Why do patients with respiratory muscle paralysis require artificial hyperventilation?

The primary reason for the need of hyperventilation in patients with respiratory paralysis is the insufficiency of the inhibitory Hering-Breuer reflex. The artificial distension of the lungs with normal tidal volume cannot inhibit the respiratory centre in contrast to the normal state.     

The tonically acting pulmonary receptors innervated by C fibres

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Muscular respiratory receptors in self-regulation of normal breathing in man.

In man, in the process of evolution the proprioceptive reflexes from the chest muscle during apnea become weak. Probably the impulses from the respiratory stretch receptors do not take part in self-regulation of eupnea.     

The waking brain: an update

Wakefulness and consciousness depend on perturbation of the cortical soliloquy. Ascending activation of the cerebral cortex is characteristic for both waking and paradoxical (REM) sleep. These evolutionary conserved activating systems build a network in the brainstem, midbrain, and diencephalon that contains the neurotransmitters and neuromodulators glutamate, histamine, acetylcholine, the catecholamines, serotonin, and some neuropeptides orchestrating the different behavioral states. Inhibition of these waking systems by GABAergic neurons allows sleep. Over the past decades, a prominent role became evident for the histaminergic and the orexinergic neurons as a hypothalamic waking center.     

Magnug reflexex of the chest musculature in man

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Hyperventilation and inhibitory synapses

Summary Injection of a subconvulsive dose of strychnine (which blocked the inhibitory synapses) increases respiratory muscle activity evoked by stimulation of the sciatic nerve as well as by inhalation of hypercapnic gas mixture. Thus the inhibitory synapses prevent an excessive hyperventilation.     

Artificial lung ventilation during diaphragmatic paralysis

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Hyperventilation and inhibitory synapses.

Injection of a subconvulsive dose of strychnine (which blocked the inhibitory synapses) increases respiratory muscle activity evoked by stimulation of a sciatic nerve as well as by inhalation of hypercapnic gas mixture. Thus the inhibitory synapses prevent an excessive hyperventilation.