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)

In 85 patinets withstatus asthmaticus, the authors have studied the acid-base balance, the blood gas tensions and various humoral parameters. The values were classified into two groups according to the PaCO2 level: below or equal to 44 torr (Group I), higher than 44 torr (Group II). In the 58 cases of Group II, there was a very close positive correlation between PaCO2 and H + ions, practically the same as that established by BRACKETT et al. [3] in experimental acute hypercapnia in man. On the contrary, the correlation derived from cases of status asthmaticus in the literature showed, in some cases, a metabolic component in acidosis. In the present work, the mean value of lactates was close to normal; there was a slow increase in protein content and hematocrit, in the two groups. The prognosis of the status asthmaticus depends on the degrees of hypercapnia: when it reaches 70 torr, mechanical ventilation is urgently needed and is the main part of the treatment; the use of additional drugs remains a matter of specific case.
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PMID:[Acid-base disorders in status asthmaticus (author's transl)]. 0 43

We studied 129 patients during acute, severe asthmatic attacks. Electrocardiograms showed P pulmonale in 49% of patients who had an arterial carbon dioxide tension (PaCo2) greater than or equal to 45 mm Hg and an arterial pH less than or equal to 7.37, whereas P pulmonale was present in only 2.5% of asthmatics who had a PaCO2 less than or equal to 44 mm Hg and a pH greater than or equal to 7.38 (p less than 0.001). P wave and QRS axes were 79 +/- 8 degrees and 80 +/- 20 degrees, respectively, in the presence of P pulmonale. When P pulmonale disappeared, the P wave and QRS axes shifted significantly to the left (p less than 0.001). Electrocardiographic P pulmonale persisted 12 to 60 hr after correction of hypoxemia, hypercapnia, and acidosis. In 7 patients with P pulmonale and respiratory acidosis, cardiac catheterization demonstrated normal artery pressures (PAPs) measured relative to atmospheric pressure. In 12 of these peak inspiratory pulmonary artery transmural pressures (PATPs) were increased. Since increased right heart transumural pressures could result in chamber distention, these data are consistent with the hypothesis that reversible P pulmonale in status asthmaticus is explainable on the basis of markedly negative tidal pleural pressures and increased right heart transmural pressures.
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PMID:P pulmonale in status asthmaticus. 3 21

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.
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PMID:Status asthmaticus. A nine-year experience. 57 61

Elevated plasma antidiuretic hormone (ADH) levels were noted in seven patients with status asthmaticus during the acute illness. These values returned to normal with resolution of the disease. The mechanism of this release is not completely understood but is consistent with the hypothesis that bronchospasm leads to decreased pulmonary blood flow, decreased volume return to the left atrium, and stimulation of the atrial volume receptors regulating ADH release. Planning for fluid therapy in patients with status asthmaticus should take into account a high probability of increased plasma ADH concentration during the acute illness. Water intoxication as well as hypoxia and hypercarbia should be considered as a possible cause of an altered state of consciousness associated with status asthmaticus.
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PMID:Elevated plasma antidiuretic hormone levels in status asthmaticus. 124 95

We compared the effects of pressure support ventilation (PSV) with those of assist control ventilation (ACV) on breathing patterns and blood gas exchange in six patients with status asthmaticus. Both PSV and ACV delivered adequate minute ventilation (PSV: 7.5 +/- 1.4 l/min/m2, ACV: 7.3 +/- 1.3 l/min/m2) to correct respiratory acidosis (pH = 7.33 +/- 0.12 during both PSV and ACV) and prevent hypoxia. Peak airway pressure during PSV was significantly lower with the same tidal volume than that during ACV (PSV: 30 +/- 10 cmH2O (2.9 +/- 1.0 kPa), ACV: 50 +/- 13 cmH2O (4.9 +/- 1.3 kPa)). The lower airway pressure during PSV was due to persistent inspiratory muscle activity. The oxygen cost of breathing estimated by oxygen consumption was equivalent in both modes. We conclude that PSV is effective in supplying tidal volumes adequate to improve hypercarbia at markedly lower airway pressures than ACV.
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PMID:Effectiveness of pressure support ventilation for mechanical ventilatory support in patients with status asthmaticus. 153 79

Bronchial lavage was performed in 10 cases with status asthmaticus who were mechanically ventilated. The mean value of PaCO2 was 64.4 +/- 17.4 Torr before bronchial lavage, and it significantly decreased to 51.9 +/- 11.0 Torr after lavage. In 7 out the 10 cases, bronchial lavage was judged to be effective from the clinical point of view. In 5 cases with values of PaCO2 of over 55 Torr before lavage, massive mucus plugs were recovered. Bronchial lavage was judged to be effective in all of them, whereas three out of the another five cases whose values of PaCO2 were less than 55 Torr showed exacerbation of hypercapnia, and the state of asthma worsened and/or continued for a longer period. The ratio of PaO2/FiO2 did not improve even in effective cases. These results indicated that bronchial lavage is a useful tool to improve the hypercapnic state in patient with status asthmaticus being mechanically ventilated, if the value of PaCO2 is over 55 Torr.
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PMID:[Bronchial lavage in the treatment of status asthmaticus]. 192 Sep 75

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.
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PMID:Intensive care of status asthmaticus. A 10-year experience. 236 33

The optimal management of asthma during pregnancy and lactation requires a cooperative approach between the physician managing asthma, the obstetrician-gynecologist, and the patient. Goals of therapy include: 1) avoidance of repeated episodes of asthma, 2) avoidance of emergency room visits, 3) avoidance of status asthmaticus, 4) prevention of death in the mother, 5) use of minimal medications in the gravida, and 6) avoidance of maternal medication use with uncertain or deleterious effects on the fetus. Because acute severe asthma may have it onset during pregnancy, the physician must be prepared to diagnose and treat the gravida to avoid or reduce episodes of maternal hypoxemia, hypocarbia or hypercarbia. Status asthmaticus has been associated with maternal and fetal deaths as well as intrauterine growth retardation. Although it is logical to assume that prevention of repeated episodes of asthma would be associated with a more favorable outcome in pregnancy, only recently was this actually documented. The purpose of this manuscript is to review issues in diagnosis and management of asthma during pregnancy and lactation.
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PMID:The management of asthma during pregnancy and lactation. 331 23

Although abnormal blood gases are unusual in status asthmaticus, hypercapnia indicates a considerable increase in bronchial resistance. The authors report their experience of 106 personal cases of acute severe asthma. Emergency management of acute respiratory failure consisted in symptomatic therapy (low rate oxygen or mechanical ventilation after nasal intubation). Corticosteroids, rehydration, antibiotics and beta-2 adrenergic agents were associated. Mechanical ventilation was necessary in patients who developed alterations of consciousness or PaCO2 above 60 mm Hg (8 kPa). In respirator-patients, sedative drugs were needed. Terbutaline and salbutamol were occasionally beneficial but epinephrine remains the drug of choice. In our series of 106 cases (79 with hypercapnia) the overall mortality was 3.8 p. 100. Of the 33 cases who underwent mechanical ventilation, there were 4 deaths (12 p. 100). A review of the literature showed a much higher mortality in other series.
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PMID:[Treatment of severe acute asthma in adults]. 370 59

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


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