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

Acute respiratory failure of chronic obstructive pulmonary disease is a common event. Vital prognosis is seldom directly engaged, and careful management generally allows patients to resume their prior respiratory status, and long term therapeutic procedures such as oxygen therapy or home ventilation to be discussed. Diagnosis is often simple, and evaluation of severity, therapeutic strategy, and etiology research are carried out simultaneously. The first step of treatment is controlled oxygen therapy. When conservative treatment fails to achieve safe level of PaO2 without inducing threatening hypercapnia, mechanical ventilation is required. Recent data strongly suggest that non invasive inspiratory pressure support brings major benefits in terms of morbidity and mortality.
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PMID:[Diagnosis and treatment of acute respiratory failure in chronic obstructive respiratory insufficiency]. 765 69

Respiratory failure is a severe impairment of pulmonary gas exchange, consequence of lung failure leading to hypoxaemia and/or pump failure causing hypercapnia. Acute respiratory failure (acute lung injury and asthma) or acute on chronic respiratory failure (COPD and chest wall disorders) are the two terms proposed to characterize different onset and development. Mechanical ventilation, is often a necessary life-saving treatment in many critically ill patients, it is associated with complications such as infection or barotrauma. Other innovative techniques are mask ventilation and proportional assist ventilation (PAV). The major aim of mask ventilation is to prevent complications related to tracheal intubation, particularly respiratory tract infections and barotrauma.
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PMID:Acute respiratory failure. 771 99

The effects of hypo-, normo- and hypercapnia on the variations in arterial oxygenation and their indices in critical patients with acute respiratory failure (ARF) receiving mechanical ventilation are studied. It is a prospective and randomized study carried out in multidisciplinary ICU. Fifteen ARF patients, intubated and mechanically ventilated, were studied within the first 48 h of evolution. Three stages were delimited: I) 30 min after the beginning of anaesthesia; II) 30 min after adding 30 cm of dead space (VD); III) 30 min after replacing the previous VD with VD of 60 cm. Ventilation parameters and FiO2 were kept stable. Stage I was characterized by respiratory alkalosis and stage II by normal acid-base balance with an increase in PaO2 (p < 0.01) and a decrease in intrapulmonary shunt (Qsp/Qt) (p < 0.001); the indices alveolar to arterial oxygen tension gradient [P(A-a)O2], respiratory index (R.I.) and estimated shunt (Est Shunt) also decreased significantly, whereas arterial to alveolar oxygen tension ratio (PaO2/PAO2) and arterial oxygen tension to inspired oxygen fraction ration (PaO2/FiO2) increased significantly. In stage III there was pure hypercapnic acidosis, with decreases in PAO2 (p < 0.001), P(A-a)O2 (p < 0.01) and R.I. (p < 0.05), while PaO2, Qsp/Qt, Est Shunt, PaO2/PAO2 and PaO2/FiO2 remained stable with respect to the previous situation. The observed PaO2 differs (p < 0.05) from the expected PaO2 in stage III. It is suggested that local or regional modifications of pulmonary perfusion are responsible for the observed variations. The P(A-a)O2 and R.I. indices do not make it possible to differentiate the causes of arterial hypoxemia in the presence of hypercapnia.
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PMID:The effect of hypo-, normo-, and hypercapnia induced by mechanical ventilation on intrapulmonary shunt. 780 Sep 19

The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to receive conventional therapy (n = 20) or conventional therapy plus NIPSV (n = 21). NIPSV was delivered to the patient by a face mask connected to a ventilator (Puritan-Bennett 7200a) set in inspiratory pressure support (IPS) mode. The mean levels of IPS, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FIO2) were respectively 15 +/- 3 cm H2O, 4 +/- 2 cm H2O, and 57 +/- 22%. The rate of endotracheal intubation (62 vs 70%, p = 0.88), the length of ICU stay (17 +/- 19 days vs 25 +/- 23 days, p = 0.16), and the mortality rate (33 vs 50%, p = 0.46) were not different between patients treated with NIPSV and those treated conventionally. Post hoc analysis suggested that in patients with PaCO2 > 45 mm Hg (n = 17), NIPSV was associated with a reduction in the rate of endotracheal intubation (36 vs 100%, p = 0.02), in the length of ICU stay (13 +/- 15 days vs 32 +/- 30 days, p = 0.04), and in the mortality rate (9 vs 66%, p = 0.06). We conclude that NIPSV is of no benefit when used systematically in all forms of acute respiratory failure not related to COPD. A subgroup of patients, characterized by acute ventilatory failure and hypercapnia, may potentially benefit from this therapy and further studies are needed to focus on this aspect.
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PMID:Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. 787 50

Disturbances in hormonal systems involved in sodium and water homeostasis are common during respiratory insufficiency. To investigate the role of hypercapnia, we designed a study to examine the hormonal response to acute hypercapnia induced at constant cardiac filling pressures and without hypoxemia. Seven sedated patients with COPD receiving mechanical ventilation were studied during five successive periods. Hemodynamics, arterial blood gases, and plasma hormone levels (atrial natriuretic peptide, renin, angiotensin II, aldosterone, vasopressin) were measured three times during 60 min of acute hypercapnia (52 +/- 5 mm Hg) and at control periods, before (36 +/- 4 mm Hg) and after (42 +/- 3 mm Hg) acute hypercapnia. During acute hypercapnia, mean pulmonary arterial pressure and cardiac output were increased without variation of other measured cardiorespiratory data and hormonal levels when compared with control values. After acute hypercapnia, cardiorespiratory variables returned to control values without variations of hormonal levels. Our results show that moderate acute hypercapnia does not significantly influence the hormonal levels when cardiac filling pressures and sympathetic tone remain stable. We suggest that changes in those plasma hormones involved in salt and water homeostasis during acute hypercapnia are secondary to hemodynamic changes induced by acute respiratory failure and not to acute hypercapnia per se.
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PMID:Effect of acute hypercapnia on alpha atrial natriuretic peptide, renin, angiotensin II, aldosterone, and vasopressin plasma levels in patients with COPD. 787 53

Acute respiratory failure is a complex disease process. However, it can be understood and appropriately managed if the key components of normal lung function are well understood and abnormalities are specifically identified. These components include oxygenation, ventilation, and respiratory mechanics. The abnormalities, which include hypoxia, hypercarbia, and altered compliance, can be present together or independent of each other. The optimum treatment modality will depend on which component predominates and on the factors producing changes from normal.
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PMID:Basic concepts of lung function and dysfunction: oxygenation, ventilation, and mechanics. 792 16

We describe polygraphic respiratory alterations during sleep in a child with neurofibromatosis. The patient, a four-year-old boy, had a medical history of neurofibromatosis and recurrent acute respiratory failure responsive to mechanical ventilation. All-night polysomnography showed severe nocturnal hypoventilation with marked hypercapnia (TcPaCO2 70 mmHg) and hypoxemia (SaO2 less than 40%). Nocturnal hypoxemia and hypercapnia and depressed response to the hyperoxic hypercapnic test confirmed the diagnosis of central hypoventilation syndrome. Cerebral magnetic resonance imaging disclosed lucent areas in the globus pallidus, mesencephalus and left upper pons. Therapy with nocturnal nasal positive bilevel ventilation reversed nocturnal hypoxemia and hypercapnia. This study suggests that patients with neurofibromatosis should be investigated for concomitant severe hypoventilation, particularly when clinical symptoms suggest brain stem lesions.
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PMID:Neurofibromatosis associated with central alveolar hypoventilation syndrome during sleep. 794 20

Mortality in acute respiratory failure in the non-neonatal pediatric patient has not changed substantially in 20 years, despite advances and refinements in conventional therapeutic strategies and technology. A host of innovative therapies are currently in various stages of investigation, including high frequency ventilation, pressure control ventilation, permissive hypercapnia, extracorporeal membrane oxygenation, exogenous surfactant administration, inhaled nitric oxide, and liquid ventilation. While none of these therapies has yet been prospectively studied in non-neonatal pediatric patients, all show much promise by virtue of their emphasis on either directly addressing pathophysiologic derangements associated with acute respiratory failure or by reducing the complications associated with conventional therapy.
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PMID:Novel therapies for acute respiratory failure. 798 88

In acute respiratory failure interstitial oedema, alveolar collapse, and multiple atelectasis are the main mechanisms which lead to increased venous admixture and impaired oxygenation. Thus the lung volume available for pulmonary gas exchange is considerably reduced. Since there is strong evidence that alveolar overdistension causes lung damage ('barotrauma/volutrauma') large tidal volumes and high airway pressures in mechanical ventilation have to be strictly avoided, even allowing hypoventilation ('permissive hypercapnia'). Recruitment of the collapsed alveoli by external or intrinsic PEEP, or by changing body position, is often possible. However, alveolar recruitment takes much longer than previously assumed: instead of occurring within one respiratory cycle ('inflection point'), it seems to take hours. This slow recruitment process can be effectively supported by a deliberate use of intrinsic PEEP as with inverse ratio ventilation, either in volume or pressure controlled mode. Assisted spontaneous breathing makes ventilatory support less invasive and offers considerable advantages for many patients, but there are still some restrictions. Individual adaptation may be difficult in some patients. New principles of assistance control ('proportional assist ventilation') may improve individual adaptation. New concepts for weaning in COPD patients seem to offer better clinical strategies.
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PMID:Artificial ventilation: some unresolved problems. 814 15

A 9-year retrospective review of 1,242 admissions to a tertiary burn center identified 137 patients who were intubated and ventilated for a critical airway or pulmonary problem. These patients varied in age from 2 months to 18 years with an average total body surface area (TBSA) burn of 55%. We evaluated this group for evidence of respiratory failure (ARF) as defined by the respiratory failure index (RFI) (PaO2/FIO2 < or = 300). While only 23% of admissions to the burn center were related to flame burns, these injuries accounted for 82% of children who had ARF. Forty-two percent of these intubated children had abnormalities on their admission chest x-ray and 61% of this cohort developed evidence of ARF as defined by the RFI. The development of sepsis along with ARF regardless of TBSA involvement doubles the mortality of ARF alone. Early burn wound excision and grafting is critically important to prevent the late complication of sepsis. We carefully monitor ventilator settings to insure low peak inspiratory pressures, allowing relative hypercapnia and avoiding hyperoxia. Despite an increased number of admissions and critically injured children, we have not seen an increase in morbidity and have had a 53% reduction in mortality in the last 2 years with these techniques. We believe this management offers the best outcome for the pediatric burn victim and would recommend this strategy to other centers dealing with these severely injured children.
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PMID:Mortality and respiratory failure in a pediatric burn population. 826 96


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