1995 Volume 35 Issue 5 Pages 407-412
Primary alveolar hypoventilation syndrome, although rare, usually results in long term mechanical ventilatory support because of its chronic hypoxic and hypercapnic pathophysiology. A 58-year-old female was admitted for the evaluation of general exhaustion and marked weight loss with BMI 13.1. The patient presented serious desaturation with excessive daytime somnolence and morning headache despite normal pulmonary and neuromuscular function. After pneumonic involvement, the patient became controlled under transtracheal ventilation for two years. The patient gradually developed depressive with suicidal idealing due to discomforts and poor QOL caused by lasting tracheostomy. The phrenic nerve pacing was not attempted because preoperative assessability and CPAP trial did not bring any improvement for desaturation. Altemative to BiPAP application improved mean oxisaturation 91% up to 94% and revealed marked reduction of hypoxic episodes during sleep. After efficacy of BiPAP was confirmed by ambulatory oximetric monitoring, tracheostomy was closed two years later. The closure of tracheostomy brought improvement of QOL associated with recovery of self-esteem. The case encourages us that undesirable symptoms, such as depression, paradoxically may break clinical deadlock and provide therapeutic success.
