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Permissive hypercapnia

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https://www.readbyqxmd.com/read/29789411/heliox-adjunct-therapy-for-neonates-with-congenital-diaphragmatic-hernia
#1
Audra C Wise, Mallory A Boutin, Ellen M Knodel, James A Proudfoot, Brian P Lane, Marva L Evans, Denise M Suttner, Amy L Kimball
BACKGROUND: Congenital diaphragmatic hernia remains a complex disease with significant morbidity and mortality. Hypercarbia is a common derangement in this population, which often requires escalating ventilator support. By decreasing airway turbulence and enhancing CO2 removal, inhaled helium-oxygen mixture (heliox) has the potential to improve ventilation and thereby decrease ventilator support and its associated lung injury. METHODS: Retrospective cohort review of all neonates with congenital diaphragmatic hernia treated at Rady Children's Hospital San Diego during 2011-2015...
May 22, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29746270/evidence-regarding-the-use-of-bubble-continuous-positive-airway-pressure-in-the-extremely-low-birth-weight-infant-benefits-challenges-and-implications-for-nursing-practice
#2
Samantha Alessi
BACKGROUND: Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neonatal intensive care units worldwide. Bubble continuous positive airway pressure (BCPAP) has been in use in newborn intensive care since 1975. PURPOSE: To synthesize the current evidence on the use of BCPAP in the ELBW infant and its relationship to outcomes, particularly morbidity and mortality...
June 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29662873/permissive-hypercapnia-results-in-decreased-functional-vessel-density-in-the-skin-of-extremely-low-birth-weight-infants
#3
Alexandra Francoise Puchwein-Schwepcke, Kristina Schottmayer, Zuzana Mormanová, Jens Dreyhaupt, Orsolya Genzel-Boroviczeny, Ulrich H Thome
Background: Ventilator-induced lung injury with subsequent bronchopulmonary dysplasia remains an important issue in the care of extremely low-birth-weight infants. Permissive hypercapnia has been proposed to reduce lung injury. Hypercapnia changes cerebral perfusion, but its influence on the peripheral microcirculation is unknown. Methods: Data were collected from 12 infants, who were randomized to a permissive high PCO2 target group (HTG) or a control group (CG)...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29615483/incidence-of-hypocapnia-hypercapnia-and-acidosis-and-the-associated-risk-of-adverse-events-in-preterm-neonates
#4
Melissa K Brown, Deborah M Poeltler, Kasim O Hassen, Danielle V Lazarus, Vanessa K Brown, Jeremiah J Stout, Wade D Rich, Anup C Katheria
BACKGROUND: Permissive hypercapnia is a lung-protection strategy. We sought to review our current clinical practice for the range of permissive hypercapnia and identify the relationship between P aCO2 and pH and adverse outcomes. METHODS: A secondary analysis of a delayed cord-clamping clinical trial was performed on all arterial blood gas tests in the first 72 h in infants < 32 weeks gestational age. All arterial blood gas values were categorized into a clinical range to determine the percent likelihood of occurring in the total sample...
April 3, 2018: Respiratory Care
https://www.readbyqxmd.com/read/29398078/the-diagnosis-and-management-of-inhalation-injury-an-evidence-based-approach
#5
REVIEW
C J Deutsch, A Tan, S Smailes, P Dziewulski
INTRODUCTION: Smoke inhalation injury (II) is an independent risk factor for mortality in burns and its management is inherently complex. We aim to make recommendations for best practice in managing II and its sequelae by reviewing all available current evidence in order to provide an evidence-based approach. METHODS: We conducted a systematic search of the Cochrane database and Embase using PRISMA guidelines with no patient population exclusion criteria. Published work was reviewed and evidence levels graded...
February 1, 2018: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/29209598/inflammatory-mediators-in-tracheal-aspirates-of-preterm-infants-participating-in-a-randomized-trial-of-permissive-hypercapnia
#6
Sarah Gentner, Mandy Laube, Ulrike Uhlig, Yang Yang, Hans W Fuchs, Jens Dreyhaupt, Helmut D Hummler, Stefan Uhlig, Ulrich H Thome
Background: Ventilator-induced lung injury is considered to be a main factor in the pathogenesis of bronchopulmonary dysplasia (BPD). Optimizing ventilator strategies may reduce respiratory morbidities in preterm infants. Permissive hypercapnia has been suggested to attenuate lung injury. We aimed to determine if a higher PCO2 target range results in less lung injury compared to the control target range and possibly reduces pro-inflammatory cytokines and acid sphingomyelinase (ASM) in tracheal aspirates (TA), which has not been addressed before...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29175086/re-examining-permissive-hypercapnia-in-ards-a-narrative-review
#7
REVIEW
Tavish Barnes, Vasileios Zochios, Ken Parhar
Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2 , acute cor pulmonale, and ICU mortality...
November 22, 2017: Chest
https://www.readbyqxmd.com/read/29144241/shifting-risks-and-conflicting-outcomes-ecmo-for-neonates-with-congenital-diaphragmatic-hernia-in-the-modern-era
#8
Joseph W Turek, Joseph R Nellis, Brenton G Sherwood, Meera Kotagal, Andrew L Mesher, Ravi R Thiagarajan, Sonali S Patel, Jeffrey R Avansino, Peter T Rycus, D Michael McMullan, Thomas V Brogan
OBJECTIVES: To update previously described trends for neonates with congenital diaphragmatic hernia (CDH) receiving ECMO with changes in recommendations for care, and to determine how recent advancements in respiratory care have affected this patient population. STUDY DESIGN: This study is a retrospective review of more than 2500 neonates with CDH who received ECMO listed in the Extracorporeal Life Support Organization (ELSO) registry. Cochran-Armitage and multivariate regression analyses were used to analyze changes in the patient population over time and in mortality-related risk factors...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29105540/mechanically-ventilating-the-severe-asthmatic
#9
Abdullah E Laher, Sean K Buchanan
The management of the critically ill patients with asthma can be rather challenging. Potentially devastating complications relating to this presentation include hypoxemia, worsening bronchospasm, pulmonary aspiration, tension pneumothorax, dynamic hyperinflation, hypotension, dysrhythmias, and seizures. In contrast to various other pathologies requiring mechanical ventilation, acute asthma is generally associated with better outcomes. This review serves as a practical guide to the physician managing patients with severe acute asthma requiring mechanical ventilation...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29078756/effects-of-lung-protective-mechanical-ventilation-associated-with-permissive-respiratory-acidosis-on-regional-extra-pulmonary-blood-flow-in-experimental-ards
#10
Rudolf Hering, Stefan Kreyer, Christian Putensen
BACKGROUND: Lung protective mechanical ventilation with limited peak inspiratory pressure has been shown to affect cardiac output in patients with ARDS. However, little is known about the impact of lung protective mechanical ventilation on regional perfusion, especially when associated with moderate permissive respiratory acidosis. We hypothesized that lung protective mechanical ventilation with limited peak inspiratory pressure and moderate respiratory acidosis results in an increased cardiac output but unequal distribution of blood flow to the different organs of pigs with oleic-acid induced ARDS...
October 27, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28828555/efficacy-of-co-2-insufflation-during-thoracoscopic-esophagectomy-in-the-left-lateral-position
#11
Itasu Ninomiya, Koichi Okamoto, Sachio Fushida, Katsunobu Oyama, Jun Kinoshita, Hiroyuki Takamura, Hidehiro Tajima, Isamu Makino, Tomoharu Miyashita, Tetsuo Ohta
OBJECTIVE: Thoracoscopic esophagectomy (TE) is widely performed as a minimally invasive technique in the management of esophageal cancer. The aim of this study was to estimate the efficacy of intrathoracic carbon dioxide (CO2 ) insufflation during TE in the left lateral position. METHODS: From January 2010 to April 2016, 58 patients with esophageal cancer underwent TE without intrathoracic CO2 insufflation (Group N) and 37 patients with esophageal cancer underwent TE with intrathoracic CO2 insufflation (Group C)...
October 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28643877/cerebral-haemodynamic-response-to-somatosensory-stimulation-in-neonatal-lambs
#12
Shinji Nakamura, David W Walker, Flora Y Wong
KEY POINTS: Cerebral haemodynamic response to neural stimulation has been extensively studied in adults, but little is known about cerebral haemodynamic response in the fetal and neonatal brain. The present study describes the cerebral haemodynamic response measured by near infrared spectroscopy to somatosensory stimulation in newborn lambs, in comparison to recent findings in fetal sheep. The cerebral haemodynamic responses in the newborn lamb brain can involve an increase in oxyhaemoglobin (oxyHb), or a decrease of oxyHb suggestive of reduced perfusion and oxygenation...
September 1, 2017: Journal of Physiology
https://www.readbyqxmd.com/read/28632754/permissive-hypercapnia-for-severe-acute-respiratory-distress-syndrome-in-immunocompromised-children-a-single-center-experience
#13
Hans Fuchs, Nicola Rossmann, Manuel B Schmid, Manfred Hoenig, Ulrich Thome, Benjamin Mayer, Daniel Klotz, Helmut D Hummler
BACKGROUND: Controlled hypoventilation while accepting hypercapnia has been advocated to reduce ventilator-induced lung injury. The aim of the study was to analyze outcomes of a cohort of immunocompromised children with acute respiratory distress syndrome (ARDS) ventilated with a strategy of stepwise increasing PCO2 targets up to 140 mm Hg. METHODS: Retrospective analysis of outcomes of a cohort of children with oncologic disease or after stem cell transplantation and severe respiratory failure in comparison with a historical control cohort...
2017: PloS One
https://www.readbyqxmd.com/read/28561251/management-of-acute-respiratory-failure-in-pregnancy
#14
REVIEW
Stephen E Lapinsky
Respiratory failure affects up to 1 in 500 pregnancies, more commonly in the postpartum period. The causes of respiratory failure include several pregnancy-specific conditions such as preeclampsia, amniotic fluid embolism, and peripartum cardiomyopathy. Pregnancy may also increase the risk or severity of other conditions, such as asthma, thromboembolism, viral pneumonitis, and gastric acid aspiration. Changes to maternal respiratory physiology and the presence of a fetus may affect the assessment and management of these patients...
April 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28328592/status-asthmaticus-and-central-herniation-a-case-for-multidisciplinary-critical-care
#15
Joelle B Karlik, Tristan Stani, Stephanie Nonas, Aclan Dogan, Ansgar Brambrink
A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. Imaging showed diffuse cerebral edema with central herniation. Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema...
June 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28130958/a-definition-of-gentle-ventilation-in-congenital-diaphragmatic-hernia-a-survey-of-neonatologists-and-pediatric-surgeons
#16
Christiana Farkouh-Karoleski, Tasnim Najaf, Julia Wynn, Gudrun Aspelund, Wendy K Chung, Charles J Stolar, George B Mychaliska, Brad W Warner, Amy J Wagner, Robert A Cusick, Foong-Yen Lim, David T Schindel, Douglas Potoka, Kenneth Azarow, C Michael Cotten, Anthony Hesketh, Samuel Soffer, Timothy Crombleholme, Howard Needelman
Ventilation practices have changed significantly since the initial reports in the mid 1980 of successful use of permissive hypercapnia and spontaneous ventilation [often called gentle ventilation (GV)] in infants with congenital diaphragmatic hernia (CDH). However, there has been little standardization of these practices or of the physiologic limits that define GV. We sought to ascertain among Diaphragmatic Hernia Research and Exploration; Advancing Molecular Science (DHREAMS) centers' GV practices in the neonatal management of CDH...
December 20, 2017: Journal of Perinatal Medicine
https://www.readbyqxmd.com/read/28121055/permissive-hypercapnia-in-extremely-low-birthweight-infants-how-far-should-we-go
#17
Hesham Abdel-Hady, Basma Shouman
No abstract text is available yet for this article.
June 2017: Acta Paediatrica
https://www.readbyqxmd.com/read/27999775/protective-ventilation-improves-gas-exchange-reduces-incidence-of-atelectases-and-affects-metabolic-response-in-major-pancreatoduodenal-surgery
#18
Vsevolod V Kuzkov, Ludmila N Rodionova, Yana Y Ilyina, Aleksey A Ushakov, Maria M Sokolova, Eugenia V Fot, Boris L Duberman, Mikhail Y Kirov
BACKGROUND: Protective perioperative ventilation has been shown to improve outcomes and reduce the incidence of postoperative pulmonary complications. The goal of this study was to assess the effects of ventilation with low tidal volume (VT) either alone or in a combination with moderate permissive hypercapnia in major pancreatoduodenal interventions. MATERIALS AND METHODS: Sixty adult patients scheduled for elective pancreatoduodenal surgery with duration >2 h were enrolled into a prospective single-center study...
2016: Frontiers in Medicine
https://www.readbyqxmd.com/read/27881376/question-2-is-permissive-hypercapnia-beneficial-to-preterm-infants
#19
Murwan Omer, Eleanor J Molloy
No abstract text is available yet for this article.
January 2017: Archives of Disease in Childhood
https://www.readbyqxmd.com/read/27876355/lung-protective-ventilatory-strategies-in-intubated-preterm-neonates-with-rds
#20
REVIEW
F Reiterer, B Schwaberger, T Freidl, G Schmölzer, G Pichler, B Urlesberger
This article provides a narrative review of lung-protective ventilatory strategies (LPVS) in intubated preterm infants with RDS. A description of strategies is followed by results on short-and long-term respiratory and neurodevelopmental outcomes. Strategies will include patient-triggered or synchronized ventilation, volume targeted ventilation, the technique of intubation, surfactant administration and rapid extubation to NCPAP (INSURE), the open lung concept, strategies of high-frequency ventilation, and permissive hypercapnia...
June 2017: Paediatric Respiratory Reviews
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