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RESPIRATORY FAILURE and Trazodone

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RESPIRATORY FAILURE Symptoms and Causes

What is respiratory failure?

Respiratory failure is a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide. Sometimes you can have both problems.

When you breathe, your lungs take in oxygen. The oxygen passes into your blood, which carries it to your organs. Your organs, such as your heart and brain, need this oxygen-rich blood to work well.

Another part of breathing is removing the carbon dioxide from the blood and breathing it out. Having too much carbon dioxide in your blood can harm your organs.

What causes respiratory failure?

Conditions that affect your breathing can cause respiratory failure. These conditions may affect the muscles, nerves, bones, or tissues that support breathing. Or they may affect the lungs directly. These conditions include

  • Lung diseases such as COPD (chronic obstructive pulmonary disease), cystic fibrosis, pneumonia, and pulmonary embolism
  • Conditions that affect the nerves and muscles that control breathing, such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, spinal cord injuries, and stroke
  • Problems with the spine, such as scoliosis (a curve in the spine). They can affect the bones and muscles used for breathing.
  • Damage to the tissues and ribs around the lungs. An injury to the chest can cause this damage.
  • Drug or alcohol overdose
  • Inhalation injuries, such as from inhaling smoke (from fires) or harmful fumes
What are the symptoms of respiratory failure?

The symptoms of respiratory failure depend on the cause and the levels of oxygen and carbon dioxide in your blood.

A low oxygen level in the blood can cause shortness of breath and air hunger (the feeling that you can't breathe in enough air). Your skin, lips, and fingernails may also have a bluish color. A high carbon dioxide level can cause rapid breathing and confusion.

Some people who have respiratory failure may become very sleepy or lose consciousness. They also may have arrhythmia (irregular heartbeat). You may have these symptoms if your brain and heart are not getting enough oxygen.

How is respiratory failure diagnosed?

Your health care provider will diagnose respiratory failure based on

  • Your medical history
  • A physical exam, which often includes
    • Listening to your lungs to check for abnormal sounds
    • Listening to your heart to check for arrhythmia
    • Looking for a bluish color on your skin, lips, and fingernails
  • Diagnostic tests, such as
    • Pulse oximetry, a small sensor that uses a light to measure how much oxygen is in your blood. The sensor goes on the end of your finger or on your ear.
    • Arterial blood gas test, a test that measures the oxygen and carbon dioxide levels in your blood. The blood sample is taken from an artery, usually in your wrist.

Once you are diagnosed with respiratory failure, your provider will look for what is causing it. Tests for this often include a chest x-ray. If your provider thinks you may have arrhythmia because of the respiratory failure, you may have an EKG (electrocardiogram). This is simple, painless test that detects and records your heart's electrical activity.

What are the treatments for respiratory failure?

Treatment for respiratory failure depends on

  • Whether it is acute (short-term) or chronic (ongoing)
  • How severe it is
  • What is causing it

Acute respiratory failure can be a medical emergency. You may need treatment in intensive care unit at a hospital. Chronic respiratory failure can often be treated at home. But if your chronic respiratory failure is severe, you might need treatment in a long-term care center.

One of the main goals of treatment is to get oxygen to your lungs and other organs and remove carbon dioxide from your body. Another goal is to treat the cause of the condition. Treatments may include

  • Oxygen therapy, through a nasal cannula (two small plastic tubes that go in your nostrils) or through a mask that fits over your nose and mouth
  • Tracheostomy, a surgically-made hole that goes through the front of your neck and into your windpipe. A breathing tube, also called a tracheostomy, or trach tube, is placed in the hole to help you breathe.
  • Ventilator, a breathing machine that blows air into your lungs. It also carries carbon dioxide out of your lungs.
  • Other breathing treatments, such as noninvasive positive pressure ventilation (NPPV), which uses mild air pressure to keep your airways open while you sleep. Another treatment is a special bed that rocks back and forth, to help you breathe in and out.
  • Fluids, often through an intravenous (IV), to improve blood flow throughout your body. They also provide nutrition.
  • Medicines for discomfort
  • Treatments for the cause of the respiratory failure. These treatments may include medicines and procedures.

If you have respiratory failure, see your health care provider for ongoing medical care. Your provider may suggest pulmonary rehabilitation.

If your respiratory failure is chronic, make sure that you know when and where to get help for your symptoms. You need emergency care if you have severe symptoms, such as trouble catching your breath or talking. You should call your provider if you notice that your symptoms are worsening or if you have new signs and symptoms.

Living with respiratory failure may cause fear, anxiety, depression, and stress. Talk therapy, medicines, and support groups can help you feel better.

NIH: National Heart, Lung, and Blood Institute

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RESPIRATORY FAILURE Clinical Trials and Studies

Treatments might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. The goal of clinical trials is to determine if a new test or treatment works and is safe. Clinical trials can also look at other aspects of care, such as improving the quality of life for people with chronic illnesses. People participate in clinical trials for a variety of reasons. Healthy volunteers say they participate to help others and to contribute to moving science forward. Participants with an illness or disease also participate to help others, but also to possibly receive the newest treatment and to have the additional care and attention from the clinical trial staff.
Rank Status Study
1 Recruiting Efficacy and Safety of Risperidone and Trazodone Monotherapy and Combination Therapy in Critically Ill Patients With Delirium
Conditions: Delirium;   Agitation
Interventions: Drug: Risperidone;   Drug: Trazodone;   Drug: Placebo
Outcome Measures: The number of days patients are without delirium during the study period (delirium-free days);   Daily prevalence of delirium as indicated by a positive Confusion Assessment Method in the ICU (CAM-ICU);   Resolution of delirium as indicated by a negative Confusion Assessment Method in the ICU (CAM-ICU) for more than 24 hours;   The number of patients who require rescue medications, the type of rescue medications utilized, and the amount of rescue medications per day;   The number of patients who receive sedative agents, amount of midazolam equivalents per day, and the number of days in which patients receive a sedative agent;   The number of patients who receive pain medications, amount of fentanyl equivalents per day, and the number of days in which patients receive a pain medication;   The number of hours spent agitated (RASS score between +4 and +2) as a percent of the time that the study drug was administered;   The number of hours spent excessively sedated or in a coma state (RASS score between -4 to -5) as a percent of the time that the study drug was administered;   The duration of mechanical ventilation from initial intubation to extubation as long as the patient remained extubated for more than 48 hours.;   The number of days that the patients were alive and breathing without assistance during the study period (ventilator-free days);   The number of episodes and number of patients who experience clinically significant QTc prolongation (≥ 500 msec or an increase of more than 60 msec from baseline);   The number of episodes and number of patients who experience clinically significant extrapyramidal effects (as evidenced by a positive Simpson-Angus Scale Score);   All-cause mortality and 28-day mortality
2 Unknown  A Clinical Study of Trazodone Hydrochloride Prolonged-Release Tablets for Treatment of Depression
Condition: Depression
Interventions: Drug: Trazodone;   Drug: Placebo
Outcome Measures: Change in Hamilton Depression Rating Scale-17 score;   Changes in HAMA-14 score;   CGI-Severity of illness and CGI-Global improvement;   Changes in evaluation of sleep quality and sexual dysfunction;   Rate changes of responders/patients
3 Recruiting Study of Trazodone & Cognitive Behavioral Therapy to Treat Insomnia
Condition: Insomnia
Interventions: Drug: Trazodone;   Behavioral: Cognitive Behavioral Therapy
Outcome Measures: Change from Baseline in objective sleep duration at 9 months;   Change from Baseline in Subjective Severity of Sleep Disturbance & Subjective Sleep Duration at 9 months
4 Recruiting The Effects of Trazodone on Sleep Apnea Severity
Condition: Sleep Apnea, Obstructive
Interventions: Drug: Placebo pill;   Drug: Trazodone
Outcome Measures: Apnea-Hypopnea Index;   Arousal threshold
5 Unknown  Comparison of the Pharmacokinetics of Three Generic Medications and Their Respective Brand Preparations
Condition: Healthy
Interventions: Drug: Trazodone;   Drug: Quetiapine;   Drug: Pindolol;   Procedure: Blood Collection
Outcome Measure: Plasma levels of Medication
6 Recruiting Algorithm Guided Treatment Strategies for Major Depressive Disorder
Condition: Major Depressive Disorder
Interventions: Drug: Escitalopram;   Drug: Mirtazapine;   Other: modified electroconvulsive therapy;   Other: repetitive transcranial magnetic stimulation;   Drug: Fluoxetine;   Drug: Citalopram;   Drug: Paroxetine;   Drug: Sertraline;   Drug: Fluvoxamine;   Drug: Venlafaxine;   Drug: Duloxetine;   Drug: Bupropion;   Drug: Trazodone
Outcome Measures: Remission defined as endpoint 17-item Hamilton Rating Scale for Depression (HRSD-17) total score ≤ 7;   Remission defined as endpoint the Quick Inventory of Depressive Symptomatology (16-item) (QIDS-SR16) total score ≤ 5;   Frequency and intensity of adverse events;   Quality of life
7 Recruiting Development of Pharmacogenomic Method to Predict Antidepressant Responsiveness
Conditions: Depression;   Antidepressant Drug Adverse Reaction
Interventions: Drug: SSRI class antidepressant;   Drug: non-SSRI class antidepressant
Outcome Measures: all pharmacogenetic and biological marker variables cause drug response;   all clinical cause drug response
8 Recruiting Sequenced Therapies for Comorbid and Primary Insomnias
Conditions: Insomnia Comorbid to Psychiatric Disorder;   Primary Insomnia
Interventions: Behavioral: Behavioral Insomnia Therapy;   Drug: Zolpidem;   Drug: Trazodone;   Behavioral: Cognitive Therapy
Outcome Measure: Insomnia Severity Index- Change from Baseline (Remission)
9 Recruiting Interpersonal Psychotherapy for Treatment Resistant Depression
Condition: Treatment Resistant Depression
Interventions: Other: IPT+ antidepressant drugs;   Drug: fluoxetine;   Drug: sertraline;   Drug: paroxetine;   Drug: Citalopram;   Drug: escitalopram;   Drug: fluvoxamine;   Drug: Venlafaxine;   Drug: Duloxetine;   Drug: Bupropion;   Drug: Lithium;   Drug: Risperidone;   Drug: tranylcypromine;   Drug: Imipramine;   Drug: amitriptyline;   Drug: Clomipramine;   Drug: nortriptyline;   Drug: Trazodone;   Drug: Mirtazapine;   Drug: sulpiride
Outcome Measures: Hamilton Depression Scale (HAM-D) - continuous;   Beck depression Inventory (BDI)
10 Recruiting Study Comparing 3 Different Treatments for Arthritis of the Lower Back (Lumbar Spinal Stenosis)
Condition: Lumbar Spinal Stenosis
Interventions: Drug: NSAIDs; adjunctive analgesics; adjunctive anti-depressants;   Procedure: Lumbar epidural injection;   Other: Joint Mobilizations (spine, sacroiliac, hip);   Other: Individualized exercises: clinical setting;   Other: Group Exercise: community setting
Outcome Measures: Swiss Spinal Stenosis Questionnaire Score;   Self Paced Walking Test
11 Recruiting The Effects of Cannabinoid on Patients With Non-GERD Related Non Cardiac Chest Pain
Condition: Chest Pain
Interventions: Drug: Marinol;   Drug: Placebo
Outcome Measures: Frequency of chest pain episodes;   Frequency of chest pain in treatment group vs baseline;   Intensity of chest pain episodes;   Sensory thresholds for first sensation;   Frequency of reactive esophageal contractions;   Amplitude of reactive esophageal contractions;   Area under the curve of reactive esophageal contractions;   Duration of chest pain episodes;   Sensory thresholds for discomfort;   Sensory thresholds for pain