Document Detail


Mechanism of respiratory insufficiency in pure or mixed drug-induced coma involving benzodiazepines.
MedLine Citation:
PMID:  11990203     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We tested the hypothesis that the mechanism of respiratory insufficiency in drug-induced coma involving benzodiazepines is an increase in upper airway resistance. METHODS: Eighteen nonintubated and seven intubated (control) patients were poisoned with hypnotic sedatives involving benzodiazepines. Neurological and respiratory parameters were measured by polysomnography before and after flumazenil. Flumazenil was administered as escalating bolus doses followed by a continuous infusion. RESULTS: Upon entry, Glasgow Coma Score was 7 +/- 1 in nonintubated and 5 +/- 1 in intubated patients. Snoring with flow limitation and obstructive apnea were recorded in 16 and 5 among the 18 nonintubated patients, respectively. Central apnea was not observed. Total pulmonary resistance was 2.5-fold higher in nonintubated patients than in intubated patients. Total and resistive work of breathing (WOB) was significantly greater in the nonintubated group. Flumazenil bolus administration was associated with an improvement in Glasgow Coma Score from 7 +/- 1 to 13 +/- 1 in the nonintubatedpatients, and from 5 +/- 1 to 11 +/- in the intubated patients. Mean effective bolus doses were 0.3 +/- 0.1 mg in nonintubated patients and 0.6 +/- 0.1 mg in intubated patients. Tidal and minute volumes increased significantly, and WOB decreased significantly in nonintubated patients. In nonintubated patients, the decrease in total WOB resulted from a significant decrease in resistive WOB. CONCLUSION: Drug-induced coma involving benzodiazepines is characterized by snoring with flow limitation and obstructive apnea. The mechanism of respiratory insufficiency in nonintubated patients with drug-induced coma involving benzodiazepines is an increase in upper airway resistance and WOB.
Authors:
Papa N Gueye; Frédéric Lofaso; Stephen W Borron; Françoise Mellerio; Eric Vicaut; Alain Harf; Frédéric J Baud
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of toxicology. Clinical toxicology     Volume:  40     ISSN:  0731-3810     ISO Abbreviation:  J. Toxicol. Clin. Toxicol.     Publication Date:  2002  
Date Detail:
Created Date:  2002-05-06     Completed Date:  2002-05-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8213460     Medline TA:  J Toxicol Clin Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  35-47     Citation Subset:  AIM; IM    
Affiliation:
Reanimation Médicale et Toxicologique, Hôpital Lariboisière, Paris, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Airway Resistance / drug effects
Anti-Anxiety Agents / poisoning*
Antidotes / therapeutic use
Coma / chemically induced,  complications*
Esophagus
Female
Flumazenil / therapeutic use
Glasgow Coma Scale
Humans
Intubation
Male
Middle Aged
Overdose
Oximetry
Polysomnography
Respiratory Insufficiency / etiology*,  physiopathology
Respiratory Muscles / drug effects
Sleep Apnea, Obstructive / etiology
Snoring / etiology
Tidal Volume / drug effects
Work of Breathing / drug effects
Chemical
Reg. No./Substance:
0/Anti-Anxiety Agents; 0/Antidotes; 78755-81-4/Flumazenil

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