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

Obesity is highly prevalent in the United States and is becoming increasingly common worldwide. The anatomic and physiological changes that occur in obese individuals may have an impact across the spectrum of critical illness. Obese patients may be more susceptible to hypoxemia and hypercapnia. During mechanical ventilation, elevated end-expiratory pressures may be required to improve lung compliance and to prevent ventilation-perfusion mismatch due to distal airway collapse. Several studies have shown an increased risk of organ dysfunction such as the acute respiratory distress syndrome and acute kidney injury in obese patients. Predisposition to ventricular hypertrophy and increases in blood volume should be considered in fluid management decisions. Obese patients have accelerated muscle losses in critical illness, making nutrition essential, although the optimal predictive equation to estimate nutritional needs or formulation for obese patients is not well established. Many common intensive care unit medications are not well studied in obese patients, necessitating understanding of pharmacokinetic concepts and consultation with pharmacists. Obesity is associated with higher risk of deep venous thrombosis and catheter-associated bloodstream infections, likely related to greater average catheter dwell times. Logistical issues such as blood pressure cuff sizing, ultrasound assistance for procedures, diminished quality of some imaging modalities, and capabilities of hospital equipment such as beds and lifts are important considerations. Despite the physiological alterations and logistical challenges involved, it is not clear whether obesity has an effect on mortality or long-term outcomes from critical illness. Effects may vary by type of critical illness, obesity severity, and obesity-associated comorbidities.
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PMID:Physiological and management implications of obesity in critical illness. 2517 6

To explore efficacy of acupoint massage combined with acupoint application on arterial blood gas and postoperative complications for patients undergoing laparoscopic cholecystectomy. Patients undergoing laparoscopic cholecystectomy (LC) in general anesthesia condition were randomly enrolled from local hospital into control group and experimental group. Four acupuncture points were prepared for acupoint massage and acupoint application, including bilateral Hegu acupoint (LI4), Neiguan Point (PC6), Zusanli Point (ST36) and Tanzhong acupoint (CV17). All patients in experimental group were treated with point acupressure treatment combined with acupoint application before LC, while control group directly receive LC surgery. The peak inspiratory pressure (PIP), end-tidal CO2 pressure (PETCO2), oxygen saturation (SpO2) and pH were examined at multiple time points during LC surgery. Related postoperative complications were documented for further analysis. All data were analyzed to assess efficacy of acupoint massage combined with acupoint application on arterial blood gas. There is no difference in baseline condition between experimental group and control group. Compared with control group, PetCO2 and SpO2 in experimental group were significantly increased while PIP was decreased. PH in experimental group ranged in a more stable domain. Hypercapnia and deep venous thrombosis were mitigated in experimental group compared with control group. Moreover, multiple pneumoperitoneum-related complications were alleviated after combined treatment, including pain and frequency of nausea and vomiting. Acupoint massage combined with acupoint application ameliorated related postoperative complications, and reduced side events of LC surgery via improving carbon dioxide metabolism.
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PMID:Efficacy of acupoint massage combined with acupoint application on arterial blood gas in patients undergoing laparoscopic cholecystectomy. 3155 Dec 18