Clinical use

Doxapram as a continuous infusion is used to support patients in acute on chronic respiratory failure with hypercapnia and to reduce postoperative complications of anesthesia. These uses, particularly the former, will be discussed in greater detail below.

Nikethamide is a short-acting analeptic agent for reversal of respiratory depression. It is a less specific respiratory stimulant than doxapram and has to be given as repeated doses. The ratio of convulsant to respiratory stimulant doses is approximately 15:1 compared with approximately 40:1 for doxapram. As a result of these disadvantages it is now little used.

Methylxanthines, amongst their other effects, act directly on brainstem respiratory centers, increasing resting ventilation in a dose-dependent manner; respiratory response to hypoxia and hypercapnia are increased. These drugs are most often used for their respiratory stimulant activity in the management of idiopathic apnea of prematurity, although this effect may also be of relevance for their use in acute exacerbations of chronic obstructive pulmonary disease.

Hormones, tricyclic antidepressants, and acetazolamide have respiratory stimulant activity, but are rarely used for their respiratory stimulant effects in the context of adult critical care and will not be discussed further.

Almitrine bismesylate has been shown to be effective in chronic respiratory failure and in supporting patients in acute respiratory failure, but it is still undergoing clinical trials. It acts on peripheral chemoreceptors in the carotid body and can be given orally or intravenously. This drug will be discussed in greater detail below.

Thus only three of these drugs, namely doxapram, almitrene bismesylate, and theophylline, are used routinely or have the prospect of significant clinical application within the context of adult intensive care.

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