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Theophylline Therapy for Near-Fatal Cheyne–Stokes Respiration: A Case Report

Catherine A. Pesek, DO; Ryan Cooley, MD; Krzysztof Narkiewicz, MD, PhD; Mark Dyken, MD; Neal L. Weintraub, MD; and Virend K. Somers, MD, PhD
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From the University of Iowa, Iowa City, Iowa.


Ann Intern Med. 1999;130(5):427-430. doi:10.7326/0003-4819-130-5-199903020-00014
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Background: Cheyne–Stokes respiration is characterized by periodic breathing that alternates with hypopnea or apnea.

Objective: To describe the effect of theophylline on near-fatal Cheyne–Stokes respiration.

Design: Case report.

Setting: Tertiary referral center.

Patient: A 48-year-old diabetic woman with a history of three cardiorespiratory arrests, a normal coronary arteriogram, normal left ventricular function, and severe Cheyne–Stokes respiration.

Measurements: Oxygen saturation, intra-arterial blood pressure, central venous pressure, chest wall movement, electrocardiography, electromyography, electroencephalography, electro-oculography, minute ventilation, arterial blood gases, and serum theophylline levels.

Results: After intravenous administration of 1.2 mg of theophylline at 0.6 mg/kg per hour (serum level, 5.6 µg/mL), both Cheyne–Stokes respiration and oxygen desaturation were markedly attenuated. After infusion of 2.4 mg of theophylline (serum level, 11.6 µg/mL), Cheyne–Stokes respiration resolved completely. No change was seen with placebo. Cheyne–Stokes respiration did not recur during outpatient treatment with oral theophylline.

Conclusion: Theophylline may be a rapid and effective therapy for life-threatening Cheyne–Stokes respiration.

Figures

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Figure 1.
Recordings of oxygen saturation (O 2 Sat), respiration (Resp), and blood pressure (BP) before and during intravenous theophylline therapy. Top.Bottom.

Before administration of theophylline, Cheyne–Stokes respiration was accompanied by marked oxygen desaturation; even the peak levels of oxygen saturation reached during Cheyne–Stokes respiration were low. Because of a lag in the oxygen saturation monitor, the oxygen saturation lows reached during the apneic period were only recorded subsequently during the hyperventilation period. After theophylline therapy, respiration was regular, sustained, and free of apnea. Oxygen saturation was maintained at a consistently higher level.

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Figure 2.
Recordings of oxygen saturation (O 2 Sat), electrocardiography (ECG), respiration measurement (Resp), and intra-arterial blood pressure (BP) at baseline, early during intravenous theophylline administration, and at the end of theophylline (Theo) infusion.ABGCO2O2A.O2V E B.CO2O2C.

Arterial blood gas ( ) values are listed as follows: pH/Pa /Pa . On the morning of the second study, the patient's theophylline level was 1.1 µg/mL. She had persistent Cheyne–Stokes respiration with oxygen desaturation to 42%. ST-segment depression is evident on the rhythm strip before institution of theophylline therapy. Arterial blood gas analysis showed carbon dioxide retention, a low Pa , and low minute ventilation ( ). Her blood pressure was 130/55 mm Hg, and her heart rate was 72 beats/min. During theophylline infusion (at 5.6 µg/mL), the patient's Cheyne–Stokes breathing began to decrease and her oxygen desaturation became attenuated; these events were accompanied by a decrease in Pa , an increase in Pa , and an increase in minute ventilation. Her blood pressure was 140/60 mm Hg, and her heart rate was 78 beats/min. After intravenous infusion of 2.4 mg of theophylline, Cheyne–Stokes breathing resolved completely.

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