Neurologic Manifestations of Respiratory Failure

Our plain-English summary of Neurologic Manifestations of Respiratory Failure, by K.H. Kilburn (1965).

The study

• Author: K.H. Kilburn
• Published: Archives of Internal Medicine, Volume 116. September 1965
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library. The article is still under copyright, so we describe it here rather than post it.

In plain English

This article is not about asbestos. It is a clinical report, from Duke University, on brain and movement problems in patients with acute respiratory failure, including some with obesity-cardiopulmonary failure. The scanned text is badly damaged, so many numbers could not be read reliably. The author studied 24 male patients. The data covered 22 episodes of respiratory failure with asterixis, a flapping tremor of the hands, and ten episodes without it. The patients' mental state and movements were assessed repeatedly, alongside measurements of acid and gases in their arterial blood. Asterixis correlated with the severity of acidosis. Two extremely low-oxygen patients had asterixis and muscle jerks with normal acid levels. Six acidotic patients with asterixis whose plasma bicarbonate was above 40 mEq/liter had less mental impairment than the others. Ten patients had headaches. All patients who had seizures died within three days. The author noted that symptom-free vascular disease of the brain in patients of this age could blur the link between acid levels and neurologic function. The author wrote that the findings suggested acidosis was primarily responsible for the brain dysfunction.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical observational report (case series) of patients with acute respiratory failure, observed repeatedly during their hospital episodes
• Who was studied: 24 male hospital patients with acute respiratory failure, some with obesity-cardiopulmonary failure. The data covered 22 episodes with asterixis and ten episodes without asterixis.
• Exposure: No asbestos or occupational exposure was studied. The conditions examined were respiratory acidosis, carbon dioxide retention and low blood oxygen during respiratory failure.
• Main results:
  • Data were presented for 22 episodes of acute respiratory failure with asterixis, and for ten episodes without asterixis
  • Asterixis correlated with the severity of acidosis and could be observed even while the patient was connected to a respirator
  • Six acidotic patients with asterixis whose plasma bicarbonate was above 40 mEq/liter had less cerebral deficit than the other patients
  • Two extremely hypoxic patients (patients 19 and 20) had asterixis and myoclonic jerks with normal hydrogen ion levels
  • Patient 17, who had obesity-cardiopulmonary failure, had asterixis and somnolence without other evidence of cerebral dysfunction
  • All patients who had seizures died within three days
  • Ten patients had dull, throbbing headaches at the back of the head that spread behind the eyes
• The authors' conclusion: The author reported that correcting low oxygen did not improve mental status or movement disorders while hypercapnic acidosis persisted. The author wrote that this suggested acidosis was primarily responsible for the cerebral dysfunction.
• Limitations the authors state:
  • The author noted that symptom-free cerebral vascular disease in patients of this age might lower the threshold for acidosis-related deficits and disturb correlations between hydrogen ion levels and neurologic function

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