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Permissive hypercapnia

Gabriella Di Lascio, Edvin Prifti, Elmi Messai, Adriano Peris, Guy Harmelin, Roland Xhaxho, Albana Fico, Guido Sani, Massimo Bonacchi
INTRODUCTION: Status asthmaticus is a life-threatening condition characterized by progressive respiratory failure due to asthma that is unresponsive to standard therapeutic measures. We used extracorporeal membrane oxygenation (ECMO) to treat patients with near-fatal status asthamticus who did not respond to aggressive medical therapies and mechanical ventilation under controlled permissive hypercapnia. MATERIALS AND METHODS: Between January 2011 and October 2015, we treated 16 adult patients with status asthmaticus (8 women, 8 men, mean age: 50...
October 6, 2016: Perfusion
Beatrice Borsellino, Marcus J Schultz, Marcelo Gama de Abreu, Chiara Robba, Federico Bilotta
INTRODUCTION: Neurocritical care (NCC) patients often require prolonged mechanical ventilation, and they are at high risk of respiratory complications. Therefore, the potential benefit role of protective lung ventilation (PLV), which demonstrated to reduce postoperative complications in patients with acute distress respiratory syndrome, has been suggested even on NCC patients. However, PLV can increase intracranial pressure as result of permissive hypercapnia and of high airway pressures during recruitment maneuvers...
October 2016: Expert Review of Respiratory Medicine
Stephen E Lapinsky
Respiratory failure affects up to 0.2% of pregnancies, more commonly in the postpartum period. Altered maternal respiratory physiology affects the assessment and management of these patients. Respiratory failure may result from pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism or peripartum cardiomyopathy. Pregnancy may increase the risk or severity of other conditions, including thromboembolism, asthma, viral pneumonitis, and gastric acid aspiration. Management during pregnancy is similar to the nonpregnant patient...
September 2015: Obstetric Medicine
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
Jianglin Ma, Hui Ye
OBJECTIVES: To perform a systematic review and meta-analysis of the efficacy and safety of permissive hypercapnia in extremely low birth weight infants. METHODS: A systematic search of MEDLINE, EMBASE, the Cochrane Database of randomized trials. Eligibility and quality of trials were assessed, and data on study design, patient characteristics, and relevant outcomes were extracted. RESULTS: Four studies that enrolled a total of 693 participants were selected...
2016: SpringerPlus
Brian Bellucci, Renli Qiao
Permissive hypercapnia is a commonly used ventilator strategy in attempt to improve refractory hypoxemia. The rationale of such practice is based on the assumption that hypercapnia, although associated with altered mental status, is well tolerated. Here we report a case in which the altered mental status caused by hypercapnia is underlined by a life-threatening mechanism. The case indicates the severity of hypercapnia may have been mistakenly overlooked in the past. This article is protected by copyright. All rights reserved...
May 23, 2016: Clinical Respiratory Journal
Changsong Wang, Xiaoyang Wang, Chunjie Chi, Libo Guo, Lei Guo, Nana Zhao, Weiwei Wang, Xin Pi, Bo Sun, Ailing Lian, Jinghui Shi, Enyou Li
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0...
2016: Scientific Reports
V P Kulikov, P P Tregub, P D Kovzelev, E A Dorokhov, A A Belousov
Investigated the role of hypercapnic component in the mechanism of activation of HIF-1α and increase the synthesis of erythropoietin in the combined and the isolated impact of hypoxia and hypercapnia. It was found that the content of proteins of interest significantly increases both in isolated hypoxia and hypercapnia, and at their combined effect. Moreover, the hypercapnic hypoxia causes maximum activation of the synthesis and accumulation of erythropoietin HIF-1α, and permissive hypercapnia enhances their content more than hypoxic exposure...
July 2015: Patologicheskaia Fiziologiia i èksperimental'naia Terapiia
Helmut D Hummler, Katharina Banke, Marla R Wolfson, Giuseppe Buonocore, Michael Ebsen, Wolfgang Bernhard, Dimitrios Tsikas, Hans Fuchs
BACKGROUND: Permissive hypercapnia has been shown to reduce lung injury in subjects with surfactant deficiency. Experimental studies suggest that hypercapnic acidosis by itself rather than decreased tidal volume may be a key protective factor. OBJECTIVES: To study the differential effects of a lung protective ventilatory strategy or hypercapnic acidosis on gas exchange, hemodynamics and lung injury in an animal model of surfactant deficiency. METHODS: 30 anesthetized, surfactant-depleted rabbits were mechanically ventilated (FiO2 = 0...
2016: PloS One
Pramod S Puligandla, Julia Grabowski, Mary Austin, Holly Hedrick, Elizabeth Renaud, Meghan Arnold, Regan F Williams, Kathleen Graziano, Roshni Dasgupta, Milissa McKee, Monica E Lopez, Tim Jancelewicz, Adam Goldin, Cynthia D Downard, Saleem Islam
OBJECTIVE: Variable management practices complicate the identification of optimal strategies for infants with congenital diaphragmatic hernia (CDH). This review critically appraises the available evidence to provide recommendations. METHODS: Six questions regarding CDH management were generated. English language articles published between 1980 and 2014 were compiled after searching Medline, Cochrane, Embase and Web of Science. Given the paucity of literature on the subject, all studies irrespective of their rank in the levels of evidence hierarchy were included...
November 2015: Journal of Pediatric Surgery
Katarina Bojanić, Ena Pritišanac, Tomislav Luetić, Jurica Vuković, Juraj Sprung, Toby N Weingarten, William A Carey, Darrell R Schroeder, Ruža Grizelj
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a congenital malformation associated with life-threatening pulmonary dysfunction and high neonatal mortality. Outcomes are improved with protective ventilation, less severe pulmonary pathology, and the proximity of the treating center to the site of delivery. The major CDH treatment center in Croatia lacks a maternity ward, thus all CDH patients are transferred from local Zagreb hospitals or remote areas (outborns). In 2000 this center adopted protective ventilation for CDH management...
2015: BMC Pediatrics
George J Crystal
Carbon dioxide (CO2) is an end product of aerobic cellular respiration. In healthy persons, PaCO2 is maintained by physiologic mechanisms within a narrow range (35-45 mm Hg). Both hypercapnia and hypocapnia are encountered in myriad clinical situations. In recent years, the number of hypercapnic patients has increased by the use of smaller tidal volumes to limit lung stretch and injury during mechanical ventilation, so-called permissive hypercapnia. A knowledge and appreciation of the effects of CO2 in the heart are necessary for optimal clinical management in the perioperative and critical care settings...
September 2015: Anesthesia and Analgesia
P P Tregub, V P Kulikov, N Yu Rucheikin, E V Belova, Yu G Motin
We compared synthetic and proliferative activity of brain cells in rats exposed hypoxia, hypercapnia, or both prior to experimental focal stroke. The mean number of nucleolus organizer regions in penumbra neurons did not change after normobaric hypoxia, but increased after permissive hypercapnia or hypercapnic hypoxia. These data attest to activation of proliferative and synthetic functions in nerve cells, which plays an important role in the neuroprotective mechanisms under conditions of combined exposure to hypoxia and hypercapnia...
July 2015: Bulletin of Experimental Biology and Medicine
O E Mitkinov, V I Gorbachev
This review deals with the current trends in protective ventilation in newborns. Volumotrauma is the most common variant of ventilator-induced lung injury. The modern research is devoted to the study of biotrauma, which is the release of inflammatory mediators in response to mechanical ventilation. There is a correlation between the ventilator-induced lung injury and the development of chronic lung diseases in infants. Now we have the "new" form of bronchopulmonary dysplasia-parenchymal lung disease characterized by impaired growth and development of the alveoli and blood vessels of the pulmonary circulation...
March 2015: Anesteziologiia i Reanimatologiia
Hans Fuchs
Of 680 000 infants born in Germany a year roughly 10% are preterm and 1% are very preterm. They are treated in around 150 level 1 perinatal centers and there are various credos how to best treat the ELGAN infant. However, many centers include the use of a sustained inflation for lung aeration in the standard protocol of delivery room care in Germany. As a result of the large studies on delivery room care, a trend for earlier or prophylactic surfactant in the most immature infants can be observed, however, surfactant is increasingly given in a new less invasive way called LISA...
2015: Acta Bio-medica: Atenei Parmensis
Ulrich H Thome, Orsolya Genzel-Boroviczeny, Bettina Bohnhorst, Manuel Schmid, Hans Fuchs, Oliver Rohde, Stefan Avenarius, Hans-Georg Topf, Andrea Zimmermann, Dirk Faas, Katharina Timme, Barbara Kleinlein, Horst Buxmann, Wilfried Schenk, Hugo Segerer, Norbert Teig, Corinna Gebauer, Roland Hentschel, Matthias Heckmann, Rolf Schlösser, Jochen Peters, Rainer Rossi, Wolfgang Rascher, Ralf Böttger, Jürgen Seidenberg, Gesine Hansen, Maria Zernickel, Gerhard Alzen, Jens Dreyhaupt, Rainer Muche, Helmut D Hummler
BACKGROUND: Tolerating higher partial pressure of carbon dioxide (pCO2) in mechanically ventilated, extremely low birthweight infants might reduce ventilator-induced lung injury and bronchopulmonary dysplasia. We aimed to test the hypothesis that higher target ranges for pCO2 decrease the rate of bronchopulmonary dysplasia or death. METHODS: In this randomised multicentre trial, we recruited infants from 16 tertiary care perinatal centres in Germany with birthweight between 400 g and 1000 g and gestational age 23-28 weeks plus 6 days, who needed endotracheal intubation and mechanical ventilation within 24 h of birth...
July 2015: Lancet Respiratory Medicine
Heike Rabe, Jose Ramon Fernandez-Alvarez
No abstract text is available yet for this article.
July 2015: Lancet Respiratory Medicine
Dakshesh H Parikh, Shree Vishna Rasiah
Antenatal diagnosis of lung lesion has become more accurate resulting in dilemma and controversies of its antenatal and postnatal management. Majority of antenatally diagnosed congenital lung lesions are asymptomatic in the neonatal age group. Large lung lesions cause respiratory compromise and inevitably require urgent investigations and surgery. The congenital lung lesion presenting with hydrops requires careful postnatal management of lung hypoplasia and persistent pulmonary hypertension. Preoperative stabilization with gentle ventilation with permissive hypercapnia and delayed surgery similar to congenital diaphragmatic hernia management has been shown to result in good outcome...
August 2015: Seminars in Pediatric Surgery
Peter C Rimensberger, Ira M Cheifetz
OBJECTIVE: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome. DESIGN: Consensus Conference of experts in pediatric acute lung injury. METHODS: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome...
June 2015: Pediatric Critical Care Medicine
Kalpalatha K Guntupalli, Dilip R Karnad, Venkata Bandi, Nicole Hall, Michael Belfort
The first of this two-part series on critical illness in pregnancy dealt with obstetric disorders. In Part II, medical conditions that commonly affect pregnant women or worsen during pregnancy are discussed. ARDS occurs more frequently in pregnancy. Strategies commonly used in nonpregnant patients, including permissive hypercapnia, limits for plateau pressure, and prone positioning, may not be acceptable, especially in late pregnancy. Genital tract infections unique to pregnancy include chorioamnionitis, group A streptococcal infection causing toxic shock syndrome, and polymicrobial infection with streptococci, staphylococci, and Clostridium perfringens causing necrotizing vulvitis or fasciitis...
November 2015: Chest
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