15 Dec

The Management of Chronic Hypoventilation: Diagnostic Evaluation (2)

The Management of Chronic Hypoventilation: Diagnostic Evaluation (2)Although signs of chronic hypoventilation are nonspecific, the physical examination is nevertheless very important for detecting predisposing illnesses. Severe obstructive or restrictive lung diseases should be detectable on physical examination. Morbid obesity, retrognathia, tonsillar hypertrophy, and macroglossia point to the obstructive sleep apnea syndrome. An examination of the thoracic cage for scoliosis and a neurologic examination seeking muscle weakness suggestive of neuromuscular syndromes or cerebrovascular disease are important components of the evaluation. flovent inhaler

A bedside evaluation of respiratory muscle function is useful in detecting bilateral diaphragmatic paralysis that can present with chronic hypoventilation. This is best achieved by having the patient lie supine and observing for paradoxic motion of the abdomen during inspiration. All patients with symptoms and signs suggestive of chronic hypoventilation should undergo a workup as outlined in Table 3 beginning with blood gases measured via arterial puncture. Noninvasive methods such as pulse oximetry or end-tidal C02 monitoring are not sufficiently sensitive to exclude the diagnosis, but they may be very helpful in subsequent follow-up. All patients should have a complete blood cell count to exclude polycythemia as well as measurements of thyroid function and serum chemistry studies.

Table 3—Diagnostic Studies for Fatients with Chronic Hypoventilation Syndrome

(1) History and physical examination
(2) Arterial blood gas
(3) Laboratory studies
Complete blood cell count
Serum electrolytes
Thyroid (unction tests
Mg, P04
(4) Pulmonary function tests
Lung volumes
Bronchodilator response
Maximal inspiratory and expiratory pressures
Supine vital capacity
For selected patients
(5) Nocturnal polysomnography
(6) Transdiaphragmatic pressure measurements

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