To summarize where we are now in this medical scientific puzzle; Paula and I are interested in altered ventilatory mechanics in some cases of disabling depression and anxiety, particular after a respiratory challenge [eg viral illness, head injury, surgery, resuscitation, cachexia and weakness of respiratory muscles, etc…] and how and when these altered ventilatory mechanics fail.
All because of a chance finding about my colleague Paula years ago when we took a basic first aid class together.
It turned out that Paula has altered breathing mechanics which no one [including herself] was aware of because doctors [or psychologists] never order measurements of respiratory rate or tidal volume or minute ventilation, all non invasive measures .
I do not think that this has been studied much, even though this peripheral motor system can easily be damaged as it has many neural and motor parts.[throat, neck, torso]. I think that measuring resting respiratory rate [carefully with a watch] will uncover past injury requiring extra effort to breath at rest [with normal lungs]. I think that unmasking altered ventilation may predict higher risk of respiratory pump failure type 2 [which is not always easy to diagnose and can result in significant but reversible cognitive impairment and distress] .
I think that respiratory breathing patterns can become altered after survival from traumatic head injury, physical trauma, surgery and resuscitation- including mechanical ventilation. I think we know too little about these altered ventilatory mechanics in survivors of critical illness. I think that this topic is especially important in the days of long COV-ID. Respiratory pump failure is hard to diagnose, laboratory tests are not sensitive enough and can cause a lot of suffering and disability [cognitive] ,if not death.
Paula and I have finally been able to verify [last week] her altered breathing pattern with various formal lung function tests , R.R, and Tidal Volume tests what we discovered when taking that class and measuring respiratory rate at rest manually with a stopwatch. [ It took us 20 years to convince a doctor to help us].
Paula has normal lung function and lungs.[spirometry and xrays] .
Paula’s breathing rate at rest is 3-5 breaths per minute, her tidal volume is 750-850 ml and her minute ventilation is thus normal, [in health] , but she uses her abdominal muscles with every breath in order to increase her tidal volume since she does not seem to be able to raise her breathing rate at rest.
The next test she will be given [next week] is a CO2 challenge to see if, at rest, she can increase her respiratory rate in response to rising CO2. [i suspect she cannot but we will see].
Her respiratory controllers seem normal as they arrange for normal minute ventilation during exercise, despite only a sluggish rise of her respiratory rate.
We are wondering if you have ever routinely measured the function of the skeletal motor ventilatory system in your patients or know of any researcher that has found abnormal respiratory rates, threatening normal gas exchange during exposure, recovery from viral illness or hormonal changes; all of which cannot easily be managed by this abnormal ventilation.
A researcher over 100 years ago also found depressed breathing rates in thousands of unmedicated patients who suffered from what looked externally like acute reversible onset of mental dullness and depression. This scientist speculated that respiratory metabolic dysfunction was the reason for these attacks.
His work was never replicated because, since his study, no one has bothered to measure respiratory rates or any vital signs in severely depressed and cognitively impaired patients.[or any other patients with any organ failure-for that matter]. We think that telemedicine could change this and patterns of vital signs, including RR could be helpful in differential diagnosis, especially of chronic, complex conditions. It seems that a normal respiratory rate pattern and effort is necessary for mental health and normal baseline cognitive status.
Paula did suffer an 18 month attack of depressive insanity 20 years ago. It took 10 years for her to fully recover to her university level cognitive function ; her respiratory rate is still abnormal but she is not recovering from any respiratory challenges [which , without supportive medical help, is harder for her].
Paula and I think that there may be other people who would benefit from rehabilitation and supportive medical care, if they were to fall ill, as she did. We think that she had an episode of hypercapnic respiratory pump failure and is now fine.
What do you think readers?
Please feel free to discuss with scientists and other curious people. We think this requires more study. Continue reading out blog if you wish to be updated on her ongoing test results as we study this with our doctor/physiology professor friend and the pulmonary function lab. [remember this is not a lung issue, it is a motor issue affecting ventilation].
Next week she will have a CO2 challenge at rest.
We suspect that she will feel huge distress but that her R.R. will remain low and minute ventilation may no longer be normal. We suspect that she has an undiagnosed respiratory defect/injury which puts her at risk for chronic quiet delirium during periods of exposure or recovery from viruses or other illnesses or both.
Please check out this blog for future ongoing ventilatory test results as we continue to explore Paula as a possible phenotype for this kind of unknown, unseen injury to the peripheral [throat, neck, torso] nerve fibres and ganglions affecting the motor skeletal system moving air in and out or the body.
It is possible that ongoing noninvasive supportive treatments supporting ventilation and other rehabilitative measures , during respiratory challenges, may help restore mental status in these patients.