIn this preliminary study twenty-eight heterogeneous Chronic Fatigue Syndrome (CFS) patients were treated with Multi-Convergent Therapy (MCT). This form of therapy has been used successfully for over ten years in the treatment of Irritable Bowel Syndrome, Tinnitus, Hyperventilation Syndrome, Chronic Pain and Anxiety Disorders. This small study was undertaken to assess whether MCT is effective in the treatment of CFS and to examine whether a more extensive investigation is warranted. Due to heterogeneity of symptoms, outcome measures were established on the basis of a shared decision-making process between patient and therapist. One patient dropped out of the study. All twenty-seven remaining patients achieved significant recoveries. Twelve patients recorded a mean improvement on baseline symptoms of 61%, eight patients who completed a Quality of Life questionnaire demonstrated a mean change from 2.4 to 6.3 (out of 10). Five patients reported a return to full normal function and two patients return...

Non-asthmatic respiratory symptomatology.

Because of the common nature of asthma and the attention this disease has been given in recent years, it is important to consider the possibility of other disorders that may present in a similar manner to asthma. Failure to consider alternative diagnoses often leads to inappropriate treatment with medications such as systemic corticosteroids that result in untoward morbidity. This review will discuss several diseases originating not only in the tracheobronchial tree but also in extrapulmonary sites, such as the gastrointestinal tract, that may be mistakenly diagnosed as asthma. Newly described entities such as irritant vocal cord dysfunction and exercise-induced hyperventilation syndrome are discussed in this article, as is new information pertaining to well-established diseases such as Churg-Strauss syndrome and sarcoidosis.

Subjective symptoms and breathing pattern at rest and following hyperventilation in anxiety and somatoform disorders

The purpose of the present study was to investigate the diagnostic specificity of bodily symptoms and respiratory behavior at rest and after a hyperventilation provocation test (HVPT) in patients that were either grouped according to the DSM classification or diagnosed as suffering from hyperventilation syndrome. Nine hundred three anxiety and somatoform patients, showing symptoms supposedly caused by psychogenic hyperventilation, and 170 healthy subjects, were studied. Breathing pattern and end-tidal CO 2 concentration were recorded during breathing at rest and following a HVPT. Subjective symptoms in daily life and after HVPT were measured. A principal-components analysis was performed on both the symptoms and breathing variables and their specificity levels were compared in the two classifications of patients. Some symptoms in daily life were grouped together with the same symptoms after the HVPT, other symptoms were not. This suggests that the HVPT elicited partly specific symptoms, and partly reproduced the symptoms experienced in daily life. Similar findings were observed with respect to the breathing variables. Patients with panic differed from other patients with anxiety disorders by an increased level of symptoms and a FETCO 2 decline at rest. The HVPT may be informative for diagnosis because it provokes some of the typical somatic and psychological symptoms, and it identifies the breathing instability that is characteristic of both patients with HVS and with anxiety. The same symptoms and breathing variables characterized the patients, whatever their classification. Overall, the specificity of breathing variables is rather low.

Developing case definitions for symptom-based conditions: the problem of specificity.

Symptom-based conditions are postulated organic diseases that are characterized primarily by chronic physical (somatic) symptoms (1, 2). Contemporary conditions associated with multisystem complaints are generally referred to as chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, siliconeassociated atypical rheumatic disease, sick building syndrome, and most recently, Gulf War syndrome (table 1). Possibly related disorders that will not be considered in the following analysis include epidemic neuromyasthenia, hyperventilation syndrome, reactive hypoglycemia, post-lyme disease syndrome, and irritable bowel syndrome (3). Although the need to consistently define symptombased conditions has been repeatedly emphasized, there has been limited progress in establishing widely accepted diagnostic criteria (1,4). Based on reports in English-language publications, symptom-based conditions were analyzed to determine why it has been difficult to develop case definitions of unique diseases.

5-39-10 Central hyperventilation syndrome secondary to brainstem glioma

5-39-10 Central hyperventilation syndrome secondary to brainstem glioma

Hypoxaemia in patients with hyperventilation syndrome.

We assessed 12 patients with hyperventilation syndrome (HVS) who had experienced hypoxaemia (PaO2 < 60 Torr or SaO2 < 90%) despite the lack of any other organic disease and variability in their blood gas data. Hypoxic and hypercapnic ventilatory responses were measured in nine. Eight of the 12 patients had been referred from other hospitals to our institution for hypoxaemia of unknown origin. Mean PaO2 (n = 12) at rest (non-attack stage) was 87.3 +/- 7.5 Torr (mean +/- SD). Their (n = 9) hypoxic (-0.53 +/- 0.32 l/min/%; range 0.12-0.99) and hypercapnic (2.01 +/- 0.76 l/min/Torr; range 0.69-3.17) ventilatory responses were both within the normal range in our laboratory. The patients with HVS had variable blood gas data, and some of them also exhibited hypercapnia (PaCO2 > 45 Torr). Clinicians who treat patients with HVS should be aware of the possibility of hypoxaemia, even when ventilatory responses are normal. Physicians should also consider HVS as a diagnosis when treating patients with hypoxaemia of unknown origin.

Hyperventilation effect on postural sway

Objective: To examine the effect of voluntary hyperventilation (HV) on postural sway. Design: Crossover controlled, experimental study. Setting: Human movement and balance clinical research unit. Subjects: Four different groups of normal subjects ( n = 6, 6, 7, and 9) and patients with bilateral absence of vestibular function ( n = 9). Intervention: Partial carbon dioxide pressure (tc-P co 2) was measured transcutaneously with surface electrodes. Body sway was measured with a force platform immediately after maximal voluntary HV for 30 to 90 seconds. Recordings were obtained with eyes open and eyes closed, standing on the platform and on foam-rubber, and after head or body movements. Main Outcome Measure: Postural sway. Results: HV increased body sway in all conditions, but the effects were more intense when subjects were standing directly on the platform surface with their eyes closed. Recordings after HV of 30, 60, and 90sec in normal subjects showed that although CO 2 levels were inversely related to the duration of HV, body sway did not increase further. HV also increased sway after active movements by the subjects. The main sway increase was in sway area and mean and maximal deviations but less for mean sway velocity. HV preferentially increased low-frequency sway oscillations. These effects were also present in labyrinthine-defective subjects. Conclusions: HV increases body sway, but the relationship between CO 2 levels and degree of unsteadiness is not linear. The dizziness reported by patients with HV syndrome may be partly caused by objective unsteadiness. The presence of HV-induced unsteadiness in patients with absent vestibular function indicates that the effects of HV are not mediated by the labyrinth.