A multicenter, observational–interventional study was conducted across three tertiary hospitals (n = 312). Patients were stratified using the VOSTFR‑ scoring system (0‑20 points) based on bedside physiological measurements and validated questionnaires. Axis‑specific interventions (e.g., controlled rebreathing for “Ventilatory,” beta‑blockade for “Sympathetic,” evaporative cooling for “Thermoregulatory”) were administered to a randomized sub‑cohort (n = 156). Primary outcome: time to normalization of arterial PaCO₂ (35–45 mmHg). Secondary outcomes: symptom resolution, length of emergency department (ED) stay, and adverse events.
| Axis | Physiologic Domain | Representative Markers | |------|--------------------|------------------------| | (Ventilatory) | Central respiratory drive, lung mechanics | Minute ventilation (VE), tidal volume (VT) | | O (Oscillatory) | Respiratory rhythm stability | Respiratory rate variability (RRV) | | S (Sympathetic) | Autonomic tone | Heart rate (HR), catecholamine levels | | T (Thermoregulatory) | Body temperature regulation | Skin temperature, sweat rate | | F (Respiratory) | Gas exchange efficiency | PaCO₂, alveolar‑arterial gradient | Hyperventilation 5 VOSTFR-
¹ Department of Pulmonary Medicine, University Hospital, City, Country ² Department of Emergency Medicine, University Hospital, City, Country ³ Institute of Clinical Physiology, University of Science, City, Country Primary outcome: time to normalization of arterial PaCO₂
Baseline characteristics were balanced (Table 1). axis‑specific therapeutic algorithm.
Current clinical practice typically categorizes hyperventilation into , metabolic , and neurologic types (American Thoracic Society, 2019). However, this taxonomy does not capture the multidimensional nature of the response, which involves intertwined ventilatory, autonomic, thermoregulatory, and respiratory‐muscle components.
[Your Name], MD, PhD Email: your.email@university.edu Abstract Background: Hyperventilation is a common physiologic response to metabolic, psychogenic, and neurologic stressors. Existing classifications lack granularity in distinguishing sub‑phenotypes that differ in pathophysiology, clinical presentation, and response to therapy. The “Hyperventilation 5 VOSTFR‑” (Ventilatory‑Oscillatory‑Sympathetic‑Thermoregulatory‑Respiratory) framework proposes five distinct mechanistic axes to better characterize acute hyperventilatory events.
To validate the 5 VOSTFR‑ model in a prospective cohort of adult patients presenting with acute hyperventilation and to assess the efficacy of a targeted, axis‑specific therapeutic algorithm.