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

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.
 ...
PMID:[Mechanical ventilation in the treatment of acute respiratory insufficiency in asthma]. 722 25

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.
 ...
PMID:The assessment and management of adults with status asthmaticus. 773 78

Asthma is a common and debilitating problem in children. Its many costs to society include morbidity, hospitalization and treatment expenses, and a rising mortality rate. This paper examines recent trends in therapy for status asthmaticus. Oxygen, inhaled beta-adrenergic agonists, and corticosteroids remain the cornerstones of therapy for the child with a severe exacerbation of asthma. Ipratropium bromide provides additional bronchodilatation in the patient who does not respond to standard therapy. Theophylline may have a role in chronic outpatient management of asthma, but the data supporting the addition of this medication in acute therapy for status asthmaticus are inconclusive. Antibiotics are only indicated in children with asthma complicated by infection, such as sinusitis or pneumonia. Magnesium sulfate and heliox may have a role in helping the asthmatic child who is critically ill and for whom other interventions have failed. Mechanical ventilation has many complications. The concept of permissive hypercapnia may be important in limiting barotrauma. Prevention of exacerbations of asthma include limiting environmental exposure to allergens and tobacco, using corticosteroids, and reinforcing compliance with therapy.
 ...
PMID:Update on the management of status asthmaticus. 881 99

Research suggests that the forces exerted on the lungs by mechanical ventilators may cause as much damage to the lungs as the original pathologic process. In an attempt to limit additional injury to damaged lungs and improve the morbidity and mortality of patients requiring mechanical ventilation, investigators have proposed a controversial method of ventilatory management, permissive hypercapnia. This method attempts to maintain adequate oxygenation while allowing ventilation to decrease; carbon dioxide increases. The use of permissive hypercapnia is advocated in patients with acute lung injury and status asthmaticus. Ventilating pressures and volumes are lowered, with a resultant lower minute ventilation. Few adverse effects have been noted when this process has occurred gradually. By using permissive hypercapnia from the initiation of mechanical ventilation, it is possible to support the body through the resolution of the disease process while preventing additional lung injury.
 ...
PMID:Preventing complications of mechanical ventilation: permissive hypercapnia. 897 Feb 49

Extracorporeal life support (ECLS) was used to treat three patients with near-fatal status asthmaticus who did not respond to aggressive medical therapies and mechanical ventilation under controlled permissive hypercapnia. ECLS was instituted in patient 1 because PaCO2 was excessively high and pH was excessively low, in patient 2 because hypoxemia and shock were not responsive to treatment, and in patient 3 because of sustained severe hypotension. ECLS supported adequate gas exchange until pulmonary function improved, diminishing the need for mechanical ventilation and preventing pulmonary complications. Pulmonary dysfunction improved markedly after only 21 to 86 hours of ECLS. Aggressive medical treatments were continued during ECLS. Our findings indicate that ECLS is a useful method for preventing death in patients with near-fatal status asthmaticus.
 ...
PMID:Emergency extracorporeal life support for patients with near-fatal status asthmaticus. 933 62

Despite improved understanding of the basic mechanisms underlying asthma, morbidity and mortality remain high, especially in the "inner cities." The treatment of choice in status asthmaticus includes high doses of inhaled beta 2-agonists, systemic corticosteroids, and supplemental oxygen. The roles of theophylline and anticholinergics remain controversial, although in general these agents appear to add little to the bronchodilator effect of inhaled beta-agonists in most patients. Anti-leukotriene medications have not yet been evaluated in acute asthma. Other therapies, such as magnesium sulfate and heliox, have their advocates but are not recommended as part of routine care. If pharmacological therapy does not reverse severe airflow obstruction in the asthmatic attack, mechanical ventilation may be temporarily required. Based on our current understanding of ventilator-induced lung injury, optimal ventilation of asthmatic patients avoids excessive lung inflation by limiting minute ventilation and prolonging expiratory time, despite consequent hypercapnia. Unless respiratory function is extremely unstable, the use of paralytic agents is discouraged because of the increased risk of intensive care myopathy. Patients who have suffered respiratory failure due to asthma are at increased risk for subsequent death due to asthma (14% mortality at 3 years) and should receive very close medical follow-up. In general, severe asthmatic attacks can best be prevented by early intervention in the outpatient setting. In the words of Dr. Thomas Petty, "... the best treatment of status asthmaticus is to treat it three days before it occurs".
 ...
PMID:Medical and ventilatory management of status asthmaticus. 953 66

All patients with bronchial asthma are at risk of developing severe episodes of airway narrowing that do not respond to the usual medical treatment, a life-threatening situation referred to as status asthmaticus. In some cases, ventilatory failure occurs, necessitating mechanical ventilation to support gas exchange and to unload the respiratory muscles, giving time for other therapeutic interventions to improve the functional status of the patient. Mechanical ventilatory support poses additional risks to the patients, due to interaction between the pathophysiology of the disease and the process of mechanical ventilation. Dynamic hyperinflation, a cardinal feature of the pathophysiology, may cause serious complications during mechanical ventilation. Setting the ventilator, such as to minimize the dynamic hyperinflation, is a key point in the management of mechanically ventilated patients with status asthmaticus. Strategies to reduce dynamic hyperinflation, such as hypoventilation (permissive hypercapnia), increase of expiratory time and promotion of patient-ventilator synchrony are mandatory and significantly decrease the morbidity and mortality of the disease. Continuous monitoring of the effectiveness of these strategies, as well as the functional status of the patient, is crucial in order to limit complications associated with mechanical ventilation and to identify the time that weaning can start.
 ...
PMID:How to set the ventilator in asthma. 1078 31

Severe asthma, although difficult to define, includes all cases of difficult/therapy-resistant disease of all age groups and bears the largest part of morbidity and mortality from asthma. Acute, severe asthma, status asthmaticus, is the more or less rapid but severe asthmatic exacerbation that may not respond to the usual medical treatment. The narrowing of airways causes ventilation perfusion imbalance, lung hyperinflation, and increased work of breathing that may lead to ventilatory muscle fatigue and life-threatening respiratory failure. Treatment for acute, severe asthma includes the administration of oxygen, beta2-agonists (by continuous or repetitive nebulisation), and systemic corticosteroids. Subcutaneous administration of epinephrine or terbutaline should be considered in patients not responding adequately to continuous nebulisation, in those unable to cooperate, and in intubated patients not responding to inhaled therapy. The exact time to intubate a patient in status asthmaticus is based mainly on clinical judgment, but intubation should not be delayed once it is deemed necessary. Mechanical ventilation in status asthmaticus supports gas-exchange and unloads ventilatory muscles until aggressive medical treatment improves the functional status of the patient. Patients intubated and mechanically ventilated should be appropriately sedated, but paralytic agents should be avoided. Permissive hypercapnia, increase in expiratory time, and promotion of patient-ventilator synchronism are the mainstay in mechanical ventilation of status asthmaticus. Close monitoring of the patient's condition is necessary to obviate complications and to identify the appropriate time for weaning. Finally, after successful treatment and prior to discharge, a careful strategy for prevention of subsequent asthma attacks is imperative.
 ...
PMID:Clinical review: severe asthma. 1194 Feb 64

The indications for mechanical ventilation in status asthmaticus are cardiopulmonary arrest, significant alteration of consciousness, respiratory exhaustion, and progressive respiratory insufficiency despite aggressive bronchodilator treatment. In mechanical ventilation for status asthmaticus, a specific strategy directed at reducing dynamic hyperinflation must be used, with low tidal volumes and long expiratory times, achieved by diminishing respiratory frequency. This ventilatory pattern produces permissive hypercapnia, which is generally well tolerated with suitable sedation. The best methods for detecting and/or controlling dynamic hyperinflation in ventilated patients with status asthmaticus are the flow/time and flow/volume respiratory curves, pulmonary volume at the end of inspiration, and the pressure plateau. In addition to mechanical ventilation the child must receive sedation with or without a muscle relaxant to prevent barotrauma and accidental extubation. Bronchodilator treatment with beta-adrenergic agonists, methyl-prednisolone, and intravenous aminophylline are also required. A combination of inhaled salbutamol and nebulized ipratropium in the inspiratory branch of the ventilator should be used in patients in whom this treatment is effective. Currently there is insufficient evidence on the efficiency of other treatments in status asthmaticus and these should be used as rescue treatments.
 ...
PMID:[Ventilation in special situations. Mechanical ventilation in status asthmaticus]. 1451 6

Acute severe asthma is defined by the occurrence of an acute exacerbation resistant to the initial medical treatment, complicated by life-threatening respiratory distress due to severe lung hyperinflation. The conventional therapeutic approach is based on oxygen therapy and on the combined treatment of inhaled beta2-agonists at repeated doses and systemic corticosteroids. Inhaled or systemic magnesium sulfate is also recommended. The unresponsiveness to the initial bronchodilating therapy and the development of respiratory distress requiring intubation significantly increases mortality, due to the complications induced by mechanical ventilation. In these situations, a ventilatory strategy, including controlled hypoventilation with permissive hypercapnia, aiming at preventing lung hyperinflation, is indicated. Non-invasive ventilation may be successful in certain patients and represents an effective alternative to intubation. In ventilated patients, helium-oxygen mixtures can be considered as adjunctive therapies. After having reviewed the basic pathophysiological principles, this article will focus on the current medical treatment and of the modalities of mechanical ventilation in acute severe asthma.
 ...
PMID:[Severe acute asthma]. 1529 40


<< Previous 1 2 3 4 Next >>