Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study reports the results obtained with mechanical ventilation in severe respiratory failure secondary to status asthmaticus. Of the 159 patients with status asthmaticus admitted to the Intensive Respiratory Unit over a 5-yr period, 26 required mechanical ventilation for a total of 34 episodes of acute respiratory acidosis. At the time of intubation, 10 patients were in coma and 5 were in respiratory arrest. Controlled mechanical ventilation was maintained for a mean of 2.5 days. Complications were few and reversible. All patients survived. These favorable results are attributed to a new strategy: mechanical ventilation is used to obtain a correction of hypoxemia with hyperoxic mixtures without attempting to restore an adequate alveolar ventilation. The respirator is adjusted to avoid high airway pressures, which appear to be more dangerous than persistent hypercapnia itself. Correction of hypercapnia is obtained later when bronchial obstruction relief provides better conditions of ventilation-perfusion distribution. So the risks of barotrauma and cardiocirculatory failure, which are frequently reported as fatal complications, appear to be significantly decreased.
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PMID:Mechanical controlled hypoventilation in status asthmaticus. 670 97

Described in this study are eight patients with alveolar hypoventilation syndromes who presented with carbon dioxide narcosis and coma. After reversal of severe hypercapnia, all patients were discharged and maintained at home for an average period of 10 years utilizing "noninvasive" nocturnal mechanical ventilation. The use of "noninvasive" mechanical ventilation at home attempted to void the hazards of tracheostomy and the difficulties inherent in continuous daytime use of oxygen. This form of treatment has allowed these patients to continue their previously productive lives. This study represents the first published long-term follow-up regarding this mode of treatment in patients with alveolar hypoventilation.
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PMID:Sustained reversal of chronic hypercapnia in patients with alveolar hypoventilation syndromes. Long-term maintenance with noninvasive nocturnal mechanical ventilation. 678 39

A study on two groups of patients in acute respiratory failure with hypercapnia (18 subjects) and in hypercapnic coma (18 subjects) has been carried out to determine the related changes in sodium ion, potassium ion, chloride ion, urea and osmolality in blood and cerebrospinal fluid. There were significant differences between the two pathological states and particularly in coma, changes in transmembrane active transport of electrolytes are significantly related to high concentrations of CO2 in the brain.
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PMID:Changes in plasma and cerebrospinal fluid electrolytes in hypercapnia. 678 28

Over an 18-month period, 56 pediatric patients who sustained severe neurologic insults underwent intracranial pressure (ICP) monitoring. Indications for monitoring ICP were (1) a Glasgow Coma Scale (GCS) score of 7 or less or (2) loss of consciousness with inability to utter recognizable words or follow commands. Diagnoses were head trauma (n = 40), Reye's syndrome (n = 10), and hypoxic encephalopathy due to near-drowning (n = 6). Eighty per cent of patients had ICP elevations requiring treatment. The complication rate was 5.3 per cent, with no serious complications or infections noted. Overall mortality was 14 per cent, but patients with hypoxic encephalopathy had significantly higher mortality (33%) when compared to patients with head trauma (12.5%) or Reye's syndrome (10%). Other factors associated with a poor outcome included presence of an intracranial mass lesion, GCS score, ICP elevations, hypoxemia, hypotension, hypercarbia, and the presence of multiple injuries (p less than 0.01). Early diagnosis and aggressive treatment in these patients, including the use of ICP monitoring, has resulted in acceptable recovery in over 85 per cent of these patients.
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PMID:Emergency intracranial pressure monitoring in pediatrics: management of the acute coma of brain insult. 708 9

Three consecutive cases of myxedema coma treated successfully with either nasogastric or intravenous route of administration of I-triiodothyronine, followed by oral thyroxine, are described. All were hypothermic, had biochemical evidence of advanced hypothyroidism (T4 less than 1.0 micrograms/dl, T3 less than 20 ng/dl and TSH greater than 150 microU/ml), severe hypoxemia, respiratory acidosis, hypercarbia and temporary depression of respiratory center responsiveness. In only one patient it was found significant hyponatremia (Na = 127 mEq/l). Two patients were successfully treated with the nasogastric route of administration of T3 (12.5 micrograms/6h) but in a female patient with intestinal atony (ileus) there was no absorption of the orally administered T3. Intravenously administered T3 promptly corrected the hypometabolic state in this patient. It was confirmed that T4 therapy, although promptly correcting low serum T4 concentration, failed to rise serum T3 levels due to lack of peripheral T4 5'-monodeiodination to T3 in these critically ill patients.
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PMID:Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. 715 77

Disease secondary to heroin abuse constitutes a rarity in Spain. While there had been no previous cases in earlier years four young heroin addicts were admitted to the Hospital "1st de Octubre" for severe medical complications of their addiction within the last twelve months. Two patients were admitted in deep coma due to drug overdose, being cardiac arrhythmias and pulmonary edema the main associated complications. Cardiac rhythm disturbances are due to a heightened vagal tone, either secondary to inhibition of acetylcholine hydrolysis or to hypoxia, hypercapnia, and acidosis, factors that diminish cholinesterase activity and act synergistically to increase vagal tone. Pulmonary edema secondary to heroin overdose is non-cardiogenic and probably due to hypoxia added to the local action of heroin on the alveolocapillary membrane. The goal of therapy in such cases is to obtain an appropriate alveolar ventilation, the use of continuous positive pressure ventilation being required when there is pulmonary edema. The third patient had staphylococcal pneumonia with multiple abscess formation secondary to venous septic embolization originated peripherally where the drug was injected. Finally, the fourth patient was admitted because of a clinical and biochemical picture of HBsAg negative acute viral hepatitis, having suffered a similar clinical picture three years previously.
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PMID:[Severe medical sequelae in heroin addicts]. 720 89

The purpose of this study was to evaluate the results of mechanical ventilation in life-threatening status asthmaticus. 16 patients were treated for a total of 22 episodes of acute respiratory acidosis, with coma in 11 cases. Controlled mechanical ventilation was maintained from 10 to 196 hours and involved only minor complications without sequelae. All patients survived. These favourable results are attributed to a new strategy: the aim of mechanical ventilation is to relieve hypoxemia with hyperoxic mixtures without seeking rapid correction of hypercapnia, which is obtained later when bronchial desobstruction provides better conditions of VA/Q distribution. This allows low tidal volumes and low frequency, avoids high airway pressures and so decreases the danger of barotrauma and cardio-circulatory complications.
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PMID:[Mechanical ventilation in the treatment of acute respiratory insufficiency in asthma]. 722 25

A study has been carried out on patients presenting respiratory failure from chronic obstructive lung disease. Acid-base balance, electrolytes and amino acids levels have been studied in plasma and in cerebrospinal fluid (CSF) of patients in hypercapnic coma and results compared with those observed in patients with primary acute hypercapnia. Additional cardiopulmonary measurements were made. The study has shown evidence of significant modification of the distribution ratios of plasma and CSF electrolytes and amino acids, particularly in the patients with coma. The changes seem to be related to variations of the transmembrane potentials and alterations of some metabolic pathways involved in the homeostasis and in neurotransmission. Finally some of the changes of amino acid in plasma and CSF appear significantly correlated to variations in pulmonary function and to modification of acid-base balance observed both in plasma and CSF.
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PMID:Biochemical changes in acute respiratory failure. 733 63

A prospective and consecutive series of 225 patients with severe head injuries who were managed in a uniform way was analyzed to relate outcome to several clinical variables. Good recovery or moderate disability were achieved by 56% of the patients, 10% remained severely disabled or vegetative, and 34% died. Factors important in predicting a poor outcome included the presence of intracranial hematoma, increasing age, abnormal motor responses, impaired or absent eye movements or pupil light reflexes, early hypotension, hypoxemia or hypercarbia, and elevation of intracranial pressure over 20 mm Hg despite artificial ventilation. Most of these predictive factors were assessed on admission, but a subset of 158 patients was identified in whom coma was present on admission and was known to have persisted at least until the following day. Although the mortality in this subset (40%) was higher than in the total series, it was lower than in several comparable reported series of patients with severe head injury. Predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma. A plea is made for inclusion in the definition of "severe head injury" of all patients who do not obey commands or utter recognizable words on admission to the hospital after early resuscitation.
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PMID:Further experience in the management of severe head injury. 746 28

The objective of the study was to explore whether hypoglycemic brain damage is affected by super-imposed acidosis. To that end, animals with insulin-induced hypoglycemic coma, defined in terms of a negative DC potential shift, massive release of K+, or cellular uptake of Ca2+, were exposed to excessive hypercapnia (PaCO2 approximately 200 or approximately 300 mm Hg) during the last 25 min of the 30-min coma period. Animals were allowed to survive for 7 days before their brains were fixed by perfusion, and the cell damage was assessed by light microscopy. Other animals were analyzed with respect to changes in extracellular pH (pHe) or extracellular K+ or Ca2+ concentrations (K+e and Ca2+e, respectively). The total CO2 content (TCO2) was also measured to allow derivation of intracellular pH (pHi). The increase in PaCO2 to 190 +/- 15 and 312 +/- 23 mm Hg (means +/- SD) reduced the pHe from a predepolarization value of approximately 7.4 and a postdepolarization value (after the first 5 min of coma) of approximately 7.3 to 6.8 and 6.7, respectively. The corresponding mean pHi values were 6.7 and 6.5. The hypercapnia did not alter the K+e, which rose to 50-60 mM at the onset of hypoglycemic coma, but it increased the Ca2+e from approximately 0.05 to 0.10-0.16 mM. Normocapnic animals with induced hypoglycemic coma of 30-min duration showed the expected neuronal lesions in the neocortex, hippocampus, and caudoputamen. Hypercapnia clearly aggravated this damage, particularly in the caudoputamen, subiculum, and CA1 region of the hippocampus, and caused additional damage to cells in the CA3 region and piriform cortex. A rise in CO2 tension from approximately 200 to 300 mm Hg did not further aggravate the damage. The results thus demonstrate that relative moderate acidosis aggravates damage that is believed to be mostly neuronal, sparing glia cells and vascular tissue.
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PMID:The influence of acidosis on hypoglycemic brain damage. 779 41


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