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

The level of urinary excretion of hydroxyproline is considered as an index of the metabolic activity of the collagen. It increases in situations which include an increase in the osteoblastic activity or in the bone resorption. In respiratory insufficiency a series of conditions occur which are theoretically capable of modyfing this parameter. Twelve patients (9 males and 3 women) with chronic respiratory disease in a situation of respiratory insufficiency (hypoxemia and/or hypercapnia at rest) were studied. The urinary excretion of hydroxyproline in these patients was 15.30 +/- 8.16 mg/day/m2, significantly greater than that of a control group with similar characteristics which was 9.97 +/- 3.07 mg/day/m2 (p less than 0.05; Student's t test). The existence of a significant correlation between the urinary excretion of hydroxyproline and the degree of hypoxemia (r = 0.66; p less than 0.01) was likewise verified; in the same way, although to a lesser degree with the hypercapnia (r = 0.62; p less than 0.05). The different factors capable of influencing the bone metabolism in respiratory insufficiency are discussed, as well as the effects of the medications used by these patients. It is possible, on the other hand, that the increase of the urinary excretion of hydroxyproline does not depend only on alterations in the metabolic condition of the bone, but also on a reduction in the hepatic metabolism of the amino acid in relation with gasometric modifications.
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PMID:[Urinary excretion of hydroxyproline in patients with chronic respiratory insufficiency (author's transl)]. 47 Apr 88

The authors analyze the role of the initial inpatient stage of long-term oxygen therapy (LOT) in combined treatment of chronic pulmonary failure in patients with chronic obstructive bronchitis, lung emphysema, and pneumosclerosis. The treatment lasted 30 days both in the main and in the control groups. In addition to basic therapy, the main group patients received 38% O2 for 15 h a day. To decrease the risk of PaCO2 elevation with a possible respiratory disorder, particularly in patients with initial hypercapnia, it is suggested that a special oxygen test with simultaneous control of acid-base balance and gas composition of the arterial blood may be carried out. In contrast to the control group, the main group patients demonstrated an improvement of gas composition of the arterial blood and of the parameters such as the alveolar-arterial gradient according to O2, the physiological pulmonary shunt. The combined use of oxygen therapy and resistance at expiration made it possible to ameliorate a number of external respiration function parameters, diffusion lung capacity, and enhanced the effect of oxygen therapy. It is shown that patients with PaO2 may be given LOT within the range of 60-69 mm Hg, provided the pulmonary physiological shunt exceeds 20%.
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PMID:[The hospital stage of the long-term oxygen therapy of chronic lung failure in patients with chronic obstructive bronchitis]. 180 14

The value of mechanical ventilation using intermittent positive pressure ventilation delivered non-invasively by nasal mask was assessed in six patients with life threatening exacerbations of chronic respiratory disease. Median (range) arterial oxygen and carbon dioxide tensions were 4.4 (3.5-7.2) kPa and 8.7 (5.5-10.9) kPa respectively, with four patients breathing air and two controlled concentrations of oxygen. The arterial oxygen tension increased with mechanical ventilation to a median (range) of 8.7 (8.0-12.6) kPa and the carbon dioxide tension fell to 8.2 (6.5-9.2) kPa. Four patients discharged after a median of 10 (8-17) days in hospital were well five to 22 months later. One died at four days of worsening sputum retention and another after five weeks using the ventilator for 12-16 hours each day while awaiting heart-lung transplantation. This technique of mechanical ventilation avoids endotracheal intubation and can be used intermittently. Hypercapnic respiratory failure can be relieved in patients with either restrictive or obstructive lung disease in whom controlled oxygen treatment results in unacceptable hypercapnia. Respiratory assistance can be tailored to individual need and undertaken without conventional intensive care facilities.
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PMID:Non-invasive mechanical ventilation for acute respiratory failure. 233 29

Portable pulse oximeters are now widely available for the assessment of arterial oxygenation, and the U.S. Medicare program considers saturation readings to be acceptable substitutes for arterial PO2 in selecting patients for long-term oxygen therapy (LTOT). Current oximeters are reasonably accurate (plus or minus 4 or 5 percent of the co-oximetry value), but the clinician should be aware of several potential problems. Readings may be inaccurate in the presence of hemodynamic instability, carboxyhemoglobinemia, jaundice, or dark skin pigmentation, and also during exercise. Indicated saturation may substantially overestimate arterial PO2 if the patient is alkalemic. Pulse oximetry cannot detect hypercapnia or acidosis. For these and other reasons, pulse oximetry should not be used in initial selection of patients for LTOT, as a substitute for arterial blood gas analysis in the evaluation of patients with undiagnosed respiratory disease, during formal cardiopulmonary exercise testing, or in the presence of an acute exacerbation. Pulse oximetry is an important addition to the clinician's armamentarium, however, for titrating the oxygen dose in stable patients, in assessing patients for desaturation during exercise, for sleep studies, and for in-home monitoring.
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PMID:Pulse oximetry versus arterial blood gas specimens in long-term oxygen therapy. 211 92

In view of their own effects and haemodynamic repercussions, abnormalities in blood gas values are increasingly recognized as being of major significance for the prognosis of chronic obstructive respiratory diseases. Controlled trials of low flow rate oxygen therapy have demonstrated that correcting hypoxaemia in such cases significantly improved the vital prognosis. Almitrine bismesylate administered in single or multiple daily doses in short-medium-or long term treatment to patients with chronic bronchitis and hypoxaemia has proved capable of increasing PaO2 and, when hypercapnia is present, decreasing PaCO2. In responsive patients, a 1.5 mg/kg dose brings about a 5 mmHg change in PaO2 values and, when applicable, PaCO2 values. Several studies with a 1 year follow-up have shown that almitrine bismesylate represents a breakthrough in the management of respiratory failure consecutive to chronic obstructive respiratory disease. Only long-term controlled trials will demonstrate whether this drug can really improve the vital prognosis and even alter the natural course of the disease.
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PMID:[Should arterial gas values be improved in patients with chronic bronchitic respiratory insufficiency? Value of almitrine dimesylate]. 614 37

Combined chest wall and lung alterations may lead to severe restrictive respiratory disorder. In advanced cases with hypercapnia, hypoxemia and oxygen intolerance during spontaneous breathing, there are almost insuperable therapeutic difficulties. Three of such patients have been treated, after tracheostomy, at home for 60, 34 and 22 months respectively by intermittent IPPV ventilation. With an improved quality of life all these patients survived up to now. This result seems to be encouraging.
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PMID:[Long-term artificial respiration at home in restrictive ventilation disorders]. 642 10

Recent reports suggest that endogenously released endorphins may exert a modifying influence on respiratory center drive in patients with respiratory disease. In this report, we employed respiratory inductive plethysmography to noninvasively assess breathing patterns with particular attention to respiratory center drive as reflected by mean inspiratory flow. We studied 10 patients with documented chronic obstructive pulmonary disease (6 with hypercapnia and 4 with normocapnia) after treatment with placebo and the opiate antagonist, naloxone. No significant change in breathing pattern was observed in either patient group after treatment with placebo or naloxone, although individual patients displayed greater respiratory drive after naloxone than placebo. Therefore, endorphins do not exert a consistent influence on respiratory center output in patients with chronic obstructive pulmonary disease.
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PMID:Effect of naloxone on breathing pattern in patients with chronic obstructive pulmonary disease with and without hypercapnia. 664 50

Data from a drug surveillance programme were analysed to estimate the frequency with which patients with a diagnosis of respiratory failure had been exposed to CNS-depressing drugs. Eleven out of 37 patients with respiratory failure had received such medication. A detailed comparison of these patients and controls admitted to hospital because of respiratory disease who did not develop respiratory failure failed to reveal significant differences in drug usage. This unexpected finding suggests that patients with respiratory disease of equal severity may vary greatly in their tendency to develop carbon dioxide retention following administration of drugs with respiratory depressant properties.
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PMID:Acute respiratory failure and CNS-depressing drugs. 730 67

In early phases of respiratory disease, patients are more likely to experience intermittent hypercapnia than a continuous increase in PCO2. The effect of intermittent arterial PCO2 elevation on subsequent breathing patterns is unclear. To examine this issue, a series of six ventilatory challenges (CH1-CH6), consisting of 2 min of breathing 5% CO2 in O2, followed by 5 min in room air (RA) were performed in 10 naive healthy subjects (age 12-39 yr). Minute ventilation (VE) increased from 11.9 +/- 1.0 (SE) l/min in RA to 27.6 +/- 3.0 l/min in 5% CO2 (P < 0.0005) in each of the six hypercapnic challenges. Respiratory rate increased from 21.3 +/- 2.6 breaths/min on RA to 29.6 +/- 3.9 breaths/min during CH1 (P < 0.05). However, respiratory rate consistently decreased with successive CO2 challenges (CH6: 21.5 +/- 2.6 breaths/min; P < 0.02). Thus, maintenance of VE was achieved by gradual increases in tidal volume with each of the first four consecutive CO2 challenges (CH1: 1.05 +/- 0.09 liters; CH4: 1.44 +/- 0.13 liters; P < 0.002). Similarly, the ratio of tidal volume to inspiratory time increased from CH1 (1.16 +/- 0.16 l/s) to CH6 (1.57 +/- 0.21 l/s; P < 0.001). These changes in ventilatory strategy were not observed when RA recovery periods were extended to 15 min in five subjects. We conclude that during repeated short hypercapnic challenges similar levels of VE are achieved. However, increased mean inspiratory flows are generated to maintain VE. We speculate that intermittent hypercapnia either modifies central controller gain or induces a long-term modulatory effect to account for the progressive changes in ventilatory components.
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PMID:Ventilatory responses to repeated short hypercapnic challenges. 761 45

An experience of surgical non-thoracic emergencies in patients admitted for chronic lung disease is herein presented. Fifty-four patients out of 10457 admitted in the four Departments of Pneumology of the Binaghi Hospital (Cagliari) between 1-1-1985 and 31-3-1993, were referred to our Department of General Surgery due to non-thoracic surgical emergencies. There was a considerable delay in the referral (only 25% of patients within 12 hours from the onset of symptoms): indeed predominant respiratory symptoms, hypoxia and hypercapnia made these patients no responsive to symptoms of surgical emergency. Surgical emergencies in causal correlation with respiratory disease (intestinal occlusion due to abdominal metastases of lung carcinoma, complicated peptic ulcer) had the worst prognosis (mortality: 52.9%). Those in chance connection, such as acute limb ischemia and preexisting abdominal disease, had a less adverse outcome. Mortality, however, was 37.5%: this datum outlines the role of chronic lung disease in defining operative risk. The authors call attention to three groups of observed patients: 1) three patients were operated on for intestinal occlusion due to unrecognized abdominal neoplasia, that showed itself in the course of hospitalization in the Department of Pneumology for lung metastases; 2) in 3 cases symptoms and signs of acute abdomen were observed without abdominal disease. The cause of acute pseudoabdomen was diaphragmatic pleural or basal pulmonary inflammation; 3) the eight patients with pulmonary embolism were all admitted in the Department of Pneumology with a wrong diagnosis of bronchopneumonia.
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PMID:[Extrathoracic surgical emergencies in hospitalized patients with bronchopulmonary diseases. Analysis of the operative risk]. 780 66


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