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Patrones respiratorios oscilatorios durante la vigilia en pacientes con insuficiencia cardíaca crónica: implicaciones
P Ponikowski1, S D Anker, T P Chua
1Cardiac Medicine, Imperial College, National Heart & Lung Institute, London, UK.
Circulation
|December 14, 1999
Resumen
Los patrones de respiración oscilatoria como la respiración de Cheyne-Stokes (CSR) y la respiración periódica (PB) son comunes en la insuficiencia cardíaca crónica (CHF). Estos patrones indican un mal pronóstico y pueden estar relacionados con una mayor quimiosensibilidad periférica.
Área de la Ciencia:
- Cardiología Cardiología.
- Pulmonología Pulmonología.
- Medicina del sueño Medicina del sueño.
Sus antecedentes:
- Los patrones de respiración oscilatoria, incluyendo la respiración de Cheyne-Stokes (CSR) y la respiración periódica (PB), son frecuentes en pacientes con insuficiencia cardíaca crónica (CHF).
- Estas anomalías respiratorias a menudo se manifiestan durante el sueño diurno y están asociadas con la afección subyacente.
Objetivo del estudio:
- Investigar de manera prospectiva las características clínicas, el control autónomo, el pronóstico y el papel de la quimiosensibilidad periférica en pacientes con CHF que presentan patrones respiratorios cíclicos.
- Para determinar si la modulación de la quimio-sensibilidad periférica tiene un impacto en estos patrones respiratorios anormales.
Principales métodos:
- El análisis espectral de potencia de la respiración se utilizó para identificar patrones de respiración cíclicos en 74 pacientes estables con ECH.
- El equilibrio autónomo se evaluó a través de la variabilidad de la frecuencia cardíaca y la sensibilidad al barorreflejo.
- La quimiosensibilidad periférica se midió utilizando el método de hipoxia transitoria, y se evaluaron los efectos de la hiperoxia y la dihidrocodeína.
Principales resultados:
- La respiración cíclica (CSR o PB) se identificó en el 66% de los pacientes y se correlacionó con síntomas avanzados de insuficiencia cardiaca congestiva, deterioro del control autónomo y aumento de la quimiosensibilidad periférica.
- La hiperoxia transitoria abolió la respiración oscilatoria en la mayoría de los pacientes analizados.
- La administración de dihidrocodeína redujo la quimiosensibilidad y mejoró los patrones respiratorios, mientras que la respiración cíclica predijo de forma independiente una pobre supervivencia a los 2 años.
Conclusiones:
- La respiración oscilatoria diurna en CHF es un marcador significativo de disfunción autónoma y presagia un mal pronóstico.
- Una mayor actividad de los quimiorreceptores periféricos parece contribuir al desarrollo de estos patrones respiratorios.
- Dirigirse a la quimiosensibilidad periférica ofrece una estrategia terapéutica potencial para el manejo de la respiración oscilatoria en pacientes con insuficiencia cardíaca congestiva.
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Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:30Alterations in Respiration II
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In Biot's breathing, the respiratory rate and depth are irregular, alternating between periods of deep gasping and apnea. Common causes include...
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