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

The possibility that arterial oxygen saturation (SaO2) decreases during sleep in children with chronic bronchial asthma was investigated. The relationship between decreases in sleep SaO2 and airflow obstruction and ventilatory drives, as characterized by ventilatory and inspiratory muscle activity responses to hypoxia and hypercapnia was also examined. Sixteen asthmatics on suboptimal bronchodilator therapy and ten healthy children were studied. Both maximum decrease in SaO2 and number of desaturations (decrease in SaO2 greater than or equal to 4%) per hour during sleep were greater in the asthmatics than in the control subjects. Both maximum decrease in SaO2 and number of desaturations per hour asleep were correlated with change in FEV1 and FEF25%-75% over the sleep period. Changes in SaO2 were not related to awake measurements of ventilatory drive. Eight of the asthmatics also were studied when on a more optimal medication regimen. On this program they had less airflow obstruction before and after sleep, and the number and extent of decreases in SaO2 were not different from those of the control subjects. We conclude: (1) decreases in SaO2 occurred during sleep in suboptimally treated asthmatic children; (2) SaO2 changes during sleep were related to the amount of air-flow obstruction that developed during sleep; (3) SaO2 changes during sleep were not related to ventilatory drive measured during wakefulness; and (4) a good therapeutic regimen eliminated abnormal amounts of sleep hypoxemia by improving airflow limitation. However, as the results of this study indicate, when their pulmonary status is unstable, asthmatic children may develop clinically significant hypoxemia during sleep.
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PMID:Arterial oxygen desaturation during sleep in children with asthma and its relation to airway obstruction and ventilatory drive. 743 80

I review my experience with life-threatening asthma, defined as hypercapnia, need for intubation, or death, at a large municipal hospital during a ten-year period. Such severe illness is rare among asthmatics and predicting its occurrence is difficult. Eighty patients had 111 admissions for life-threatening asthma; 773 patients were hospitalized for asthma 851 times during the study period. Only 15% of these 773 patients had experienced severe asthma previously and the duration of asthma and frequency of hospitalization was similar to that of the other patients admitted for asthma. Follow-up study of the survivors of life-threatening asthma has revealed a very high rate of recurrence. More than 35% had a recurrence in one to ten years, and those who had three to four episodes had a recurrence rate of 45% and 60%, respectively. Although life-threatening asthma is rare, unpredictable, and occurs only after many years of symptomatic illness, once it does occur there is a real risk of recurrence. Patients who have experienced such a severe episode of asthma require continuing careful supervision and management.
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PMID:Life-threatening asthma. 745 95

The objective of this study was to retrospectively review the medical records of 38 consecutive admissions to the medical intensive care unit of a tertiary-care university hospital of patients with severe asthma, and to determine the clinical characteristics of these patients, treatment regimens, and ultimate outcome. The 38 patients presented with severe asthma accompanied by hypoxemia, hypercapnia (mean pCO2 of 54.3 +/- 4.5 mm Hg), and decreased peak flow rates (125.5 +/- 12.4 L/min). The patients spent a mean of 60.1 +/- 9.7 hr in the medical intensive care unit. Seventeen of the 38 patients required intubation and mechanical ventilation. Overall, there were no deaths or significant complications. All 38 patients were discharged from the hospital. We conclude that severe, life-threatening asthma can be appropriately managed in the medical intensive care unit with a low incidence of complications and death. Prolonged mechanical ventilation is rarely required and most patients respond while the relatively simple management strategies.
J Asthma 1995
PMID:Clinical features, management, and outcome of patients with severe asthma admitted to the intensive care unit. 755 78

Respiratory failure is a severe impairment of pulmonary gas exchange, consequence of lung failure leading to hypoxaemia and/or pump failure causing hypercapnia. Acute respiratory failure (acute lung injury and asthma) or acute on chronic respiratory failure (COPD and chest wall disorders) are the two terms proposed to characterize different onset and development. Mechanical ventilation, is often a necessary life-saving treatment in many critically ill patients, it is associated with complications such as infection or barotrauma. Other innovative techniques are mask ventilation and proportional assist ventilation (PAV). The major aim of mask ventilation is to prevent complications related to tracheal intubation, particularly respiratory tract infections and barotrauma.
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PMID:Acute respiratory failure. 771 99

Despite advancing knowledge of the pathophysiology and treatment of asthma, asthma morbidity and mortality are on the rise. To help avert this trend, clinicians and patients must focus their attention on the early identification and treatment of asthma exacerbations. As in the words of Dr. Thomas Petty: " ... the best treatment of status asthmaticus is to treat it three days before it occurs." (7) Still, there will be asthmatics with life-threatening attacks that require careful assessment and aggressive management. Inhaled beta-agonists, systemic corticosteroids, and oxygen remain the drugs of choice in SA. Anticholinergics play a lesser role in the treatment of acute asthma, and debate continues regarding the efficacy of theophylline in this setting. Available data do not support the routine use of magnesium sulfate or antibiotics in patients with SA. Patients failing drug therapy should be considered early for intubation and mechanical ventilation. A strategy of mechanical ventilation that prolongs TE by limiting VE and decreasing inspiratory time, and that tolerates hypercapnia, avoids excessive lung hyperinflation and barotrauma and should improve the outcome of these most critically ill asthmatics. Intubated and mechanically ventilated patients should be aggressively sedated. Paralytic agents should be used only if adequate control of the cardiopulmonary status cannot be achieved by sedation alone. Minimizing the use of paralytic agents may decrease risk of myopathy and other adverse consequences of muscle paralysis. Finally, after successful treatment of a life-threatening episode of asthma, the treatment team should address prevention of future episodes of SA prior to discharge.
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PMID:The assessment and management of adults with status asthmaticus. 773 78

Permissive hypercapnia (PHY) represents an interesting approach in critically ill ventilated patients, because it allows to ensure adequate gas exchange while avoiding the adverse effects related to excessive airway pressures. Its objective is to improve oxygenation while reducing the risk of barotrauma and circulatory impairment. This concept is all the more important when considering that in majority of lung diseases for which MV is applied, lung involvement is highly inhomogeneous, meaning that the functionally normal or near normal areas are the most exposed to the deleterious effects of overdistension. Undesired physiological effects of non massive respiratory acidosis (PaCO2 < or = 80 mmHg, arterial pH > or = 7.15) are reversible and mostly minor. This good tolerance legitimizes two strategies: firstly to accept hypercapnia in conditions such as acute severe asthma for which enforced normalization of PaCO2 would imply potentially lethal complications, and secondly to deliberately induce respiratory acidosis while using very low airway pressures and alveolar ventilation to limit or prevent overdistension lung damage in injured as well as in normal areas. When the cerebral vasodilation induced by CO2 might aggravate a preexisting intracranial disorder, PHY is obviously contraindicated.
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PMID:[Controlled hypercapnia: a new strategy in the treatment of severe respiratory insufficiency]. 778 44

Arterial blood gas data were correlated with clinical variables including patients' perception of dyspnea and spirometry in 79 episodes of acute asthma attacks. Among several variables that showed univariate significance with severity, only subjective degree of dyspnea rated on a modified Borg scale (MBS) remained predictive to discriminate the presence or absence of hypoxia/hypercapnia in multivariate analyses. MBS alone could predict the arterial blood gas status with accuracy of approximately 75%. Therefore, patients' sensation of dyspnea seemed to be an important factor in the evaluation of acute asthma in an emergency room.
J Asthma 1994
PMID:Clinical features to predict hypoxia and/or hypercapnia in acute asthma attacks. 792 36

In a multicenter, randomized, double-blind study, we compared the effects of nebulized (5 mg x 2) and intravenous (0.5 mg) albuterol (salbutamol) over 1 h in 47 patients admitted to hospital with severe acute asthma defined as a peak expiratory flow (PEF) below 150 L/min and hypercapnia (Pa(CO2) > or = 40 mm Hg). Additional treatment included nasal oxygen and hydrocortisone succinate. The efficacy was assessed after 1 h. In the group treated by nebulization (NEB group, n = 22) 19 (86%) patients (95% confidence interval: 65 to 97%) had been treated successfully according to predefined criteria, versus 12 (48%) patients (95% confidence interval: 28 to 69%) in the intravenously treated group (i.v. group, n = 25), p = 0.006. The mean increase in PEF was greater in the NEB group than in the i.v. group (+107 +/- 94 L/min versus +42 +/- 66 L/min, p = 0.01) as well as the decrease in Pa(CO2) values (-10 +/- 5 mm Hg versus -2 +/- 12 mm Hg, p < 0.01). Beta agonist-induced hypokalemia was more pronounced in the i.v. group than in the NEB group. We conclude that, in hypercapnic acute asthma, the nebulized route has a greater efficacy and fewer side effects than the intravenous route.
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PMID:Nebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study. 800 99

During the last 4 years, fifty-seven patients of acute severe asthma (ASA) were admitted to intensive care unit (ICU). Twenty-three patients required mechanical ventilation (MV) on 25 occasions. Indications to intubate were persistent hypoxia (PaO2 < or = 55 mm Hg) or hypercapnia with respiratory acidosis (64%), abnormal mentation (24%) and respiratory arrest (12%). All the patients were monitored for clinical features, arterial blood gases (ABG) and peak airway pressure (PAP). During MV, there was one case of pneumothorax (4%), seven (28%) cases of transient hypertension and one (4%) patient died. Mean duration of MV was 3 days and the outcome was favourable. Therefore, resorting to aggressive treatment early in the course of disease proves life saving in acute severe asthma.
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PMID:Role of mechanical ventilation in acute severe asthma. 803 18

Platelet-activating factor (PAF) present in the blood of the patients with chronic pulmonary heart disease and asthma has been detected by high performance thin layer chromatography (HPTLC). The patients with chronic pulmonary heart disease accompanied by carbon dioxide retention (PaCO2 > 6.67 kPa) have a higher level of PAF in blood (0.75 +/- 0.27 microgram/ml) than those who have no carbon dioxide retention (PaCO2 < 6.67 kPa, PAF 0.41 +/- 0.25 microgram/ml) and those in the normal control group (0.45 +/- 0.20 microgram/ml), with P < 0.05 in all. The patients with asthma have a higher PAF in blood (0.83 +/- 0.05 microgram/ml) than those in the control group (P < 0.005). These findings suggest that PAF plays an important role in episodes of chronic pulmonary heart disease and asthma.
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PMID:Measurement of platelet-activating factor in human blood by high performance thin layer chromatography and its clinical application. 815 42


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