Ling Tan Pei, Poh Lim Chuan, Ong Sharon, Sithamparapillai Samuel Geoffrey
Singapore General Hospital, Singapore, Singapore.
J Crit Care Med (Targu Mures). 2023 Feb 8;9(1):49-54. doi: 10.2478/jccm-2023-0003. eCollection 2023 Jan.
Caffeine is commonly used as a respiratory stimulant for the treatment of apnea of prematurity in neonates. However, there are no reports to date of caffeine used to improve respiratory drive in adult patients with acquired central hypoventilation syndrome (ACHS).
We report two cases of ACHS who were successfully liberated from mechanical ventilation after caffeine use, without side effects. The first case was a 41-year-old ethnic Chinese male, diagnosed with high-grade astrocytoma in the right hemi-pons, intubated and admitted to the intensive care unit (ICU) in view of central hypercapnia with intermittent apneic episodes. Oral caffeine citrate (1600mg loading followed by 800mg once daily) was initiated. His ventilator support was weaned successfully after 12 days. The second case was a 65-year-old ethnic Indian female, diagnosed with posterior circulation stroke. She underwent posterior fossa decompressive craniectomy and insertion of an extra-ventricular drain. Post-operatively, she was admitted to the ICU and absence of spontaneous breath was observed for 24 hours. Oral caffeine citrate (300mg twice daily) was initiated and she regained spontaneous breath after 2 days of treatment. She was extubated and discharged from the ICU.
Oral caffeine was an effective respiratory stimulant in the above patients with ACHS. Larger randomized controlled studies are needed to determine its efficacy in the treatment of ACHS in adult patients.
咖啡因通常用作呼吸兴奋剂，用于治疗新生儿早产呼吸暂停。然而，迄今为止，尚无关于咖啡因用于改善获得性中枢性低通气综合征（ACHS）成年患者呼吸驱动力的报道。
我们报告了两例ACHS患者，在使用咖啡因后成功脱离机械通气，且无副作用。第一例是一名41岁的华裔男性，被诊断为右侧半脑桥高级别星形细胞瘤，因中枢性高碳酸血症伴间歇性呼吸暂停发作而插管并入住重症监护病房（ICU）。开始口服枸橼酸咖啡因（负荷剂量1600mg，随后每日一次800mg）。12天后他的呼吸机支持成功撤机。第二例是一名65岁的印度裔女性，被诊断为后循环卒中。她接受了后颅窝减压颅骨切除术并插入了脑室外引流管。术后，她入住ICU，观察到24小时无自主呼吸。开始口服枸橼酸咖啡因（每日两次300mg），治疗2天后她恢复了自主呼吸。她拔管后从ICU出院。
口服咖啡因对上述ACHS患者是一种有效的呼吸兴奋剂。需要更大规模的随机对照研究来确定其在成年ACHS患者治疗中的疗效。
