ozij wrote:-SWS wrote:It sounds as if Dr. Silvana Simão thinks that central issues are primary.
Where do you get that from , -SWS? I couldn't find it in her first letter.
Perhaps very bad interpretation on my own part, ozij. Or at the very least, my own guess at what Dr. Silvana Simão conveys is psychologically biased by my own interpretive views.
However, my view is that what you transcribed below is a
ventilatory response issue of undetermined etiology. I suspect this pathology has absolutely nothing to do with standard obstructive apnea as the primary cause (despite the PSG summary text that
seems to indicate OSA as primary). Larisa's inadequate ventilatory response is a central issue, regardless of the pathogenesis (there's my own interpretive bias peeking out once again---albeit potentially an incorrect bias).
Please bear in mind that I find it highly doubtful that standard obstructive apnea causes this particular pathology, entailing such inadequate ventilatory response. And I also suspect recurring major respiratory infection would have routinely returned corroborative blood panel results, that would have been conveyed in these reports.
Not at all your standard OSA, and yet very clearly an inadequate central ventilatory response is involved here:
ozij wrote: My guesses - google trantslator, and some knowledge of French coming to my aid:
On L.'s May 07 she was admitted with "partial sepsis" -(my comment: could be a result of a major respiratory infection of course). Since the first admission course with retention of CO2 demanding respiratory support, which necessitated her hopitalization in CTI (probably intesnive care) for 3 times.
At her last admission (11/07/2007) she presented with severe respiratory acidosis (PH 6.91, pCO2=241mmhg). At the time of her intubation she had a 3 minute cardiac arrest, but there was rapid return to spontaneous circulation. Permanently on mechanical ventilation till 18/08/2007 when she was extubated, and since then has been having apneas during sleep which cause drops (quedas) in the O2 saturation (My emphasis, O.).
It is my (O's) impression from the text that the severe hypercapnia and/ or hypoxemia occur only when she sleeps, (she's been in the hospital since Aug. 07 because of that) and the doctor wants to avoid those with the requested equipment.
(so(m)no --> somnolence --> sleep).
Last sentence in the PSG report:
"The SaO2 remained over 90% for more than 90% of the time, however without oxygen levels fell to 71%."
O.
I haven't thrown CCHS out the window just yet as long as we're all guessing. CCHS is a central disorder that can be concomitant with obstructive apneas. Of course, not to confuse concern and conversation with attempts at treating via message-board quarterbacking. No one can or should treat this kind of case via a message board IMO.
I still think it's great when message board posters routinely straighten out inadequate OSA xPAP settings (since that real-world problem happens so often according to
very many anecdotal posts requesting help). But Larissa's case doesn't come close to being anything of that simple nature. I personally think it's great for us to discuss and learn and care about Larissa.
And she may go home soon thanks to Banned, brazilian, and others!
P.S. Thanks for that text translation, O!
