Relationship between arterial blood partial pressure of carbon dioxide and prognosis of neurological function after cardiopulmonary resuscitation / 中国基层医药

Objective:To investigate the relationship between arterial blood partial pressure of carbon dioxide and neurological outcome after cardiopulmonary resuscitation.Methods:The clinical data of 116 patients who underwent cardiopulmonary resuscitation admitted to the Intensive Care Unit and Emergency Department of the Second People's Hospital of Hefei from January 2018 to January 2020 were retrospectively analyzed. According to the average arterial blood partial pressure of carbon dioxide within 24 hours after admission, patients were divided into normal (35 mmHg ≤ PaCO 2 ≤ 55 mmHg, 1 mmHg = 0.133 kPa, n = 44), hypercapnia (PaCO 2 > 55 mmHg, n = 51), and hypocapnia (PaCO 2 < 35 mmHg, n = 21) groups. ICU stay, in-hospital mortality, and neurological outcome at discharge were compared among groups. A logistic regression analysis model was established. The relationship between PaCO 2 and neurological outcome was determined. Results:There were no significant differences in age, sex, cardiac arrest time, acute physiological and chronic health evaluation II score at admission, 1-hour mean arterial pressure, location of cardiac arrest, and initial heart rhythm among the three groups (all P > 0.05). ICU stay in the normal group [(7.23 ± 2.55) days] was significantly higher than that in the hypercapnia [(12.21 ± 4.12) days] and hypocapnia [(11.78 ± 4.72) days] groups ( t = 6.48, 4.59, both P < 0.01). In-hospital mortality in the normal group was 38.6% (17/44), which was significantly lower than 60.8% (31/51) in the hypercapnia group and 66.7% (14/21) in the hypocapnia group ( χ2 = 4.63, 4.47, both P < 0.05). The good neurological outcome rate in the normal group was 55.6% (15/44), which was significantly higher than 25.0% (5/51) in the hypercapnia group and 28.6% (2/21) in the hypocapnia group ( χ2 = 8.38, 5.14, both P < 0.05). Multivariate logistic regression analysis showed that cardiac arrest time, 1-hour mean arterial pressure, acute physiological and chronic health evaluation II score, and PaCO 2 are important factors for neurological outcomes of resuscitated patients at discharge (all P < 0.01). Conclusion:Within 24 hours after cardiopulmonary resuscitation, maintaining a normal PaCO 2 level can help improve the neurological outcome of patients at discharge.

Effects of chronic obstructive pulmonary disease patients complicated with OSAHS on hypercapnia and related factors / 中华健康管理学杂志

Objective:To analyze the effects of chronic obstructive pulmonary disease (COPD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS) on hypercapnia and its related factors.Methods:In this cross-sectional study, patients with stable COPD were continuously recruited from July 2016 to December 2018 in the Respiratory Department of Peking University Third Hospital. General clinical data of patients were collected, and lung function test, arterial blood gas analysis and portable sleep monitoring were also conducted. Patients with COPD complicated with apnea hypopnea index (AHI)≥10 times/h and apnea events being mainly blockage-type events, accompanied by snoring, sleep apnea, daytime sleepiness and other symptoms were defined as overlapping group, patients with COPD complicated with AHI<10 times/h were defined as simple COPD group. Correlation analysis and logistic regression model were used to explore the determinants of daytime hypercapnia in patients with COPD.Results:Compared with simple COPD group, the median arterial partial pressure of carbon dioxide (PaCO 2) was significantly higher in the overlapping group (42.00 vs 38.95 mmHg (1 mmHg=0.133 kPa), P<0.001), and the rate of daytime hypercapnia was significantly higher (23.3% vs 3.3%, P=0.002). PaCO 2 was correlated with forced vital capacity (FVC), percent predicted forced expiratory volume in one second (FEV 1%pred), the ratio of residual volume (RV) to total lung capacity (TLC), AHI, nocturnal average transcutaneous oxygen saturation (SpO 2), nocturnal minimum SpO 2 and the total sleep time spent with SpO 2≤90% (T90) (all P<0.05). In logistic regression analysis, after adjusting for age, sex, and body mass index (BMI), only severe OSAHS, GOLD Ⅲ-Ⅳ grade (FEV 1%pred<50%), and T90>1% were independent risk factors for hypercapnia. Conclusions:OSAHS can increase the risk of hypercapnia in patients with COPD. AHI, lung function injury and T90 are closely related to hypercapnia.

Recent research on extracorporeal carbon dioxide removal / 中国当代儿科杂志

Extracorporeal carbon dioxide removal is an artificial lung auxiliary technique based on extrapulmonary gas exchange and can effectively remove carbon dioxide and provide oxygenation to a certain extent, and it is one of the effective treatment techniques for hypercapnia developed after mechanical ventilation and extracorporeal membrane oxygenation in recent years and has wide application prospect. This article elaborates on the development, working principle, advantages, classification, complications, and clinical application of extracorporeal carbon dioxide removal, so as to provide a new choice for extracorporeal carbon dioxide removal in clinical practice.

Investigação da associação de dois oxigenadores em paralelo ou em série durante o suporte respiratório com oxigenação por membrana extracorpórea / Exploring the association of two oxygenators in parallel or in series during respiratory support using extracorporeal membrane oxygenation

RESUMO Objetivo: Caracterizar as pressões, as resistências, a oxigenação e a eficácia da descarboxilação de dois oxigenadores associados em série ou em paralelo durante o suporte com oxigenação veno-venosa por membrana extracorpórea. Métodos: Usando os resultados de insuficiência respiratória grave em suínos associada à disfunção de múltiplos órgãos, ao modelo de suporte com oxigenação por membrana extracorpórea veno-venosa e à modelagem matemática, exploramos os efeitos na oxigenação, descarboxilação e pressões do circuito de associações de oxigenadores em paralelo e em série. Resultados: Testaram-se cinco animais com peso mediano de 80kg. Ambas as configurações aumentaram a pressão parcial de oxigênio após os oxigenadores. O teor de oxigênio da cânula de retorno também foi ligeiramente maior, mas o efeito na oxigenação sistêmica foi mínimo, usando oxigenadores com alto fluxo nominal (~ 7L/minuto). Ambas as configurações reduziram significativamente a pressão parcial de dióxido de carbono sistêmico. Como o fluxo sanguíneo na oxigenação por membrana extracorpórea aumentou, a resistência do oxigenador diminuiu inicialmente, com aumento posterior, com fluxos sanguíneos mais altos, mas pouco efeito clínico. Conclusão: A associação de oxigenadores em paralelo ou em série durante o suporte com oxigenação veno-venosa por membrana extracorpórea proporciona um modesto aumento na depuração da pressão parcial de dióxido de carbono, com leve melhora na oxigenação. O efeito das associações de oxigenadores nas pressões de circuitos extracorpóreos é mínimo.

ABSTRACT Objective: To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support. Methods: Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators. Results: Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact. Conclusion: Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.

Exercise causes oxygen desaturation and hypercapnia in stable chronic obstructive pulmonary disease patients

Background: Assessment of severity of chronic obstructive pulmonary disease (COPD) is the cornerstone of therapy. Spirometric measurements have traditionally remained as the popular diagnostic tool of choice. Oxygenation and carbon dioxide removal cannot be assessed by Spirometry alone, especially during exercise. Therefore, we studied whether desaturation and hypercapnea occur in response to exercise in COPD patients. Aims and Objectives: To know whether bicycle pedaling as an exercise can unravel the gas exchange abnormalities and airflow limitation that might be precipitated by physical activity. This is done by estimating the changes in Oxygen saturation by pulse oximetry, and by estimating the changes in Blood CO2 levels by capnography. Materials and Methods: Thirty stable COPD patients and controls were included for the study. Here we measured the change in oxygen saturation from rest to submaximal exercise (done using bicycle ergometry). Concomitantly, we measured the change in carbon dioxide levels of expired air from rest to submaximal exercise. Results: We found that COPD patients experience oxygen desaturation. ?SaO2 (difference between resting and exercise SaO2) was only 1% in controls whereas 8.86% in COPD. Hypercapnia occurred in response to a submaximal exercise in COPD patients (End tidal carbon dioxide of 48.87 mmHg). We also found that they become tachypneic and show greater degree of exhaustion. Conclusion: Our study points out that exercise-induced desaturation and hypercapnia are a definite occurrence in COPD patients. It is a marker of progressive disease. It can be used as a form of stress test for the pulmonary system.

Estrategia ventilatoria para el aclaramiento de dióxido de carbono en un lactante con hipercapnia incontrolable / Ventilatory strategy for carbon dioxide clearance in an infant with persistent hypercapnia / Estratégia ventilatória para depuração de dióxido de carbono em uma criança com hipercapnia incontrolável

Resumen Se presenta la experiencia de combinar la ventilación convencional y una técnica modificada de insuflación de gas paratraqueal para evitar complicaciones de la insuflación traqueal directa en un lactante con hipercapnia refractaria, quien ingresó con falla respiratoria aguda secundaria a neumonía multilobar. Al iniciar la ventilación mecánica presentó neumotórax, fístulas broncopleurales y acidemia hipercápnica refractaria a tratamiento convencional. Se inició insuflación de gas paratraqueal en ventilación convencional en modo de presión control, con 10 L/min de aire humidificado con una presión control máxima sostenida de 20 cmH2O. Tres horas después se observó una mejoría de la gasometría arterial y pasadas 72 horas se logró retirar el dispositivo paratraqueal sin complicaciones, con adecuada evolución clínica. Al no incluir un catéter intratraqueal se evitaron complicaciones conservando los mecanismos que mejoran la oxigenación e hipercapnia. La técnica presentada es prometedora; sin embargo, se deben realizar estudios con un mayor número de individuos.

Abstract The experience of combining conventional ventilation and a modified paratracheal gas insufflation technique to avoid complications is presented. An infant with acute respiratory failure secondary to multilobar pneumonia who after start off mechanical ventilation developed pneumothorax, bronchopleural fistulas, and persistent hypercapnic acidemia refractory to conventional ventilatory strategies. It was decided to initiate paratracheal gas insufflation in conventional ventilation in pressure control mode, with 10 L/min of humidified air with a maximum sustained control pressure of 20 cmH2O. Three hours after an improvement in arterial blood gas was recorded and after 72 hours the paratracheal device was removed without complications, with adequate clinical evolution. By not incorporate an intratracheal catheter some complications are avoided, preserving the mechanisms that improve oxygenation and CO2 elimination. Paratracheal gas insufflation is a promising technique, although more studies are required with a greater number of individuals.

Resumo Apresenta-se a experiência de combinar ventilação convencional e técnica modificada de insuflação de gás paratraqueal para evitar complicações da insuflação traqueal direta em uma criança com hipercapnia refratária que foi admitido com insuficiência respiratória aguda secundária a pneumonia multilobar. Ao iniciar ventilação mecânica, apresentou pneumotórax, fístulas broncopleurais e acidemia hipercápnica refratária ao tratamento convencional. A insuflação de gás paratraqueal foi iniciada em ventilação convencional no modo de controle de pressão, com 10 L/min de ar umidificado com pressão de controle máxima sustentada de 20 cmH2O. Três horas após, observou-se melhora da gasometria arterial e após 72 horas o dispositivo paratraqueal foi retirado sem intercorrências, com evolução clínica adequada. Ao não incluir um cateter intratraqueal, as complicações foram evitadas, preservando os mecanismos que melhoram a oxigenação e a hipercapnia. A técnica apresentada é promissora, porém, estudos com um número maior de indivíduos devem ser realizados.

Evaluation of macular and choroidal thickness in healthy residents living at high altitude

Purpose: Assessment of long?term effects of high altitude on choroidal thickness. Methods: This prospective cross?sectional study included 88 and 79 age? and sex?matched healthy individuals who were living at sea?level (SL group) and high?altitude (HA group), respectively. Participants were required to have resided in the same place for at least 10 years. Spectral?domain optical coherence tomography (SD?OCT) scans were conducted in two different and were performed within the same time (08:00 am to 10:00 am). Central macular thickness (CMT) and choroidal thickness were measured at five different points (i.e., at the central fovea and 1 mm and 2 mm temporal and nasal of the fovea). Blood hemoglobin (Hb), red blood cell (RBC), hematocrit (Htc) levels, blood oxygen saturation, heart rate, and body mass index (BMI) were compared between groups statistically. Results: The HA group had a mean age of 47.5 ± 13.3 years, whereas the SL group was 48.7 ± 13.4 years (P = 0.57). There was no significant difference between the groups in terms of CMT. Subfoveal choroidal thickness (SCFT) was 282.73 ± 87.82 ?m in the HA group and 310.49 ± 74.73 in the SL group (P = 0.02). The choroid was found to be thinner at all the measured locations in the HA group except the 2 mm nasal point of the fovea. However, only the difference at an SFCT was statistically significant. Furthermore compared with the SL group statistically significant higher Hb, RBC, Htc levels were determined in the HA group. In the multiple linear regression model analysis, age was found an only effective confounder factor for SCFT (P = 0.001, 95% CI 4.132–2.476). Conclusion: The systemic adaptive changes due to chronic high altitude exposure may cause structural changes in the choroidal vascular network. The current study results revealed significant thinning only at SFCT. Large?scale longitudinal studies are needed to obtain more definitive data on this subject.

¿Cuándo debería y cuándo no debería utilizarse oxígeno en las enfermedades neuromusculares? / When should and when should not use oxygen in neuromuscular diseases?

Resumen A pesar de las referencias que advierten sobre los efectos adversos de la utilización de O2 suplementario sin asistencia ventilatoria en pacientes con enfermedades neuromusculares (ENM), aún hoy continúan ingresando pacientes en unidades de cuidados intensivos con hipercapnia grave y narcosis por CO2. Parecería que el problema es redescubierto según pasan los años y las generaciones. Muchos pacientes y su red de cuidadores formales e informales no son conscientes de este riesgo que puede llevar a un empeoramiento significativo de los síntomas, eventos agudos, ingresos hospitalarios y, en algunos casos, causar la muerte. Este artículo está centrado en los riesgos de la administración de O2, así como en sus indicaciones puntuales en personas con ENM. El problema central es que la administración de O2 puede quitar el impulso hipóxico para ventilar, aunque otros mecanismos podrían estar involucrados. El retiro completo de la oxigenoterapia sin apoyo de asistencia ventilatoria, es un error aún mayor. Es posible administrar O2 y controlar el CO2 de forma segura. Nunca se debe administrar O2 sin monitorear constantemente el nivel de CO2. La ventilación no invasiva binivelada (BiPAP) mediante interfaz nasal, bucal o boquilla, es la principal medida para revertir la hipoventilación y lograr el descenso de la PaCO2. Las indicaciones de oxigenoterapia en personas con ENM han sido consensuadas y están reservadas a situaciones específicas. Para mejorar la atención de aquellos enfermos con ENM y evitar intervenciones iatrogénicas, se requiere educación al equipo de salud y contención en el entorno del paciente.

Abstract Although the references warn about the adverse effects of adding O2 without ventilatory assistance in patients with neuromuscular diseases (NMD), patients are still to be admitted to intensive care units with severe hypercapnia and CO2 narcosis. It seems that the problem is rediscovered as the years and generations go by. Unfortunately, many patients and their network of formal and informal caregivers are unaware of this risk, leading to significant worsening of symptoms, acute events, hospital admissions, and, in some cases, cause death. This article focuses on the dangers of O2 administration as well as its precise indications in people with NMD. The central problem is that the administration of O2 can remove the hypoxic impulse to ventilate, however, other mechanisms could be involved, but. The complete withdrawal of oxygen therapy is an even greater mistake if it is not supported by ventilatory assistance. It is possible to supply O2 and control CO2 safely. Oxygen should never be administered without constantly monitoring the CO2 level. Bi-level non-invasive ventilation (BiPAP) through a buccal, nasal interface or mouthpiece is the primary measure to reverse hypoventilation and achieve a decrease in PaCO2. The indications for oxygen therapy in people with NMD have been agreed upon and are reserved for specific situations. To improve the care of those with NMD and avoid iatrogenic interventions, education of the health team and support in the patient's environment is required.

Electrical stimulation relieves muscle atrophy induced by chronic hypoxia-hypercapnia through the PTEN/Akt/FoxO1 pathway / 中华物理医学与康复杂志

Objective:1. To detect any change in the PTEN/Akt/FoxO1 signaling pathway in the muscles of rats with chronic hypoxia-hypercapnia treated using neuromuscular electrical stimulation (NMES), and 2. To document the role of chronic hypoxia-hypercapnia in inducing muscle atrophy.Methods:Thirty-two male Sprague-Dawley rats were randomly divided into a control group, a model group, a mock stimulation group, and an NMES group, each of eight. All of the rats in the model group, the mock stimulation group and the NMES group were placed in a hypoxia-hypercapnia chamber with a 9-11% O 2 and 5.5-6.5% CO 2 atmosphere for 8h per day and 7d per week, lasting 4 weeks. The control group were placed in a similar chamber with normal air. In the last 2 weeks, after the 8h in the chamber, the NMES group were given 30min of electrical stimulation at 100Hz to the calf muscles of their bound lower limbs. The mock stimulation group were only bound without any electrical stimulation. After the 4-week intervention, the gastrocnemius muscles were resected and their cross-sectional areas (CSAs) were observed using hematoxylin-eosin staining. Immunohistochemistry and western blotting were employed to detect the protein expression of phosphatase and tensin (PTEN), p-Akt, Akt and FoxO1. Results:Compared with the control group, a significant decrease was observed in the average CSA and in the expression of p-Akt and Akt in the model group, while a significant increase was found in the average protein expression of PTEN and FoxO1. Compared with the model group, there was a significant increase in the average CSA, as well as the average expression of p-Akt and Akt in the NMES group, but a significant decrease in the average expression of PTEN and FoxO1.Conclusion:Neuromuscular electrical stimulation can relieve muscle atrophy from chronic hypoxia-hypercapnia by inducing skeletal muscle protein synthesis through regulating the PTEN/Akt/FoxO1 signaling pathway, at least in rats.

Adenosine A 2A receptor deficiency prevents p38MAPK activation and apoptosis of prefrontal cortex cells in mice with chronic hypoxic hypercapnia / 中华物理医学与康复杂志

Objective:To observe the effect of genetic inactivation of adenosine A 2A receptor on apoptosis in the prefrontal cortex and on the expression of phosphorylated p38 mitogen-active protein kinase (p38MAPK) in mice with chronic hypoxic hypercapnia. Methods:Sixteen male wild-type mice and 16 male mice in which the adenosine A 2A receptor gene had been knocked out were randomly divided into a 4 weeks group (including 4HH+ /+ and 4HH-/- subgroups) and a normal control group (including NC+ /+ and NC-/- subgroups). The 4HH+ /+ and 4HH-/- group mice were exposed to an atmosphere containing 9-11% O 2 and 5-6% CO 2 8 hours a day, 6 days a week for 4 weeks. The apoptosis index (AI) in their prefrontal cortices was then evaluated using terminal-deoxynucleoitide transferase mediated nick end labelling (TUNEL) staining. The expression of p38MAPK protein in the prefrontal cortices was measured using western blotting. Results:The average AI had increased significantly in the 4HH+ /+ and 4HH-/- groups compared with the controls, with significantly more apoptotic cells in the 4HH+ /+ group than in the 4HH-/- group. In the 4HH+ /+ and 4HH-/- groups the average expression of p38 protein in the prefrontal cortex was significantly higher than among their controls. Moreover, the average expression of p-p38MAPK protein in the prefrontal cortex of the 4HH-/- group was significantly lower than in the 4HH+ /+ group.Conclusion:Adenosine A 2A receptor knockout inhibits apoptosis in the prefrontal cortex and down-regulates the p38MAPK activation of mice after exposure to chronic hypoxic hypercapnia.

Effect of permissive hypercapnia on perioperative pulmonary inflammatory response in patients undergoing thoracoscopic combined with laparoscopic esophagectomy / 中华内分泌外科杂志

Objective:To study the effect of permissive hypercapnia on pulmonary infection in patients underwent thoracoscopic combined with laparoscopic radical esophagectomy.Methods:From 2018 to 2020, 90 who patients underwent thoracoscopic laparoscopy combined with radical esophagectomy were divided into 3 groups by random who number table method, including 30 patients in experimental group 1, 30 patients in experimental group 2, and 30 patients in control group.PaCO 2 was maintained in the range of 56 mmHg-65 mmHg in experimental group 1, 46 mmHg-55 mmHg in experimental group 2 and 35 mmHg-45 mmHg in control group. The peak airway pressure (Ppeak) , lung dynamic compliance (Cdyn) and oxygenation index (OI) were observed and compared among the three groups after endotracheal intubation (T1) , 30 min after right artificial pneumothorax (T2) and 30 min after right lung recruitment (T3) ;The clinical pulmonary infection score (CPIS) , serum procalcitonin (PCT) on the 1st, 4th and 7th day after operation were analyzed and compared. Results:At T2, observation group A had the highest dynamic lung compliance (25.13 ± 5.70 vs 22.28 ± 4.26 vs 19.99 ± 4.36), the fastest heart rate (102.04 ± 10.91 vs 96.46 ± 9.91 vs 92.28 ± 8.08) and the lowest airway pressure (17.62 ± 1.79 vs 18.96 ± 1.90 vs 20.39 ± 1.71) ( P < 0.05). Observation group A had the lowest CPIS on the 1st, 4th and 7th day after operation compared with observation group B and control group (1.12±0.77 vs 1.71±0.90 vs 2.64±1.07) (6.08±1.20 vs 7.43±1.10 vs 8.31±1.55) (1.69±1.12 vs 2.32±0.98 vs 3.44±1.25) ( P<0.05) . Conclusion:Permissive hypercapnia can reduce airway resistance, improve lung compliance and reduce the risk of postoperative pulmonary infection.

Locus Coeruleus Acid-Sensing Ion Channels Modulate Sleep–Wakefulness and State Transition from NREM to REM Sleep in the Rat / 神经科学通报·英文版

The locus coeruleus (LC) is one of the essential chemoregulatory and sleep–wake (S–W) modulating centers in the brain. LC neurons remain highly active during wakefulness, and some implicitly become silent during rapid eye movement (REM) sleep. LC neurons are also involved in CO

Fibrosis quística y alto flujo termo humidificado, una nueva estrategia en el tratamiento / High-flow nasal cannula therapy in cystic fibrosis, a New Treatment Strategy

Se presenta el caso de un paciente con fibrosis quística, insuficiencia respiratoria crónica tipo II, en tratamiento con solución hipertónica, DNAsa, salbutamol, VNI nocturna y oxigenoterapia 24 horas, quien consulta por presentar desaturación y cefalea en el contexto de cambio de equipo de VNI. Se inicia tratamiento con HFNC y AVAPS presentando mejoría clínica, disminución de los requerimientos de oxígeno, descenso de la PaCO2 , disminución de los tapones mucosos en la tomografía y fluidificación de las secreciones respiratorias. Se plantea al HFNC como posible estrategia de tratamiento en los pacientes con FQ. Al prevenir el daño de la mucosa, disminuir la inflamación y las infecciones podría enlentecer el deterioro de la función pulmonar.

We present the case of a patient with cystic fibrosis and type II chronic respiratory failure under treatment with hypertonic solution, DNAse, salbutamol, night NIV and 24-hour oxygen therapy. The patient consults for desaturation and cephalea in the context of changing NIV equipment. The patient begins treatment with HHHF and AVAPS and shows clinical improvement, decrease in oxygen requirements, decrease in PaCO2 , less mucous plugging on the tomography and fluidifying of respiratory secretions. The HHHF is proposed as possible treatment strategy for patients with CF. By preventing damage to the mucosa and reducing inflammation and infections it could slow down impairment of the lung function.

Seizures in patients with respiratory disease - a retrospective single center study / Convulsões em pacientes com doença respiratória - estudo retrospectivo de centro único

ABSTRACT Objective: Seizures are a neurological condition commonly experienced during the follow-up period after systemic or metabolic disorders. The aim of the present study was to determine the etiological factors of seizures in patients at a tertiary care chest clinic. Methods: We reviewed all neurology consultations that were requested due to seizures in inpatient clinics in a tertiary care hospital specializing in respiratory disorders between January 2011 and January 2018 were retrospectively reviewed. Results: The present study included 705 of 2793 (25.2%) patients who requested consultations for seizures during the study period. The mean age of the sample was 64.05±17.19 years. Of the 705 patients, 307 (43.5%) had a previous history of epilepsy (Group I) and 398 (56.5%) had a first-time seizure and were considered to have symptomatic seizures (Group II). Multiple factors played roles in the development of seizures in 54.8% of the patients. In most patients, metabolic causes, systemic infections, and drug use were identified and an intracranial metastatic mass lesion was the major cause in patients with lung cancer. Rates of hypoxemia and respiratory acidosis were significantly higher in patients with symptomatic seizures (Group II) than in patients with primary epilepsy (Group I). Conclusions: Blood gas changes such as hypoxemia and respiratory acidosis were among the factors statistically associated with the development of symptomatic seizures in patients with respiratory diseases. Additionally, hypoxemia, hypercapnia, and respiratory acidosis were correlated with mortality in patients hospitalized for respiratory system diseases who requested consultations for seizures.

RESUMO Objetivo: Convulsões são uma condição neurológica comumente vivenciada durante o período de acompanhamento após distúrbios sistêmicos ou metabólicos. O objetivo do presente estudo foi determinar os fatores etiológicos das convulsões em pacientes de uma clínica torácica de atendimento terciário. Métodos: Foram revisadas retrospectivamente todas as consultas neurológicas solicitadas devido a convulsões em clínicas de internação em um hospital terciário especializado em distúrbios respiratórios entre janeiro de 2011 e janeiro de 2018. Resultados: O presente estudo incluiu 705 dos 2.793 (25,2%) pacientes que solicitaram consultas para convulsões durante o período do estudo. A idade média da amostra foi de 64,05±17,19 anos. Dos 705 pacientes, 307 (43,5%) tinham história prévia de epilepsia (Grupo I) e 398 (56,5%) tiveram uma convulsão inicial e foram considerados como tendo crises sintomáticas (Grupo II). Vários fatores desempenharam papel no desenvolvimento de convulsões em 54,8% dos pacientes. Na maioria dos pacientes, causas metabólicas, infecções sistêmicas e uso de drogas foram identificadas e uma lesão em massa metastática intracraniana foi a principal causa em pacientes com câncer de pulmão. As taxas de hipoxemia e acidose respiratória foram significativamente maiores em pacientes com crises sintomáticas (Grupo II) do que em pacientes com epilepsia primária (Grupo I). Conclusões: Alterações dos gases sanguíneos, como hipoxemia e acidose respiratória, foram alguns dos fatores estatisticamente associados ao desenvolvimento de convulsões sintomáticas em pacientes com doenças respiratórias. Além disso, hipoxemia, hipercapnia e acidose respiratória foram correlacionadas com a mortalidade em pacientes hospitalizados por doenças do sistema respiratório que solicitaram consultas para convulsões.

Insuficiencia de la bomba ventilatoria: una perspectiva histórica / Ventilatory pump failure: historical perspective

En humanos, PaCO2 es controlada muy estrictamente. A diferencia de PaO2 y todas las pruebas funcionales respiratorias que cambian con la edad, PaCO2 permanece constante durante toda la vida. Por lo tanto, su desviación sostenida representa una alteración significativa de la homeostasis. La estructura responsable de mantener la PaCO2 dentro de límites muy estrechos es la bomba ventilatoria. Se compone de varias unidades anatómicas y funcionales que van desde la corteza cerebral hasta los músculos respiratorios. Varias condiciones clínicas que involucran estas estructuras pueden conducir a la insuficiencia de la bomba respiratoria, cuyo sello distintivo es la hipercapnia. La relevancia del concepto de bomba respiratoria ha sido reconocida a lo largo de las décadas. Unos pocos trabajos germinales abrieron la puerta a un notable número de proyectos básicos, aplicados y clínicos en torno a la insuficiencia de la bomba respiratoria y su relevancia clínica. Este artículo revisará algunos de estos estudios y narrará el camino hacia nuestro estado actual de conocimiento sobre el tema.

IIn humans, PaCO2 is very strictly controlled. Unlike PaO2 and all respiratory functional tests that change with age, PaCO2 remains constant throughout life. Therefore, its sustained deviation represents a significant alteration of homeostasis. The structure responsible for keeping PaCO2 within very narrow limits is the ventilatory pump. It consists of several anatomical and functional units that go from the cerebral cortex to the respiratory muscles. Several clinical conditions involving these structures can lead to failure of the respiratory pump, whose hallmark is hypercapnia. The relevance of the respiratory pump concept has been acknowledged for decades. A few initial works allowed for a remarkable number of basic, applied and clinical projects regarding the respiratory pump failure and its clinical relevance. This article reviews some of these studies and describes the process that lead to our current state of knowledge on the subject

High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study

BACKGROUND: Usually, high-flow nasal cannula (HFNC) therapy is indicated for de novo acute hypoxemic respiratory failure (AHRF). Although only a few researches have examined the effectiveness of HFNC therapy for respiratory failure with hypercapnia, this therapy is often performed under such conditions for various reasons. We investigated the effectiveness of HFNC therapy for AHRF patients with hypercapnia compared to those without hypercapnia.METHODS: All consecutive patients receiving HFNC therapy between January 2012 and June 2018 at a university hospital were enrolled and classified into nonhypercapnic and hypercapnic groups. We compared the outcomes of both groups and adjusted the outcomes with propensity score matching.RESULTS: A total of 862 patients were enrolled, of which 202 were included in the hypercapnic group. HFNC weaning success rates were higher, and intensive care unit (ICU) and hospital mortality was lower in the hypercapnic group than in the nonhypercapnic group (all P < 0.05). However, no statistical differences in HFNC weaning success (adjusted P = 0.623, matched P = 0.593), ICU mortality (adjusted P = 0.463, matched P = 0.195), and hospital mortality (adjusted P = 0.602, matched P = 0.579) were noted from the propensity-adjusted and propensity-matched analyses. Additionally, in the propensity score-matched subgroup analysis (according to chronic lung diseases and causes of HFNC application), there was also no significant difference in outcomes between the two groups.CONCLUSION: In AHRF with underlying conditions, HFNC therapy might be helpful for patients with hypercapnia. Large prospective and randomized controlled trials are required for firm conclusions.

Prevalence and clinical significance of microalbuminuria and hypoxemia in patients with chronic obstructive pulmonary disease

Background: Microalbuminuria is a sign of glomerular dysfunction in general and sign of tubulointerstitial disease to a lesser extent. Hypoxia induces endothelial cell to release a number of different vasoactive agents including endotheline-1, platelet derived growth factor (PDGF), nitric oxide; that causes endothelial injury and lead to microalbuminuria. This study was aimed to assess the prevalence of microalbuminuria in COPD patients and assess the Relationship of microalbuminuria with the disease severity in the forms of FEV1, PaO2, PaCO2, and BODE INDEX in COPD patients.Methods: Total 130 COPD patients were included in our cross sectional study. Total patients were divided into two groups, 1st group was COPD with microalbuminuria while 2nd group was COPD without microalbuminuria. Lung function test, 6 min walk distance, arterial blood pressure (BP), BODE index, arterial blood gases, fasting and post prandial plasma glucose and kidney function tests were measured. Screening for microalbuminuria was done by measuring urinary microalbumin in a random spot urine collection.Results: The prevalence of microalbuminuria was 29.23% in patients of COPD. As compared with COPD without microalbuminuria group, COPD with microalbuminuria group were more hypoxic (12% vs 74%, P=0.0001 ), more hypercapnic (22% vs 84%, p=0.00001) and most of the patients with grade III (16% vs 34%, p=0.00001) or grade IV (19% vs 47%, p=0.00001) severity (according to GOLD criteria).Conclusions: Patients with severe COPD with hypoxemia or hypercapnia were significantly associated with microalbuminuria.

Hypercapnia attenuates ventilator-induced lung injury through vagus nerve activation

Abstract Purpose: To investigate the role of vagus nerve activation in the protective effects of hypercapnia in ventilator-induced lung injury (VILI) rats. Methods: Male Sprague-Dawley rats were randomized to either high-tidal volume or low-tidal volume ventilation (control) and monitored for 4h. The high-tidal volume group was further divided into either a vagotomy or sham-operated group and each surgery group was further divided into two subgroups: normocapnia and hypercapnia. Injuries were assessed hourly through hemodynamics, respiratory mechanics and gas exchange. Protein concentration, cell count and cytokines (TNF-α and IL-8) in bronchoalveolar lavage fluid (BALF), lung wet-to-dry weight and pathological changes were examined. Vagus nerve activity was recorded for 1h. Results: Compared to the control group, injurious ventilation resulted in a decrease in PaO2/FiO2 and greater lung static compliance, MPO activity, enhanced BALF cytokines, protein concentration, cell count, and histology injury score. Conversely, hypercapnia significantly improved VILI by decreasing the above injury parameters. However, vagotomy abolished the protective effect of hypercapnia on VILI. In addition, hypercapnia enhanced efferent vagus nerve activity compared to normocapnia. Conclusion: These results indicate that the vagus nerve plays an important role in mediating the anti-inflammatory effect of hypercapnia on VILI.

Cardiopulmonary Bypass Strategies to Maintain Brain Perfusion during Lung Transplantation in a Patient with Severe Hypercapnia / 대한흉부외과학회지

Herein, we report a case of lung transplantation in a patient with profound preoperative hypercapnia, focusing on the cardiopulmonary bypass strategy used for brain perfusion during the operation. We applied the pH-stat method for acid-base regulation, and thereby achieved the desired outcome without any neurologic deficit.

Cerebrovascular reactivity to hypercapnia during sevoflurane or desflurane anesthesia in rats / 대한마취과학회지

BACKGROUND: Hypercapnia causes dilation of cerebral vessels and increases cerebral blood flow, resulting in increased intracranial pressure. Sevoflurane is reported to preserve cerebrovascular carbon dioxide reactivity. However, the contribution of inhaled anesthetics to vasodilatory responses to hypercapnia has not been clarified. Moreover, the cerebrovascular response to desflurane under hypercapnia has not been reported. We examined the effects of sevoflurane and desflurane on vasodilatory responses to hypercapnia in rats. METHODS: A closed cranial window preparation was used to measure the changes in pial vessel diameters. To evaluate the cerebrovascular response to hypercapnia and/or inhaled anesthetics, the pial vessel diameters were measured in the following states: without inhaled anesthetics at normocapnia (control values) and hypercapnia, with inhaled end-tidal minimal alveolar concentration (MAC) of 0.5 or 1.0 of either sevoflurane or desflurane at normocapnia, and an MAC of 1.0 of sevoflurane or desflurane at hypercapnia. RESULTS: Under normocapnia, 1.0 MAC, but not 0.5 MAC, of sevoflurane or desflurane dilated the pial arterioles and venules. In addition, under both 1.0 MAC of sevoflurane and 1.0 MAC of desflurane, hypercapnia significantly dilated the pial arterioles and venules in comparison to their diameters without inhaled anesthetics. The degrees of vasodilation were similar for desflurane and sevoflurane under both normocapnia and hypercapnia. CONCLUSIONS: Desflurane induces cerebrovascular responses similar to those of sevoflurane. Desflurane can be used as safely as sevoflurane in neurosurgical anesthesia.