Central Respiratory Arrest Due to Medullary Stroke

Q: Central Respiratory Arrest Due to Medullary Stroke

Hello： Medullary strokes can indeed affect the respiratory centers in the body, leading to respiratory suppression during sleep. <br>During sleep, the control of respiratory muscles diminishes, resulting in carbon dioxide accumulation, a condition known as Ondine's curse. <br>It

Central apnea caused by medullary stroke?

Dear Doctor,
My father was hospitalized earlier this year due to respiratory failure (elevated carbon dioxide levels in the blood) and was advised by the physician to use a ventilator.
In August of this year, he was again admitted for the same condition with altered consciousness.
After intubation and improvement in his condition, he was transferred to a regular ward, but three days later, he experienced a recurrence of the same issue and was readmitted to the intensive care unit.
The pulmonologist indicated that my father is suffering from central apnea due to a medullary stroke and recommended a tracheostomy.
They mentioned that if a tracheostomy is not performed, there is a possibility that after extubation, he may experience another respiratory arrest that could be irreversible.
I would like to ask the doctor:
1.
Are there any treatment options other than a tracheostomy?
2.
Is it necessary to transfer him to another hospital, considering he is currently intubated?

Niming, 30~39 year old female. Ask Date: 2019/08/17

Dr. Hong Weibin reply Neurology

Hello: Medullary strokes can indeed affect the respiratory centers in the body, leading to respiratory suppression during sleep.
During sleep, the control of respiratory muscles diminishes, resulting in carbon dioxide accumulation, a condition known as Ondine's curse.
It is also important to consider whether there is an underlying infection, such as pneumonia, that could worsen respiratory status.
Tracheostomy with mechanical ventilation can help remove carbon dioxide and prevent further deterioration of respiratory conditions.
If tracheostomy is not desired, another option is the use of positive pressure ventilation.
However, a drawback of positive pressure ventilation is that it may push oral secretions into the airways or lungs, potentially leading to lung infections.
You should discuss these medical interventions and their pros and cons with your attending physician.
Currently, Shared Decision Making (SDM) is available for reference.
Whether to transfer to another facility depends on your needs and the patient's condition.
Wishing you a speedy recovery.

Reply Date: 2019/08/17

More Info

Understanding central respiratory arrest due to medullary stroke is crucial, especially in the context of your father's health condition. Central respiratory arrest occurs when the brainstem, which controls the autonomic functions of breathing, is damaged. This can happen due to a stroke affecting the medulla oblongata, leading to respiratory failure. In your father's case, the repeated episodes of respiratory failure and the need for intubation indicate significant impairment of his respiratory drive.

1. Alternative Treatments to Tracheostomy: While tracheostomy is often recommended for patients with severe respiratory failure due to central respiratory arrest, there are other options to consider. Continuous Positive Airway Pressure (CPAP) or Bi-level Positive Airway Pressure (BiPAP) can be used to support breathing without the need for invasive procedures. These non-invasive ventilation strategies can help maintain adequate oxygenation and carbon dioxide removal. However, they may not be suitable for all patients, especially those with severe neurological impairment. It is essential to have a thorough discussion with your healthcare team about the risks and benefits of each option, considering your father's specific condition and prognosis.

2. Transfer to Another Facility: The decision to transfer your father to another facility depends on several factors, including the level of care he requires and the resources available at the current hospital. If the current facility has the capability to manage his respiratory needs and provide appropriate rehabilitation, transfer may not be necessary. However, if specialized care or advanced respiratory support is required, transferring to a facility with a dedicated respiratory care unit or a rehabilitation center may be beneficial. It is important to communicate with the medical team about your father's condition and the potential need for transfer based on his ongoing respiratory challenges.

In summary, your father's situation is complex, and the management of central respiratory arrest due to medullary stroke requires a multidisciplinary approach. Continuous monitoring and assessment of his respiratory status are essential. Engaging in shared decision-making with the healthcare team will help you understand the best course of action for your father's care. It is also crucial to consider the psychological and emotional aspects of his condition, as these can significantly impact recovery and quality of life.

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