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Titolo:
Permissive hypercapnia impairs pulmonary gas exchange in the acute respiratory distress syndrome
Autore:
Feihl, F; Eckert, P; Brimioulle, S; Jacobs, O; Schaller, MD; Melot, C; Naeije, R;
Indirizzi:
Erasme Univ Hosp, Dept Intens Care, B-1070 Brussels, Belgium Erasme Univ Hosp Brussels Belgium B-1070 Care, B-1070 Brussels, Belgium Univ Lausanne Hosp, Dept Internal Med, Lausanne, Switzerland Univ LausanneHosp Lausanne Switzerland rnal Med, Lausanne, Switzerland
Titolo Testata:
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
fascicolo: 1, volume: 162, anno: 2000,
pagine: 209 - 215
SICI:
1073-449X(200007)162:1<209:PHIPGE>2.0.ZU;2-D
Fonte:
ISI
Lingua:
ENG
Soggetto:
EUROPEAN CONSENSUS CONFERENCE; END-EXPIRATORY PRESSURE; TIDAL VOLUME REDUCTION; MECHANICAL VENTILATION; CARDIAC-OUTPUT; VASCULAR TONE; LUNG INJURY; ARDS; PERFUSION; ARTERIAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
36
Recensione:
Indirizzi per estratti:
Indirizzo: Naeije, R Erasme Univ Hosp, Dept Intens Care, Lennik Rd 808, B-1070 Brussels, Belgium Erasme Univ Hosp Lennik Rd 808 Brussels Belgium B-1070 Belgium
Citazione:
F. Feihl et al., "Permissive hypercapnia impairs pulmonary gas exchange in the acute respiratory distress syndrome", AM J R CRIT, 162(1), 2000, pp. 209-215

Abstract

Current recommendations for mechanical ventilation in the acute respiratory distress syndrome (ARDS) include the use of small tidal volumes (V-T), even at the cost of respiratory acidosis. We evaluated the effects of this permissive hypercapnia on pulmonary gas exchange with the multiple inert gas elimination technique (MIGET) in eight patients with ARDS. After making baseline measurements, we induced permissive hypercapnia by reducing V-T from 10 +/- 2 ml/kg to 6 +/- 1 ml/kg (mean +/- SEM) at constant positive end-expiratory pressure. After restoration of initial V-T, We infused dobutamine to increase cardiac output ((Q) over dot) by the same amount as with hypercapnia. Permissive hypercapnia increased (Q) over dot by an average of 1.4 L(.)min(-1.)m(2), decreased arterial oxygen tension from 109 +/- 10 mm Hg to 92 +/- 11 mm Hg (p < 0.05), markedly increased true shunt (Q) over dot(S)/(Q) over dot(T)), from 32 +/- 6% to 48 +/- 5% (p < 0.0001), and had no effect on the dispersion of (V) over dot(A)/(Q) over dot. On reinstatement of baseline V-T with maintenance of a high (Q) over dot, (Q) over dot(S)/(Q) over dot(T) remained increased, to 38 +/- 6% (p < 0.05), and Pao,remained decreased, to 93 +/- 4 mm Hg (p < 0.05). These results agreed with effects of changes in V-T and (Q) over dot predicted by the mathematical lung model of the MIGET. We conclude that permissive hypercapnia increases pulmonary shunt, and that deterioration in gas exchange is explained by the combined effects of increased (Q) over dot and decreased alveolar ventilation.

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Documento generato il 05/07/20 alle ore 03:53:34