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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective analysis of 811 patients admitted to the hospital for status asthmaticus over a nine-year period was performed. Eight patients died, and 19 required mechanical ventilation. All persons who died of status asthmaticus were in the group that required mechanical ventilation. In 12 of the patients who received ventilation, no definite cause for the acute exacerbation could be identified, although initial arterial blood gas analyses showed profound hypoxemia, hypercapnia, and acute respiratory acidosis. Seventy-eight major complications occurred during mechanical ventilation. Pneumothorax, endotracheal tube malfunction, alveolar hypoventilation on the ventilator, and pneumonia were associated with decreased survival. Mucous plugging of the airways was found in all autopsied patients. Mechanical ventilation in status asthmaticus is a life-support system associated with substantial morbidity and should be instituted only when it becomes evident that maximal medical therapy will not be efficacious.
JAMA 1977 Sep 12
PMID:Status asthmaticus. A nine-year experience. 57 61

Of 100 consecutive patients with severe head injury who arrived at a major trauma center, half of whom came direct from the accident site and half from another hospital, potentially serious systemic insults to the brain were present in 44 cases. Arterial hypotension (13 cases), anemia (12 cases), and hypercarbia (4 cases) were almost exclusively associated with multiple injuries, which were present in 57 patients and were caused usually by vehicular accidents. Hypoxia was seen in 30 patients, including several with brain injury alone. These systemic insults to the already injured brain were associated with an increase in mortality and morbidity. We believe that direct transfer to a trauma center that has full-time neurosurgical facilities for victims of automobile accidents and patients who have been rendered unconscious by a fall or blow on the head will increase survival. Care for the patient with head injuries should start at the roadside.
JAMA 1978 Aug 04
PMID:Early insults to the injured brain. 66 Aug 88

Cor pulmonale is right ventricular enlargement secondary to pulmonary hypertension. Although most often caused by parenchymal lung disease, derangements of the ventilatory drive, the respiratory pumping mechanism, or the pulmonary vascular bed may also result in right ventricular hypertrophy and dilatation. Arterial hypoxemia (and resultant polycythemia), hypercapnia, and respiratory acidosis all contribute to the increased afterload on the right ventricle. Diagnosis is often difficult, since pulmonary vascular disease, pulmonary hypertension, and cor pulmonale have few specific manifestations, especially early in their evolution. Treatment is primarily directed at the underlying pulmonary or ventilatory disorder, rather than at the right ventricular failure per se. Supplemental oxygen is essential to avoid hypoxia; corticosteroids, anticoagulants, vasodilators, and other specific therapies are used as indicated to treat the underlying pulmonary disorders. When medical therapies fail, lung or heart-lung transplantation has become a possibility for selected patients.
JAMA 1990 May 02
PMID:Chronic cor pulmonale. Etiology and management. 239 36

Previous reports have disclosed a high morbidity and mortality in hospitalized asthmatics, especially those treated in the intensive care unit. Recently, it has been questioned whether the benefits of treating asthmatics in the intensive care unit outweigh the potential hazards. To address this issue, we examined the outcome of status asthmaticus in our medical intensive care unit between January 1, 1978, and December 31, 1987. Eighty episodes of status asthmaticus occurred in 64 patients. In 50 episodes, respiratory failure (PaCO2 greater than 50 mm Hg) was present. In half of these episodes, mechanical ventilation was avoided despite severe acidosis and hypercapnia; in the remainder mechanical ventilation was required as a lifesaving measure. Most patients improved rapidly and required only a short stay in the intensive care unit. There were no deaths and few complications. This was accomplished by close monitoring and repetitive blood gas analysis. We believe that the previous high complication rates and mortality associated with the hospital care of status asthmaticus can be avoided.
JAMA 1990 Jul 18
PMID:Intensive care of status asthmaticus. A 10-year experience. 236 33

Pretreatment and posttreatment arterial blood gas and pulmonary function testing measurements were prospectively compared as to their ability to assess asthma severity accurately and, thus, predict the outcome in 102 episodes of acute bronchial asthma initially seen in the emergency department. The Pao2, Paco2, or pH was unable to separate these patients requiring admission from those that could be confidently discharged, while the 1-s forced expiratory volume (FEV1) and peak expiratory flow rate (PEFR) did so both before and after treatment. Furthermore, virtually all patients with hypercarbia (Paco2 greater than 42 mm Hg) and/or severe hypoxemia (Pao2 less than 60 mm Hg) had a PEFR below 200 L/min, or an FEV1 below 1.0 L. Thus, selective use of arterial blood gas analysis should substantially decrease both diagnostic cost and patient discomfort without jeopardizing health care.
JAMA 1983 Apr 15
PMID:Arterial blood gases and pulmonary function testing in acute bronchial asthma. Predicting patient outcomes. 640 19

Asystole can be the presenting ECG finding of accidental hypothermia when the core temperature is less than 28 degrees C. Even two hours of persistent asystole does not represent irreversible cardiac compromise. With cardiopulmonary support and active rewarming, resuscitation and survival without serious sequelae can be achieved. Case reports and electrophysiology studies suggest that asystole is a primary manifestation of hypothermia potentiated by carbon dioxide retention. However, ventricular fibrillation in this setting is probably a secondary complication of resuscitation efforts, being precipitated by hypocapnic alkalosis, physical manipulation of the heart, and rewarming.
JAMA 1980 Mar 28
PMID:Recovery after prolonged asystolic cardiac arrest in profound hypothermia. A case report and literature review. 698 23

The last 30 years have brought a significant emphasis on home care for ventilator-dependent children. While the movement was driven by the desire to minimize healthcare costs, the advancements in medical knowledge and technology, and the change in the perception of a ventilator-dependent child have offered a fertile environment for the development of programs that support the chronic care of ventilator-dependent children at home (N. Engl. J. Med. 309(21) (1983) 1319; J. Pediatr. 106(5) (1985) 850; N. Engl. J. Med. 310(17) (1984) 1126; JAMA 258(23) (1987) 3398). In addition, the advances in medical and nursing care have led to the steady increase in the number of children with chronic respiratory failure and development of multi-disciplinary teams experienced and dedicated to the care of these children. Another trend that has also contributed to the rise in the number of pediatric patients using long-term mechanical ventilation is the parental expectation of long-term survival of their child. This parental expectation continues to grow as the effect of long-term mechanical ventilation on quality of life and longer survival becomes more evident. The primary indication for use of home mechanical ventilation is chronic respiratory failure (CRF) as indicated by hypoxemia and or hypercapnia. CRF is considered to be a condition persisting for greater than 1 month and requiring mechanical ventilation during part or all of the day to provide adequate gas exchange for the support of vital function (Chest 103(5) (1993) 1463).
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PMID:Tracheostomy and home ventilation in children. 1500 Nov 49