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Titolo:
Effect of acute moderate changes in Paco(2) on global hemodynamics and gastric perfusion
Autore:
Mas, A; Saura, P; Joseph, D; Blanch, L; Baigorri, F; Artigas, A; Fernandez, R;
Indirizzi:
Corp Sanitaria Parc Tauli, Intens Care Serv, Sabadell, Spain Corp Sanitaria Parc Tauli Sabadell Spain ens Care Serv, Sabadell, Spain Ctr Hosp & Cardiol Manresa, Manresa, Spain Ctr Hosp & Cardiol Manresa Manresa Spain ardiol Manresa, Manresa, Spain
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 2, volume: 28, anno: 2000,
pagine: 360 - 365
SICI:
0090-3493(200002)28:2<360:EOAMCI>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; INTRAMUCOSAL PH; PERMISSIVE HYPERCAPNIA; MECHANICAL VENTILATION; TISSUE OXYGENATION; CARBON-DIOXIDE; BLOOD-FLOW; TONOMETRY; CONSUMPTION; TRANSPORT;
Keywords:
hypercapnia; hypocapnia; respiratory acidosis; respiratory alkalosis; gastric perfusion; tonometry; deadspace ventilation; mechanical ventilation; hemodynamics; critical illness;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
31
Recensione:
Indirizzi per estratti:
Indirizzo: Mas, A Corp Sanitaria Parc Tauli, Intens Care Serv, Sabadell, Spain Corp Sanitaria Parc Tauli Sabadell Spain e Serv, Sabadell, Spain
Citazione:
A. Mas et al., "Effect of acute moderate changes in Paco(2) on global hemodynamics and gastric perfusion", CRIT CARE M, 28(2), 2000, pp. 360-365

Abstract

Objective: To describe global hemodynamics and splanchnic perfusion changes in response to acute modifications in Pace, in hemodynamically stable patients. Design: Prospective, randomized crossover study. Setting: Medical-surgical intensive care unit at a community hospital (400,000 inhabitants). Patients: Ten critically ill patients who were sedated, paralyzed, and mechanically ventilated. Interventions: Hypercapnia and hypocapnia were obtained by increasing and reducing instrumental deadspace in random order. After each intervention, patients returned to the basal condition. Each period lasted 80 min: 20 min to achieve stable Paco(2) and 60 min for tonometer equilibration. In each period, global hemodynamic variables and tonometric data were collected. Theperiods were compared using analysis of variance. Measurements and Main Results: Acute hypercapnia (Paco(2) from 40 +/- 3 to52 +/- 3 torr, p < .05) increased cardiac index (3.43 +/- 0.37 vs. 3.97 +/- 0.43 mL/min/m(2), p < .05), heart rate (95 +/- 6 vs. 105 +/- 3 heats/min,p < .05), and mean pulmonary artery pressure(21 +/- 1 vs. 24 +/- 1 mm Hg, p < .05) and reduced systemic vascular resistance (992 +/- 98 vs. 813 +/- 93 dyne.sec/cm(5), p < .05) and oxygen extraction ratio (27 +/- 3% vs. 22 +/- 2%, p < .05). Standardized intramucosal Pco(2) increased from 49 +/- 2 to61 +/- 3 torr (p < .05) with an associated decrease in calculated intramucosal pH ([pHi] 7.35 +/- 0.03 vs. 7.25 +/- 0.02, p < .05), but the gastro-arterial Pco(2) gradient (Delta Pco(2) did not change. Acute hypocapnia (Paco(2) from 41 +/- 3 to 34 +/- 3 torr, p < .05; pH 7.41 +/- 0.01 to 7.47 +/- 0.02, p < .05) induced slight increments in systemic vascular resistance (995 +/- 117 vs. 1088 +/- 160 dyne sec/cm(5), p < .05) and oxygen extraction ratio (28 +/- 2% vs. 30 +/- 2%, p < .05). Standardized intramucosal Pco(2) decreased (50 +/- 4 vs. 44 +/- 3 torr, p < .05), pHi increased (7.33 +/- 0.03 vs. 7.36 +/- 0.02; p < .05), but Delta Pco(2) did not change. Conclusions: In this small group of stable patients, moderate acute variations in Pace, had a significant effect on global hemodynamics, but splanchnic perfusion, assessed by Delta Pco(2), did not change. In these conditions, the use of pHi to evaluate gastric perfusion appears unreliable.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 13:59:33