Clinical challenges to ventilatory control.
Clinical challenges to ventilatory control.
复制标题
通气控制的临床挑战。
DOI：
10.1016/j.resp.2013.09.006
复制
发表时间：
2013
影响因子：
2.3
通讯作者：
Mitchell,GordonS
中科院分区：
文献类型：
--
作者：
Ramirez,Jan-Marino;Mitchell,GordonS
Breathing is essential for survival. Clinical disorders that challenge breathing often have severe consequences, potentially leading to catastrophic ventilatory failure and death. In some cases, we believe that we know the “primary cause (s)” of a particular breathing disturbance, but that limited understanding is not always sufficient to explain the clinical phenotype. For example, as indicated by its name, airway obstruction seems to be the primary cause for breathing cessation (or apneas) in Obstructive Sleep Apnea. However, genetic predisposition, reflex mechanisms, neuromodulatory mechanisms associated with sleep states, hypoxic and oxidative stress, mechanisms of central respiratory rhythm generation and alterations at the level of motor nuclei play equally important roles in this disorder (Kheirandish-Gozal and Gozal, 2013; Plataki et al., 2013; Ramirez et al., 2013a). With Chronic Obstructive Pulmonary Disease (COPD), impaired breathing seems to result primarily from impaired pulmonary mechanics caused by lung/airway obstructions (Jacono, 2013). But, hypoxia and hypercapnic conditions alter intrinsic properties of muscles, chemoreceptor signaling and central respiratory control. Some breathing disorders result from specific gene mutations, such as Rett Syndrome, a neurological disorder caused by mutations in the Mecp2 gene (Ramirez et al., 2013b), but the mutation causes multiple alterations in synaptic transmission and neuromodulation and disturbed breathing, which in turn has secondary consequences to aspects of respiratory control. Many suspect that Sudden Infant Death Syndrome (SIDS) results from impaired function of the serotonergic nervous system, but the genetic predisposition and/or prior experiences (Paterson, 2013), make this a highly complex syndrome (Garcia et al., 2013). Thus, although in many instances we seem to know the primary cause of clinical disorders that impair breathing, we are beginning to realize that the clinical phenotype is the result of a complex interplay of multiple mechanisms that are still poorly understood–even in the best known examples.
