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[A significance of measurement of breathing nervous regulation, respiratory resistance and spirometry in clinical toxicology - retrospective review].

The exogenous central nervous
system depressants such opioides,
alcohol and carbon monoxide may
affect nervous respiratory regulation
and lead to disturbances in respiratory
system efficiency. The aim of this study
was to evaluate the breathing nervous
regulation and ventilatory efficiency in
patients treated in Clinical Toxicology,
UJCM in Krakow in the period 1994-
2000.


Methods
There were 385 persons
under examination: 144 alcohol abusers
and 70 opiate abusers (group I),
91 persons treated because of acute
carbon monoxide poisoning (group
II) and 80 healthy persons - control
group. The examinations performed
before and after treatment included
measurements of respiratory pattern
parameters, occlusion pressure and
evaluation of ventilatory efficiency
determined on the basis of “flow-volume”
loop results, spirometry and
the measurements of respiratory tract
resistance.


Results
The central respiratory
drive (VT/T(in) index) and the parasympathetic
control of breathing cycle (T(in)/
T(tot) index) were similar in alcohol and
opiate abusers in the initial examination
but in abusers classified to methadone
maintenance treatment programme
the VT/T(in) index was elevated. After
treatment the values of both indices
were similar. In the group of acute CO
poisoned patients the disturbances in
breathing regulation were connected
with increased value of the VT/Tin parameter
and the diminished of T(in)/T(tot)
value. After treatment in the slightly CO
poisoned patients the both respiratory
pattern components were comparable
to the healthy control group but in the
moderately and severely poisoned
group the VT/T(in) index was elevated
and the T(in)/T(tot) index was lessened
compared to the controls. The values
of respiratory resistance were higher
than upper level of normal values
(except participants of methadone
programme). The bronchial obturation
was most often stated disturbance in respiratory system
efficiency, especially in alcohol abusers. Ventilatory
parameters in moderate and severe CO poisoned were
significantly lower than in the slightly poisoned patients.


Conclusion
Presented methods of evaluation of respiratory
system efficiency and nervous breathing regulation
are of special value and should be implemented in clinical
toxicology as essential to diagnosis and monitoring, especially
in case of alcohol and drug dependent patients and in
patients poisoned with central nervous system depressants.