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

A case of severe ARDS following amniotic fluid embolism is described. During the 15 month period of I.C.U. treatment a number of respiratory complications had to be overcome. Chronic hypercapnia led to changes of bone and soft tissue composition. The patient was discharged home with a marked restriction of pulmonary function. Respiratory infections continue to occur.
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PMID:[ARDS following amniotic fluid embolism. Case report of successful long-term intensive therapy]. 310 18

Excess carbohydrate calories in total parenteral nutrition (TPN) solutions can precipitate acute hypercapnic respiratory failure in patients with chronic lung disease secondary to increased carbon dioxide (CO2) production. Two young patients recovering from the adult respiratory distress syndrome experienced hypercapnia during weaning as a result of nutritionally related increased CO2 production. As carbohydrate calories were decreased, CO2 production diminished and hypercapnia resolved. Hypercapnia as a complication of nutritional support during weaning can occur in patients without chronic lung disease and is corrected by decreasing carbohydrate calories.
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PMID:Hypercapnia during weaning. A complication of nutritional support. 392 89

A 31-year-old woman sustained multiple injuries, including severe contusion of the right lung with massive subcutaneous emphysema. Four weeks later she was transferred to our institution with post-traumatic adult respiratory distress syndrome and carbon dioxide retention, resulting from a postlaceration stenosis of the left main-stem bronchus. Bronchoplasty was contraindicated because of the serious condition of the patient. Repeated bronchial dilatations produced initial improvement in oxygenation and minute ventilation requirements. However, because of the nature of the stenosis and the lack of recovery of right lung function, the patient's encouraging clinical course reached a plateau and attempts at weaning from the respirator were unsuccessful. Bronchoplasty was performed on postadmission day 50 and resulted in gradual recovery of pulmonary function. Six months following discharge, the patient continues a steady improvement. Management of the patient's injuries represented a unique challenge previously unencountered.
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PMID:Post-traumatic bronchial stenosis and acute respiratory insufficiency. 737 4

The management of increased intracranial pressure (ICP) in patients with an associated acute lung injury is difficult. High levels of PaCO2 as tolerated for permissive hypercapnia are deleterious for cerebral circulation. In such circumstances, tracheal gas insufflation (TGI), which was recently proposed to reduce PaCO2, may be of benefit. We report the cases of two patients with severe adult respiratory distress syndrome and head trauma complicated with elevated ICP. The introduction of TGI decreased PaCO2 by 17 and 26%, decreased ICP, and increased calculated cerebral perfusion pressure. We conclude that TGI could be added to a pressure-targeted strategy of ventilatory management when severe adult respiratory distress syndrome was associated to an intracranial hypertension.
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PMID:Intracranial hypertension and adult respiratory distress syndrome: usefulness of tracheal gas insufflation. 747 82

The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS). Over a 2-year period, 39 trauma patients were treated for ARDS. Permissive hypercapnia was used in 11, and the remaining patients were treated conventionally. Demographics and risk factors were well matched in PH patients and controls. The duration of mechanical ventilation was greater in PH patients [49.2 +/- 15.2 vs. 20.8 +/- 10 days (p < 0.01)]. Survival was also greater in the PH group [91% vs. 48% (p < 0.01)]. A reduction in intensity of mechanical ventilation is associated with a prolongation of ventilatory support and an improved outcome from ARDS.
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PMID:Permissive hypercapnia in trauma patients. 747 99

The complex pathophysiology of adult respiratory distress syndrome (ARDS) makes preventive and therapeutic concepts difficult. Ample experimental evidence indicates that ARDS can be prevented by blocking systemic inflammatory agents. Clinically, only heparin, for inhibition of coagulation phenomena, is presently used among this array of approaches. Corticosteroids have not proven to be beneficial in ARDS. Alternative antiinflammatory agents are being proposed and are under current clinical investigation (e.g. indomethacin, acetylcysteine, alpha 1-proteinase inhibitor, antitumor necrosis factor, interleukin 1 receptor antagonist, platelet-activating factor antagonists). Symptomatic therapeutic strategies in early ARDS include selective pulmonary vasodilation (preferably by inhaled vasorelaxant agents) and optimal fluid balance. Transbronchial surfactant application, presently tested in pilot studies, may be available for ARDS patients in the near future and may have acute beneficial effects on gas exchange, pulmonary mechanics, and lung hemodynamics; its impact on survival cannot be predicted at the present time. Strong efforts should be taken to reduce secondary nosocomial pneumonia in ARDS patients and thus avoid the vicious circle of pneumonia, sepsis from lung infection, and perpetuation of multiple organ dysfunction syndrome. Optimal respirator therapy should be directed to ameliorate gas-exchange conditions acutely but at the same time should aim at minimizing potentially aggravating side effects of artificial ventilation (barotrauma, O2 toxicity). Several new techniques of mechanical ventilation and the concept of permissive hypercapnia address these aspects. Approaches with extracorporeal CO2 removal and oxygenation are being used in specialized centers.
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PMID:Prevention and therapy of the adult respiratory distress syndrome. 761 57

A progressive pulmonary disease resulting in severe respiratory failure and death in an average of 3 weeks was diagnosed in 11 young Dalmatian dogs. The dogs were from 4 litters, all genetically related by a common ancestor. The initial clinical signs were tachypnea and noisy respiration. Respiratory distress developed shortly before death and was characterized by strenuous and rapid respirations, along with cyanosis and vomiting. On blood gas analysis, there were severe arterial hypoxemia, hypercapnia, and marked alveolar-arterial oxygen difference. Radiographically, a diffuse pattern of alveolar, interstitial, and peribronchial densities was observed in the lungs. Most dogs developed pneumomediastinum and gastroesophageal intussusception in the terminal phase of the disease. There was no response to treatment with antibiotics, corticosteroids, diuretics, or oxygen. At necropsy, the lungs were wet, heavy, and relatively airless. Absence of 1 kidney in 2 dogs and severe internal hydrocephalus in 2 dogs were additional necropsy findings. Pulmonary histopathology included metaplasia and atypia of the alveolar and bronchiolar epithelium, a nonpurulent inflammatory reaction characterized mainly by mononuclear cells and macrophages, eosinophilic hyaline membrane formation, and focal pulmonary fibrosis. The histological manifestations were typical of acute lung injury. Clinically, the findings were consistent with adult respiratory distress syndrome (ARDS), except for the relatively long course. No known risk factors for ARDS, such as trauma, toxin exposure, infection, or endotoxemia could be identified. The relationship of the other abnormalities (ie, renal aplasia, hydrocephalus) to the pulmonary disease also remains obscure. An inherited defect is suspected, because segregation analysis of the 4 litters suggests autosomal recessive inheritance.
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PMID:Lung injury leading to respiratory distress syndrome in young Dalmatian dogs. 767 17

This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H2O (p = 0.005) and minute ventilation from 13 +/- 3.5 to 11 +/- 3 L/min. CO2 removal by IVOX allowed a significant decrease in PaCO2 from 66 +/- 15 to 59 +/- 13 mm Hg. Improvement of oxygenation with IVOX was not significant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study.
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PMID:Permissive hypercapnia and intravascular oxygenator in the treatment of patients with ARDS. 786 32

Concern that barotrauma may lead to further deterioration in pulmonary function in patients with ARDS has stimulated interest in developing methods of reducing it. These new modalities have had limited acceptance. The reasons for this include technical difficulties, associated complications, and the hypercapnia produced by the reduction in minute ventilation associated with diminished peak inspiratory pressure (PIP). Recent reports have shown that hypercapnia does not produce many of the adverse effects previously attributed to it. We studied the effects of moderate levels of hypercapnia produced by inverse ratio ventilation with low tidal volumes in patients with severe pulmonary dysfunction (Lung Injury Score > or = 2.5). The mean peak PaCO2 and PIP of the group were 63.3 +/- 15.7 mm Hg and 44.0 +/- 12.4 cm H2O, respectively. We found no adverse effects on cardiac function, oxygen utilization, or long-term neurologic function in patients after hypercapnia. We conclude that moderate levels of hypercapnia are safe, and may be permitted in the care of patients with severe pulmonary dysfunction.
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PMID:Hypercapnia: is there a cause for concern? 802 63

Conventional treatment of the adult respiratory distress syndrome (ARDS) includes pressure-limited ventilation, permissive hypercapnia, posture changes, aggressive dehydration, selective lung ventilation, and extracorporeal gas exchange. New strategies such as nitric oxide inhalation, the implantation of an intravenous membrane oxygenator (IVOX), and surfactant replacement are currently under evaluation. Nitric oxide (NO) is an important endothelium-derived relaxing factor that is rapidly inactivated by binding to haemoglobin. Inhaling this substance has been shown to induce selective vasodilatation of ventilated lung regions. Thus, inhaled NO reduces pulmonary hypertension, increases right heart ejection fraction, and improves arterial oxygenation by redistributing blood flow away from areas with intrapulmonary shunts to areas with a normal ventilation/perfusion ratio. Dose-response analysis has revealed that effective doses for improvement of oxygenation are lower than for reduction of mean pulmonary artery pressure. The use of a miniaturised membrane lung, IVOX, for intracaval oxygen and carbon dioxide exchange is a new approach to augment gas exchange. The IVOX is inserted via an introducer into the femoral vein and is designed for placement in the full length of the vena cava. Initial experiences with this device show that the currently used prototype provides a maximum of one-third of basal gas exchange. Therefore, a more efficient device will be needed to significantly reduce high inspired oxygen concentrations and airway pressures. Moreover, there exists evidence that IVOX causes caval obstruction. Lung surfactant recovered in BAL from patients with ARDS demonstrates that fractional contents of phosphatidylcholine and phosphatidylglycerol are reduced, and that the total concentration of apoproteins is decreased. Furthermore, the surfactant surface tension-lowering activity is abnormal. Thus, administration of exogenous surfactant may have therapeutic benefits. However, the optimal surfactant preparation, the optimal amount required to restore lung surfactant activity, and the optimal method to deliver it to patients with ARDS are unknown and currently under evaluation.
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PMID:[Therapy of ARDS. 2. New management methods--first clinical experiences]. 804 71


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