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

Noninvasive positive pressure ventilation in patients with stable chronic obstructive pulmonary disease. The role of non-invasive positive pressure ventilation (NIPPV) is well documented in patients with restrictive thoracic diseases like kyphoscoliosis, tuberculosis sequelae or neuromuscular disease. There is also a good evidence for the use of NIPPV in acute respiratory failure in patients with an exacerbation of COPD. The application of NIPPV in patients with chronic respiratory failure is growing, but there is less evidence than in restrictive disorders. NIPPV can unload the respiratory muscles in patients with chronic hypercapnic COPD and so alleviates fatigue of the respiratory pump, but improvement in the maximal inspiratory pressure (Pi (max)) is small or even absent. An improvement of sleep quality has also postulated, there was an increase in total sleep time and sleep effectiveness when using higher inspiratory pressure. An increase of the walking distance was shown in short term studies, only. In most studies, there was an increase in quality of life as a main topic. Mortality was unchanged in the two long-term randomised controlled studies. Current data suggest a possible role of NIPPV in patients with severe hypercapnia. A high effective inspiratory pressure and a ventilator mode with a significant reduction in the work of breathing should be choosen. NIPPV should be started in hospital, a close reassessment must be performed. Patients who accepted NIPPV in the first weeks had a good compliance for long-term use.
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PMID:[Noninvasive mechanical ventilation in patients with stable severe COPD]. 1521 36

We report the combined use of heliox and high-frequency jet ventilation to augment carbon dioxide clearance, with a focus on the important technical considerations. Our case is a 5-month old infant with acute respiratory failure associated with gas trapping, hypercarbia, respiratory acidosis, and air leak. Despite maximal conventional ventilation, bronchodilator therapy, corticosteroids, and sedation, the infant continued to demonstrate worsening gas exchange necessitating an escalation of support to high-frequency oscillatory ventilation. After the development of an air leak and continued difficulties with carbon dioxide clearance, the patient was transitioned to high-frequency jet ventilation. Persistent hypercarbia resulted in the addition of heliox to facilitate ventilation. Improvements in gas exchange occurred rapidly. The combination of heliox and high frequency jet ventilation resulted in improved carbon dioxide clearance, respiratory stabilization, and the ability to wean ventilator settings.
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PMID:Heliox administration during high-frequency jet ventilation augments carbon dioxide clearance. 1532 76

We used Noninvasive Positive Pressure Ventilation (NPPV) in nine patients with acute respiratory failure (ARF), not related to chronic obstructive pulmonary disease (COPD). After separating the nine patients into a hypercapnic group (five patients) and a non-hypercapnic group (four patients), we investigated its effectiveness in physiological improvement and avoiding intubation. Dyspnea, physiological findings and ABG improved rapidly in both groups without serious adverse effects. The intubation avoidance rate was 66.7% (6 of 9) in total, and 80% in the hypercapnic group and 50% in the non-hypercapnic group. The ratio of PaO2 to FiO2 (P/F ratio) increased during NPPV in most cases where intubation could be avoided. It is worthwhile to use NPPV as a bridging therapy between O2 therapy and invasive ventilation in patients with non-COPD related ARF, regardless of the existence of hypercapnia. Careful monitoring of the P/F ratio and complications is needed to make an appropriate decision whether avoiding intubation will be possible or not.
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PMID:Noninvasive positive pressure ventilation in treatment of non-COPD related acute respiratory failure cases. 1545 93

The pathophysiology of upper-airway obstruction (UAO) is complex. Possible causes of UAO that may lead to acute respiratory failure, are as follows: infections like acute epiglottitis and croup, obstructing tumors in the base of the tongue, larynx or hypopharynx, aspirated food or liquid contents, obesity and anatomical variations. Management changes according to the pathogenesis of the disorder. In patients with severe carbon dioxide retention or apnea, emergency endotracheal intubation must be carried out. Hereby, we describe a 23-year-old patient with susceptible upper-airway anatomy and UAO occurred following an upper respiratory infection and complicated with pulmonary hypertension and pulmonary edema. Our patient seems to be one of the complicated UAO cases, with an unusual but critical clinical presentation, evaluated in a wide spectrum and nicely returned to life.
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PMID:Pulmonary hypertension and acute pulmonary edema in a 23-year-old male with a history of an upper respiratory tract infection. 1576 90

Due to the its great morbidity and mortality, home mechanical ventilation via tracheotomy is reserved, as a mandatory support, just to the patients with chronic obstructive pulmonary disease (COPD), who, after an episode of acute respiratory failure, cannot acquire a full ventilatory autonomy. During the last two decades the potential benefits of non-invasive ventilation (NIV) as a domiciliary treatment of severe COPD with CO2 retention have been investigated. Patho-physiologic basis of its employ are resting of respiratory muscles and/or resetting of respiratory centres. Due to its poor tolerability, negative pressure NIV has been taken over by positive pressure technique. As the results of the few available controlled studies obtained with the latter ventilatory technique aren't very enthusiastic and univocal, it's not possible to draw clear guidelines about the domiciliary use of NIV in COPD. In conclusion, the author suggests that, in order to avoid useless waste of resources, the application of NIV to stable COPD should be reserved to very selected cases (significant hypercapnia, frequent nocturnal desaturations and/or sleep disordered breathing and/ or hospital admissions) with demonstrated effectiveness and adequate compliance to the treatment. With the aim of better define the real field of application of home NIV in stable COPD, further and larger studies are needed having as end-points not only the crude survival and the lung functional data but also the quality of life of the patient and the impact upon the health expenses.
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PMID:[Home mechanical ventilation in chronic obstructive pulmonary disease]. 1681 6

Here we report two cases of congenital myopathy visited our hospital with respiratory failure. Case 1 was a 31-year-old woman, who had muscular weakness from birth but had never been diagnosed. She had an onset of pneumonia followed by severe type 2 respiratory failure. Even after the healing of pneumonia, hypercapnia remained. A diagnosis of nemaline myopathy was made after muscle biopsy. Case 2 is a 62-year-old man, who had slowly progressing respiratory failure accompanied with severe hypercapnea. His respiratory failure was improved by NIPPV. He also under went muscle biopsy and nemaline myopathy was diagnosed. Nemaline myopathy is one of congenital myopathy and is known to be a nonprogressive or slowly progressive disorder. However, some patients are diagnosed appropriately only when adult onset acute respiratory failure occurs.
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PMID:[Two cases of nemaline myopathy diagnosed after episodes of respiratory failure]. 1684 21

In recent years, pumpless arteriovenous systems for extracorporeal gas exchange have become a new therapeutic option for the treatment of patients suffering from acute respiratory failure. Experiences with the pumpless extracorporeal membrane lung in animal experiments and in patients with adult respiratory distress syndrome published in the current literature are reviewed. In addition this article presents a case of varicella pneumonia with persistent hypoxemia and hypercapnia under mechanical ventilation that showed a significant improvement with treatment with a pumpless extracorporeal lung assist using an arteriovenous shunt for eight days. The patient made a complete recovery. This is the first report of a patient with a life-threatening varicella pneumonia successfully treated with pumpless extracorporeal lung assist device. This review provides an update on interventional lung assist devices and a critical discussion of their advantages and limitations.
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PMID:An update on interventional lung assist devices and their role in acute respiratory distress syndrome. 1690 42

The mechanisms underlying acute respiratory failure induced by respiratory loads are unclear. We hypothesized that, in contrast to a moderate inspiratory resistive load, a severe one would elicit central respiratory failure (decreased respiratory drive) before diaphragmatic injury and fatigue. We also wished to elucidate the factors that predict endurance time and peak tracheal pressure generation. Anesthetized rats breathed air against a severe load ( approximately 75% of the peak tracheal pressure generated during a 30-s occlusion) until pump failure (fall in tracheal pressure to half; mean 38 min). Hypercapnia and hypoxemia developed rapidly ( approximately 4 min), coincident with diaphragmatic fatigue (decreased ratio of transdiaphragmatic pressure to peak integrated phrenic activity) and the detection in blood of the fast isoform of skeletal troponin I (muscle injury). At approximately 23 min, respiratory frequency and then blood pressure fell, followed immediately by secondary diaphragmatic fatigue. Blood taken after termination of loading contained cardiac troponin T (myocardial injury). Contrary to our hypothesis, diaphragmatic fatigue and injury occurred early in loading before central failure, evident only as a change in the timing but not the drive component of the central respiratory pattern generator. Stepwise multiple regression analysis selected changes in mean arterial pressure and arterial Pco(2) during loading as the principal contributing factors in load endurance time, and changes in mean arterial pressure as the principal contributing factor in peak tracheal pressure generation. In conclusion, the temporal development of respiratory failure is not stereotyped but depends on load magnitude; moreover respiratory loads induce cardiorespiratory, not just respiratory, failure.
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PMID:Cardiorespiratory failure in rat induced by severe inspiratory resistive loading. 1713 35

We report the first case of witnessed sudden death of an Emery-Dreifuss muscular dystrophy (EDMD) patient with a properly functioning implantable cardioverter-defibrillator (ICD). This 38-yr-old woman with normal left ventricular function had a history of recurrent syncope and nonsustained ventricular tachycardia, for which a single-chamber ventricular ICD was implanted. She later collapsed suddenly and unexpectedly while at home, with witnesses present, and was found cyanotic with pulseless electrical activity by the emergency squad. This event took place in the setting of previously documented hypercapnic ventilatory insufficiency, for which she had refused the use of respiratory muscle aids to normalize alveolar ventilation. Subsequent interrogation of the ICD demonstrated normal function, with no evidence of ventricular tachycardia or ventricular fibrillation. In the hospital, her myocardial function was found to be normal by echocardiography. Further workup revealed that the patient had severe anoxic encephalopathy. She was eventually made "do not resuscitate," and she died on the sixth day of hospitalization. An autopsy was performed, and no obvious cause for the sudden death could be established. Review of the clinical presentation, with all the data available, suggests acute respiratory failure as the likely primary cause of this patient's sudden death, which then secondarily led to the observed pulseless electrical activity of the heart. The use of respiratory muscle aids--in particular, noninvasive mechanical ventilation to prevent chronic hypercapnia and cor pulmonale--is crucial for EDMD patients with symptomatic ventilatory insufficiency, for whom sudden deaths may not necessarily be of primarily cardiac origin.
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PMID:Sudden death in an Emery-Dreifuss muscular dystrophy patient with an implantable defibrillator. 1835 23

Mechanical ventilation using high tidal volume (VT) and transpulmonary pressure can damage the lung, causing ventilator-induced lung injury. Permissive hypercapnia, a ventilatory strategy for acute respiratory failure in which the lungs are ventilated with a low inspiratory volume and pressure, has been accepted progressively in critical care for adult, pediatric, and neonatal patients requiring mechanical ventilation and is one of the central components of current protective ventilatory strategies.
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PMID:Permissive hypercapnia. 1905 93


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