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1.
Trials ; 22(1): 718, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34666820

RESUMO

BACKGROUND: Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial. METHODS: multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality. DISCUSSION: Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04582799 . Registered 12 October 2020, .


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Dióxido de Carbono , Humanos , Hipercapnia , Estudos Multicêntricos como Assunto , Ventilação não Invasiva/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Pan Afr Med J ; 39: 119, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34512855

RESUMO

Introduction: the use of invasive mechanical ventilation (IMV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) constitutes a negative turning point in the progression of the disease. The purpose of this study is to determine factors predicting the need for IMV in AECOPD. Methods: we conducted a retrospective study by reviewing the medical records of patients with AECOPD hospitalized in our Department over a 18-year period (2000-2017). We compared 2 groups: G1: patients with AECOPD undergoing at least one IMV and G2: patients who had never undergone IMV following AECOPD. Results: the study included 1152 patients with COPD: 133 in the G1 group (11.5%), and 1019 in the G2 group (88.5%). G1 patients were more symptomatic (p < 0.001), with more severe bronchial obstruction (p < 0.001). G1 patients had more exacerbations (p < 0.001), more hospitalizations and a higher need for non-invasive ventilation (NIV) (p < 0.001). Similarly, G1 patients more often developed chronic respiratory failure (p < 0.001) and had significantly lower survival rates. Independent risk factors associated with IMV were hypercapnia and decreased pH (in patients with severe AECOPD), a history of NIV, and chronic respiratory failure (CRF). Conclusion: respiratory function impairment, the severity of exacerbation and the need for NIV in a previous episode are factors predicting the need for IMV and poor outcomes.


Assuntos
Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/estatística & dados numéricos , Idoso , Progressão da Doença , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipercapnia/epidemiologia , Masculino , Pessoa de Meia-Idade , Ventilação não Invasiva/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
3.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(10): 873-879, 2021 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-34565113

RESUMO

Objective: To investigate the effects of daytime hypercapnia on logical memory and working memory in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This prospective study recruited patients complaining of snoring and diagnosed with OSAHS at the Sleep Center of the Second Affiliated Hospital of Soochow University from January to November 2020. Patients were assessed clinically and scored for their memory function. All patients underwent daytime transcutaneous carbon dioxide (PtcCO2) test, and overnight polysomnography (PSG). Logical memory was scored using the Logical Memory Test (LMT), while working memory was evaluated by Digit Span Test (DST) and Cambridge Neuropsychological Test Automated Battery (CANTAB) which included Pattern Recognition Memory (PRM), Spatial Span (SSP), and Spatial Working Memory (SWM). Patients were divided into the normocapnic group and the hypercapnic group using the daytime PtcCO2 test. The clinical and PSG parameters and the memory test scores between the two groups were compared. Binary logistic stepwise regression was conducted to identify risk factors of memory impairment in OSAHS patients. Results: Among the 123 enrolled OSAHS patients, 79 were normocapnic and 44 were hypercapnic. There was no significant difference in the general clinical parameters between the two groups. The snoring history in years in the hypercapnic group was longer than that in the normocapnic group (P<0.05). Compared with the normocapnic group, the apnea-hyponea index (AHI), oxygen desaturation index (ODI) and percentage of total sleep time with oxygen saturation level<90% (TS90) of the hypercapnic group were higher (all P<0.05), while other PSG parameters exhibited no statistically significant differences. There was no statistically significant difference in the immediate logical memory and PRM immediate accuracy rate between the two groups, while the delayed logical memory, verbal and spatial working memory, and executive function were worse in the hypercapnic group, as shown by lower total LMT scores, lower DST, lower SSP scores (all P<0.05), and higher between errors and strategy scores (P<0.01) of SWM in the hypercapnic group. Binary logistic stepwise regression showed that PtcCO2 ≥45 mmHg (1 mmHg=0.133 kPa, OR=3.055, 95%CI 1.359-6.868, P=0.007) and higher body mass index (BMI) (OR=1.132, 95%CI 1.005-1.275, P=0.041) were risk factors for poor performance in Digit Span Backwards Test. Therefore, PtcCO2 ≥45 mmHg was an independent risk factors for poor performance in delayed LMT, SSP, and between errors and strategy scores in SWM (OR=3.109, 3.941, 3.238 and 2.785, respectively, all P<0.05). Conclusion: Hypercapnia had negative impacts on logical memory and working memory of OSAHS patients, especially on the delayed logical memory, verbal working memory and spatial working memory impairment.


Assuntos
Hipercapnia , Apneia Obstrutiva do Sono , Humanos , Memória de Curto Prazo , Polissonografia , Estudos Prospectivos
4.
Am J Physiol Regul Integr Comp Physiol ; 321(5): R655-R671, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34494485

RESUMO

White seabass (Atractoscion nobilis) increasingly experience periods of low oxygen (O2; hypoxia) and high carbon dioxide (CO2, hypercapnia) due to climate change and eutrophication of the coastal waters of California. Hemoglobin (Hb) is the principal O2 carrier in the blood and in many teleost fishes Hb-O2 binding is compromised at low pH; however, the red blood cells (RBC) of some species regulate intracellular pH with adrenergically stimulated sodium-proton-exchangers (ß-NHEs). We hypothesized that RBC ß-NHEs in white seabass are an important mechanism that can protect the blood O2-carrying capacity during hypoxia and hypercapnia. We determined the O2-binding characteristics of white seabass blood, the cellular and subcellular response of RBCs to adrenergic stimulation, and quantified the protective effect of ß-NHE activity on Hb-O2 saturation. White seabass had typical teleost Hb characteristics, with a moderate O2 affinity (Po2 at half-saturation; P50 2.9 kPa) that was highly pH-sensitive (Bohr coefficient -0.92; Root effect 52%). Novel findings from super-resolution microscopy revealed ß-NHE protein in vesicle-like structures and its translocation into the membrane after adrenergic stimulation. Microscopy data were corroborated by molecular and phylogenetic results and a functional characterization of ß-NHE activity. The activation of RBC ß-NHEs increased Hb-O2 saturation by ∼8% in normoxic hypercapnia and by up to ∼20% in hypoxic normocapnia. Our results provide novel insight into the cellular mechanism of adrenergic RBC stimulation within an ecologically relevant context. ß-NHE activity in white seabass has great potential to protect arterial O2 transport during hypoxia and hypercapnia but is less effective during combinations of these stressors.


Assuntos
Agonistas Adrenérgicos beta/farmacologia , Bass/metabolismo , Eritrócitos/efeitos dos fármacos , Proteínas de Peixes/agonistas , Hipercapnia/metabolismo , Hipóxia/metabolismo , Isoproterenol/farmacologia , Oxiemoglobinas/metabolismo , Trocadores de Sódio-Hidrogênio/agonistas , Aclimatação , Animais , Bass/sangue , Ecossistema , Eritrócitos/metabolismo , Eritrócitos/ultraestrutura , Proteínas de Peixes/metabolismo , Proteínas de Peixes/ultraestrutura , Hipercapnia/sangue , Hipóxia/sangue , Transporte Proteico , Trocadores de Sódio-Hidrogênio/metabolismo , Trocadores de Sódio-Hidrogênio/ultraestrutura
5.
J Physiol ; 599(21): 4925-4948, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34510468

RESUMO

Active expiration is essential for increasing pulmonary ventilation during high chemical drive (hypercapnia). The lateral parafacial (pFL ) region, which contains expiratory neurones, drives abdominal muscles during active expiration in response to hypercapnia. However, the electrophysiological properties and synaptic mechanisms determining the activity of pFL expiratory neurones, as well as the specific conditions for their emergence, are not fully understood. Using whole cell electrophysiology and single cell quantitative RT-PCR techniques, we describe the intrinsic electrophysiological properties, the phenotype and the respiratory-related synaptic inputs to the pFL expiratory neurones, as well as the mechanisms for the expression of their expiratory activity under conditions of hypercapnia-induced active expiration, using in situ preparations of juvenile rats. We also evaluated whether these neurones possess intrinsic CO2 /[H+ ] sensitivity and burst generating properties. GABAergic and glycinergic inhibition during inspiration and expiration suppressed the activity of glutamatergic pFL expiratory neurones in normocapnia. In hypercapnia, these neurones escape glycinergic inhibition and generate burst discharges at the end of expiration. Evidence for the contribution of post-inhibitory rebound, CaV 3.2 isoform of T-type Ca2+ channels and intracellular [Ca2+ ] is presented. Neither intrinsic bursting properties, mediated by persistent Na+ current, nor CO2 /[H+ ] sensitivity or expression of CO2 /[H+ ] sensitive ion channels/receptors (TASK or GPR4) were observed. On the other hand, hyperpolarisation-activated cyclic nucleotide-gated and twik-related K+ leak channels were recorded. Post-synaptic disinhibition and the intrinsic electrophysiological properties of glutamatergic neurones play important roles in the generation of the expiratory oscillations in the pFL region during hypercapnia in rats. KEY POINTS: Hypercapnia induces active expiration in rats and the recruitment of a specific population of expiratory neurones in the lateral parafacial (pFL ) region. Post-synaptic GABAergic and glycinergic inhibition both suppress the activity of glutamatergic pFL neurones during inspiratory and expiratory phases in normocapnia. Hypercapnia reduces glycinergic inhibition during expiration leading to burst generation by pFL neurones; evidence for a contribution of post-inhibitory rebound, voltage-gated Ca2+ channels and intracellular [Ca2+ ] is presented. pFL glutamatergic expiratory neurones are neither intrinsic burster neurones, nor CO2 /[H+ ] sensors, and do not express CO2 /[H+ ] sensitive ion channels or receptors. Post-synaptic disinhibition and the intrinsic electrophysiological properties of glutamatergic neurones both play important roles in the generation of the expiratory oscillations in the pFL region during hypercapnia in rats.


Assuntos
Expiração , Neurônios , Animais , Hipercapnia , Ratos
6.
Medicine (Baltimore) ; 100(36): e27199, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34516524

RESUMO

ABSTRACT: To avoid ventilator-associated lung injury in acute respiratory distress syndrome (ARDS) treatment, respiratory management should be performed at a low tidal volume of 6 to 8 mL/kg and plateau pressure of ≤30 cmH2O. However, such lung-protective ventilation often results in hypercapnia, which is a risk factor for poor outcomes. The purpose of this study was to retrospectively evaluate the effectiveness and safety of the removal of a catheter mount (CM) and using heated humidifiers (HH) instead of a heat-and-moisture exchanger (HME) for reducing the mechanical dead space created by the CM and HME, which may improve hypercapnia in patients with ARDS.This retrospective observational study included adult patients with ARDS, who developed hypercapnia (PaCO2 > 45 mm Hg) during mechanical ventilation, with target tidal volumes between 6 and 8 mL/kg and a plateau pressure of ≤30 cmH2O, and underwent stepwise removal of CM and HME (replaced with HH). The PaCO2 values were measured at 3 points: ventilator circuit with CM and HME (CM + HME) use, with HME (HME), and with HH (HH), and the overall number of accidental extubations was evaluated. Ventilator values (tidal volume, respiratory rate, minutes volume) were evaluated at the same points.A total of 21 patients with mild-to-moderate ARDS who were treated under deep sedation were included. The values of PaCO2 at HME (52.7 ±â€Š7.4 mm Hg, P < .0001) and HH (46.3 ±â€Š6.8 mm Hg, P < .0001) were significantly lower than those at CM + HME (55.9 ±â€Š7.9 mm Hg). Measured ventilator values were similar at CM + HME, HME, and HH. There were no cases of reintubation due to accidental extubation after the removal of CM.The removal of CM and HME reduced PaCO2 values without changing the ventilator settings in deeply sedated patients with mild-to-moderate ARDS on lung-protective ventilation. Caution should be exercised, as the removal of a CM may result in circuit disconnection or accidental extubation. Nevertheless, this intervention may improve hypercapnia and promote lung-protective ventilation.


Assuntos
Hipercapnia/terapia , Respiração Artificial/instrumentação , Síndrome do Desconforto Respiratório/terapia , Idoso , Feminino , Temperatura Alta , Humanos , Umidificadores , Masculino , Estudos Retrospectivos
7.
Am J Physiol Regul Integr Comp Physiol ; 321(4): R558-R571, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34405704

RESUMO

Orexin neurons are active in wakefulness and mostly silent in sleep. In adult rats and humans, orexin facilitates the hypercapnic ventilatory response but has little effect on resting ventilation. The influence of orexin on breathing in the early postnatal period, and across states of vigilance, have not been investigated. This is relevant as the orexin system may be impaired in Sudden Infant Death Syndrome (SIDS) cases. We addressed three hypotheses: 1) orexin provides a drive to breathe in infancy; 2) the effect of orexin depends on stage of postnatal development; and 3) orexin has a greater influence on breathing in wakefulness compared with sleep. Whole body plethysmography was used to monitor breathing of infant rats at three ages: postnatal days (P) 7-8, 12-14, and 17-19. Respiratory variables were analyzed in wakefulness (W), quiet sleep (QS), and active sleep (AS), following suvorexant (5 mg/kg ip), a dual orexin receptor antagonist, or vehicle (DMSO). Effects of suvorexant on ventilatory responses to graded hypercapnia ([Formula: see text] = 0.02, 0.04, 0.06), hypoxia ([Formula: see text] = 0.10), and hyperoxia ([Formula: see text] = 1.0) at P12-14 were also tested. At P12-14, but not at other ages, suvorexant significantly reduced respiratory frequency in all states, reduced the ventilatory equivalent in QW and QS, and increased [Formula: see text] to ∼5 mmHg. Suvorexant had no effect on ventilatory responses to graded hypercapnia or hypoxia. Hyperoxia eliminated the effects of suvorexant on respiratory frequency at P12-14. Our data suggest that orexin preserves eupneic frequency and ventilation in rats, specifically at ∼2 wk of age, perhaps by facilitating tonic peripheral chemoreflex activity.


Assuntos
Células Quimiorreceptoras/metabolismo , Pulmão/inervação , Orexinas/metabolismo , Ventilação Pulmonar , Reflexo , Mecânica Respiratória , Animais , Animais Recém-Nascidos , Azepinas/farmacologia , Células Quimiorreceptoras/efeitos dos fármacos , Hipercapnia/metabolismo , Hipercapnia/fisiopatologia , Hipóxia/metabolismo , Hipóxia/fisiopatologia , Antagonistas dos Receptores de Orexina/farmacologia , Receptores de Orexina/metabolismo , Ventilação Pulmonar/efeitos dos fármacos , Ratos Sprague-Dawley , Reflexo/efeitos dos fármacos , Mecânica Respiratória/efeitos dos fármacos , Sono , Triazóis/farmacologia , Vigília
8.
Interact Cardiovasc Thorac Surg ; 33(3): 483-488, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34363470

RESUMO

OBJECTIVES: Carbon dioxide (CO2) gas insufflation is used for continuous de-airing during open heart surgery. The aim was to evaluate if an additional separate venous reservoir eliminates CO2 insufflation-induced hypercapnia and keeps sweep gas flow of the oxygenator constant. METHODS: A separate reservoir was used during cardiopulmonary bypass in addition to a standard venous reservoir. The additional reservoir received drained blood and CO2 gas continuously via a suction drain (1 l/min) and handheld suction devices from the surgical wound. CO2 gas was insufflated via a gas diffuser in the open wound at 10 l/min. In a cross-over design for each patient, gas and blood were either continuously drained from the additional to the standard venous reservoir or not. CO2 pressure in arterial blood (PaCO2) was measured after adjustment of sweep gas flow as necessary and after steady state of PaCO2 was observed. Mean values for each setup (median 4 times) for each patient were analysed with Wilcoxon rank-sum test. RESULTS: Ten adult patients undergoing open aortic valve replacement were included. Median PaCO2 did not differ between setups (5.41; 5.29-5.57, interquartile range vs 5.41; 5.24-5.58, P = 0.92), whereas sweep gas flow (l/min) was lower (2.58; 2.50-3.16 vs 4.42; 4.0-5.40, P = 0.002) when CO2 gas was not drained from the additional to the standard reservoir. CONCLUSIONS: An additional venous reservoir for the evacuation of blood from the open surgical wound eliminates CO2 insufflation-induced hypercapnia in open heart surgery keeping PaCO2 and sweep gas flow constant. This prevents possible CO2-induced hyperperfusion of the brain and decreases the risk of cerebral particulate embolization during CO2 insufflation for de-airing in open heart surgery. CLINICAL TRIAL REGISTRATION: NCT04202575. IRB APPROVAL DAT AND NUMBER: 2018-07-13 and 2018/1091-31.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuflação , Dispositivos de Acesso Vascular , Adulto , Dióxido de Carbono/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos , Hipercapnia , Insuflação/efeitos adversos
9.
Chemosphere ; 277: 130314, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34384180

RESUMO

The tambaqui (Colossoma macropomum), migrates annually between whitewater and blackwater rivers of the Amazon. Unlike the whitewater, blackwater is characterized by higher levels of dissolved organic carbon (DOC), including humic acids (HA). Because humic substances impair sensory processes, the current study tested the hypothesis that O2 and/or CO2 chemoreception is impeded in blackwater owing to the presence of HA. Thus, the ventilatory responses of tambaqui to hypoxia or hypercapnia were assessed in well water transported from Manaus, local blackwater, and in well water containing HA either extracted from Rio Negro water or obtained commercially (Sigma Aldrich; SA). In well water, tambaqui exhibited typical hyperventilatory responses to hypoxia or hypercapnia. These responses were prevented by simultaneously exposing fish to SA HA (20 mg l-1). The negative effects of SA HA on ventilation were prevented when natural DOC (30 mg l-1; extracted from Rio Negro water after first removing the endogenous HA fraction) was added concurrently, indicating a protective effect of this non-humic acid DOC fraction. The hyperventilatory responses were unaffected during acute exposure or after acclimation of fish to Rio Negro water. HA extracted from Rio Negro water did not impair the hyperventilatory responses to hypoxia or hypercapnia. This study, while demonstrating a negative effect of SA HA derived from peat (coal) on the control of breathing in tambaqui, failed to reveal any detrimental consequences of HA (derived from the decomposition of a variety of lignin-rich plants) naturally occurring in the blackwaters of the Rio Negro.


Assuntos
Carbono , Caraciformes , Animais , Hipercapnia , Hipóxia , Reflexo
10.
Adv Exp Med Biol ; 1319: 255-269, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34424519

RESUMO

Naked mole-rats are extremely tolerant to low concentrations of oxygen (hypoxia) and high concentrations of carbon dioxide (hypercapnia), which is consistent with the environment that they inhabit. Naked mole-rats combine subterranean living with living in very densely populated colonies where oxygen becomes depleted and carbon dioxide accumulates. In the laboratory, naked mole-rats fully recover from 5 h exposure to 5% O2 and 5 h exposure to 80% CO2, whereas both conditions are rapidly lethal to similarly sized laboratory mice. During anoxia (0% O2) naked mole-rats enter a suspended animation-like state and switch from aerobic metabolism of glucose to anaerobic metabolism of fructose. Additional fascinating characteristics include that naked mole-rats show intrinsic brain tolerance to anoxia; a complete lack of hypoxia-induced and CO2-induced pulmonary edema; and reduced aversion to high concentrations of CO2 and acidic fumes. Here we outline a constellation of physiological and molecular adaptations that correlate with the naked mole-rat's hypoxic/hypercapnic tolerance and which offer potential targets for ameliorating pathological conditions in humans, such as the damage caused during cerebral ischemia.


Assuntos
Hipercapnia , Ratos-Toupeira , Adaptação Fisiológica , Animais , Hipóxia , Camundongos , Oxigênio
11.
Int J Chron Obstruct Pulmon Dis ; 16: 2217-2226, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34349507

RESUMO

Purpose: Home mechanical ventilation (HMV) use in chronic obstructive pulmonary disease (COPD) is becoming increasingly widespread. The aim of this study was to provide an accurate description of the current practices and clinical characteristics of COPD patients on HMV in Portugal. Methods: The study was designed as a cross-sectional, multicenter real-life study of COPD patients established on HMV for at least 30 days. Data related to clinical characteristics, adaptation and ventilatory settings were collected. Results: The study included 569 COPD patients on HMV from 15 centers. The majority were male, with a median age of 72 years and a high prevalence of obesity (43.2%) and sleep apnea (45.8%). A high treatment compliance was observed (median 8h/day), 48.7% with inspiratory positive airway pressure ≥20 cmH2O and oronasal masks were the preferred interface (91.7%). There was an equal distribution of patients starting HMV during chronic stable condition and following an exacerbation. Patients in stable condition were initiated in the outpatient setting in 92.3%. Despite the differences in criteria and setting of adaptation and a slightly lower BMI in patients starting HMV following an exacerbation, we found no significant differences regarding age, gender, ventilation pressures, time on HMV, usage, severity of airflow obstruction or current arterial blood gas analysis (ABGs) in relation to patients adapted in stable condition. Conclusion: Patients were highly compliant with the therapy. In agreement with most recent studies and recommendations, there seems to be a move towards higher ventilation pressures, increased use of oronasal masks and an intent to obtain normocapnia. This study shows that chronic hypercapnic and post exacerbation patients do not differ significantly regarding patient characteristics, physiological parameters or ventilatory settings with one exception: chronic hypercapnic patients are more often obese and, subsequently, more frequently present OSA.


Assuntos
Serviços de Assistência Domiciliar , Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Idoso , Estudos Transversais , Feminino , Humanos , Hipercapnia , Masculino , Ventilação não Invasiva/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Respiração Artificial/efeitos adversos
12.
Int J Clin Pract ; 75(10): e14712, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34383989

RESUMO

INTRODUCTION AND AIM: Despite the improvement in survival among patients with lung cancer as a result of the development of novel treatment options, acute respiratory failure (ARF), which may occur because of the disease itself, comorbidities or complications in treatment may be life threatening. The most commonly utilised treatment option in cancer patients with ARF is invasive mechanical ventilation (IMV). The prognosis of lung cancer patients admitted to the intensive care unit is poor. The use of non-invasive mechanical ventilation (NIMV) in the setting of ARF not only supports the respiratory muscles and facilitates alveolar ventilation and airway patency, but also reduces the risk of serious complications of IMV, such as ventilator-associated pneumonia. NIMV treatment in the event of respiratory failure has been associated with a high rate of mortality in recently diagnosed or progressive lung cancer with organ failure. However, studies in this regard are limited, and the role of NIMV has yet to be investigated in patients in hospital wards. Accordingly, the present study investigates retrospectively the success of NIMV among patients with lung cancer (including all stages and histopathological types) in a hospital ward setting and the influential factors. MATERIAL AND METHOD: The data of 42 patients with lung cancer and respiratory failure who were admitted to the palliative care service and received NIMV between 2014 and 2018 were reviewed retrospectively. Demographic features, comorbidities, respiratory failure types, rate of withdrawal from NIMV, frequencies of tracheostomy and intubation, bacteriologic examination of the airway samples, rate of discharge from hospital and any history of NIMV/USOT use at home were recorded. NIMV success was defined as the discharge of the patient from the hospital, with or without a respiratory support device. The primary end-point of the study was NIMV success, while the secondary end-point was NIMV success with respect to the underlying diagnosis and respiratory failure type. RESULTS: A total of 42 patients (38 males and 4 females) were included in the study, with a mean age of 67.4 ± 9.5 years. The rate of discharge from hospital was 71% across the entire study population, among which, 13 (31%) were discharged with USOT and 16 (38.1%) with NIMV. Among the 12 patients under palliative supportive treatment, 8 were discharged from the hospital. The success rates of NIMV in the respiratory failure aetiological subgroups were: 66% (12 patients) in the pneumonia subgroup and 71.4% (15 patients) in the COPD subgroup. The difference between these subgroups was not significant (P = .841). The success rate of NIMV in the hypercapnic and hypoxaemic respiratory failure subgroups was 72.7% (24 patients) and 66.6% (6 patients), respectively. There were no significant differences between the type of respiratory failure subgroups (P = .667). The success rate of NIMV was similar in patients with a positive airway sample microbiology (71.4%, n = 14) and those with no growth identified in the culture (70.3%, n = 28) (P = .834). CONCLUSION: In lung cancer patients with no contraindication, NIMV can be used to reduce or postpone the need for ICU admission, independent of disease stage, cellular type and underlying cause.


Assuntos
Neoplasias Pulmonares , Ventilação não Invasiva , Insuficiência Respiratória , Idoso , Feminino , Humanos , Hipercapnia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Respiração Artificial , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
13.
J Pharmacol Toxicol Methods ; 111: 107101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34242797

RESUMO

INTRODUCTION: Whole-body plethysmography (WBP) in unrestrained, non-anesthetized rodents is a preclinical method to assess the respiratory depressant effects of opioids, the leading cause of opioid overdose death in humans. However, low baseline respiration rates under normocapnic conditions (i.e., "floor" effect) can render the measurement of respiratory decreases challenging. We assessed hypercapnia-induced increases in respiration as a strategy to assess opioid-induced decreases in respiration in rats. METHODS: WBP was used to assess respiration frequency, tidal volume and minute volume in the presence of normocapnic and hypercapnic (8% CO2) conditions in rats during the rat diurnal period of the light cycle. The mu-opioid receptor agonist fentanyl was administered intravenously, and the hot plate test was used to assess acute antinociception. RESULTS AND DISCUSSION: Hypercapnia-induced increases in respiratory parameters (frequency, minute volume, and tidal volume) were decreased by fentanyl at doses that did not decrease the same parameters under the normocapnic conditions. These findings show that hypercapnia increases sensitivity to respiratory depressant effects of fentanyl, as compared with assessments during the rat diurnal period when activity and breathing rate are generally low, i.e., there is a floor effect. The current approach is highly sensitive to opioid-induced respiratory depression, and therefore provides a useful method for assessment in a pre-clinical setting.


Assuntos
Analgésicos Opioides , Insuficiência Respiratória , Analgésicos Opioides/toxicidade , Animais , Fentanila/toxicidade , Hipercapnia , Ratos , Insuficiência Respiratória/induzido quimicamente , Volume de Ventilação Pulmonar
14.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(6): 686-691, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34296687

RESUMO

OBJECTIVE: To observe the effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and mild hypercapnia, and to evaluate the early predictive ability of physiological parameters in these patients. METHODS: A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-IV (MIMIC-IV) updated in September 2020 and the data of adult patients with COPD and mild hypercapnia [45 mmHg (1 mmHg = 0.133 kPa) < arterial partial pressure of carbon dioxide (PaCO2) ≤ 60 mmHg] from 2008 to 2019 were collected. These patients were assigned to the HFNC group or non-invasive ventilation (NIV) group according to whether they received HFNC or NIV. Baseline data such as gender, age, body mass index (BMI), simplified acute physiology score II (SAPS II), Charlson comorbidity index (CCI) and physiological parameters were collected. A propensity score matching was conducted according to the baseline data of the HFNC group patients. The 48-hour and 28-day intubation rates, 28-day mortality, length of intensive care unit (ICU) stay, the length of hospital stay, and the changes in physiological parameters within 48 hours after treatment were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn and the ratio of heart rate over pulse oxygen saturation (HR/SpO2) and ROX index [SpO2/(inhaled oxygen concentration, FiO2×respiratory rate, RR)] were analyzed to predict the 24-hour and 48-hour intubation rates. RESULTS: A total of 524 520 inpatient records were screened and 153 patients were included, while 37 patients in the HFNC group and 116 patients in NIV group. There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data. There were no significant differences in the baseline data of gender, age, BMI, SAPS II, CCI score, physiological parameters and prognosis data except the length of ICU stay. The length of ICU stay in HFNC group was significant longer than that of the NIV group [days: 4.6 (3.1, 10.0) vs. 3.1 (1.6, 5.8), P < 0.05]. HR and RR at 40-48 hours were significantly lower than those at 0-8 hours after treatment only in the HFNC group [HR (bpm): 84.1±12.2 vs. 91.1±16.4, RR (times/min): 19.8±4.9 vs. 21.6±4.1, both P < 0.05]. Both in the HFNC group and NIV group the pH increased (7.42±0.08 vs. 7.36±0.05 and 7.41±0.06 vs. 7.36±0.05, both P < 0.05) and PaCO2 decreased significantly [mmHg: 46.3 (39.5, 51.0) vs. 49.8 (45.5, 54.0) and 46.0 (40.5, 51.5) vs. 49.5 (45.5, 55.3), both P < 0.05]. The HR, PaO2 were higher in the HFNC group than those in the HFNC group at 40-48 hours after treatment [HR (bpm): 91.1±15.4 vs. 84.1±12.2, PaO2 (mmHg): 99.5 (86.0, 132.3) vs. 85.8 (76.5, 118.0), both P < 0.05], PaO2/FiO2 were lower in the HFNC group than that in the HFNC group at 40-48 hours after treatment [mmHg: 223.8 (216.5, 285.0) vs. 278.0 (212.3, 306.0), P < 0.05]. Both HR/SpO2 and ROX index at 4 hours after treatment had predictive value for 24-hour and 48-hour intubation in the HFNC group. The areas under ROC curve (AUC) of HR/SpO2 at 4 hours after treatment in the HFNC group were larger than those of ROX index for predicting 24-hour and 48-hour intubation (24-hour: 0.649 vs. 0.574, 48-hour: 0.692 vs. 0.581, both P < 0.01); the 95% confidence interval (95%CI) of 4 hours HR/SpO2 and for ROX index predicting 24 hours and 48 hours intubation were 0.497-0.780, 0.567-0.799, 0.450-0.694 and 0.454-0.716, respectively. The high sensitivity of HR/SpO2 and ROX index in predicting 24-hour and 48-hour intubation were 84.6%, 92.9%, 88.2% and 94.4%, respectively, and the low specificity were 52.3%, 23.7%, 54.7% and 29.6%, respectively. CONCLUSIONS: HFNC can be used in COPD patients with mild hypercapnia, but it cannot replace NIV. The accuracy of ROX index at 4 hours after HFNC treatment in predicting intubation in COPD patients with mild hypercapnia is poor.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Adulto , Cânula , Cuidados Críticos , Humanos , Hipercapnia , Oxigênio , Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
15.
Nutrients ; 13(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207775

RESUMO

Arterial hypercapnia reduces renal perfusion. Beetroot juice (BRJ) increases nitric oxide bioavailability and may improve renal blood flow. We tested the hypothesis that acute consumption of BRJ attenuates both decreases in blood velocity and increases in vascular resistance in the renal and segmental arteries during acute hypercapnia. In fourteen healthy young adults, blood velocity and vascular resistance were measured with Doppler ultrasound in the renal and segmental arteries during five minutes of breathing a carbon dioxide gas mixture (CO2) before and three hours after consuming 500 mL of BRJ. There was no difference between pre- and post-BRJ consumption in the increase in the partial pressure of end-tidal CO2 during CO2 breathing (pre: +4 ± 1 mmHg; post: +4 ± 2 mmHg, p = 0.4281). Segmental artery blood velocity decreased during CO2 breathing in both pre- (by -1.8 ± 1.9 cm/s, p = 0.0193) and post-BRJ (by -2.1 ± 1.9 cm/s, p = 0.0079), but there were no differences between pre- and post-consumption (p = 0.7633). Segmental artery vascular resistance increased from room air baseline during CO2 at pre-BRJ consumption (by 0.4 ± 0.4 mmHg/cm/s, p = 0.0153) but not post-BRJ (p = 0.1336), with no differences between pre- and post-consumption (p = 0.7407). These findings indicate that BRJ consumption does not attenuate reductions in renal perfusion during acute mild hypercapnia in healthy young adults.


Assuntos
Beta vulgaris , Sucos de Frutas e Vegetais , Hemodinâmica/efeitos dos fármacos , Hipercapnia/fisiopatologia , Rim/irrigação sanguínea , Raízes de Plantas , Adulto , Pressão Arterial , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Dióxido de Carbono , Ingestão de Líquidos/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Artéria Renal/fisiopatologia , Respiração/efeitos dos fármacos , Volume de Ventilação Pulmonar/efeitos dos fármacos , Ultrassonografia Doppler , Resistência Vascular/efeitos dos fármacos
16.
Clin Respir J ; 15(10): 1130-1138, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34224645

RESUMO

INTRODUCTION: Although long-term home non-invasive ventilation (H-NIV) has been used among chronic hypercapnic COPD patients, its clinical benefit is still on debate. We aim to assess the impact of H-NIV in chronic hypercapnic COPD patients. METHODS: COPD patients who initiated H-NIV between January 2010 and December 2017 were included. Patients with concomitant respiratory disorders were excluded. Acute exacerbation (AE) before and 2 years after H-NIV initiation was assessed as main outcome. Secondary outcomes included lung function and gas exchange parameters. Survival since H-NIV initiation was determined, and factors related with survival were explored. RESULTS: Seventy-two patients were enrolled. A decrease in partial pressure of carbon dioxide (PaCO2 ) in arterial blood (p < 0.001) and an improvement of partial pressure of oxygen (PaO2 ) (p < 0.001) were achieved using a high-intensity H-NIV. Regarding lung function, residual volume (RV) reduced (p = 0.010) and forced-expiratory volume in 1 s (FEV1 ) improved (p = 0.043) after H-NIV initiation. No significant differences in 6-min walking test (6MWT) were found. Compared with the year before H-NIV initiation, the number of AE diminished in the first and in the second years of follow-up (p < 0.001). The median survival was 79.0 months (95% confidence interval [CI], 52.9-105.1), and the covered distance in 6MWT predicted survival (hazard ratio [HR] = 0.026, p = 0.003) in the multivariate analysis. CONCLUSIONS: High-intensity H-NIV significantly improved FEV1 and hyperinflation, decreased frequency of AEs and led to a remarkable median survival, which was independently predicted by the walking distance in 6MWT.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Humanos , Hipercapnia , Pulmão , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia
17.
Int J Clin Pract ; 75(10): e14595, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34228853

RESUMO

BACKGROUND AND AIM: Intelligent volume-assured pressure support (iVAPS) is a relatively new hybrid mode of non-invasive ventilation (NIV). There is still limited evidence for iVAPS. The aim of this study was to compare the effectiveness of iVAPS to that of bi-level positive airway pressure spontaneous/timed (BPAP S/T) in patients with acute hypercapnic respiratory failure or acute-on-chronic hypercapnic respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department. MATERIAL AND METHODS: This was an observational, retrospective study. Eighty-two patients with hypercapnic respiratory failure caused by AECOPD, who were admitted to our emergency department, were analysed. Arterial blood gas (ABG) parameters, length of hospital stay and rate of intensive care unit (ICU) admission were compared between iVAPS and BPAP S/T. RESULTS: A total of 82 patients (26 females, 56 males, mean age 68.26 ± 11.63 years) who were treated with iVAPS (N = 26) or BPAP S/T (N = 56) were enrolled. There were no significant differences between two modes with respect to demographics such as age, gender, presence of comorbidity, usage of long-term oxygen therapy or NIV, and the baseline ABG parameters. The presence of pneumonia was significantly higher in BPAP S/T (P = .01). The rate of ICU admission was 26.9% in iVAPS vs 25% in BPAP S/T. The mean length of hospital stay was 11.5 ± 12.3 days in iVAPS and 9.7 ± 7.4 days in BPAP S/T (P = .53). The mean values of ABG parameters at the 1st and 24th hours of NIV therapy did not differ in both groups. CONCLUSION: Both modes were similarly effective in the management of appropriately selected patients with hypercapnic respiratory failure caused by AECOPD. Hence, we underline that NIV mode selection in the emergency department should be performed in line with experiences of clinicians/institutions and accessibility of ventilator devices/modes.


Assuntos
Ventilação não Invasiva , Doença Pulmonar Obstrutiva Crônica , Insuficiência Respiratória , Idoso , Feminino , Humanos , Hipercapnia , Masculino , Pessoa de Meia-Idade , Respiração com Pressão Positiva , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/terapia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos
18.
Eur J Anaesthesiol ; 38(11): 1148-1157, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34313609

RESUMO

BACKGROUND: Rapid emergence from general anaesthesia is desirable only if safety is not sacrificed. Mechanical hyperventilation during hypercapnia produced by carbon dioxide infusion into the inspired gas mixture or by rebreathing was reported to shorten emergence time from inhalation anaesthesia. OBJECTIVES: To test the hypothesis that hypercapnia produced by hypoventilation before desflurane cessation shortens emergence time from general anaesthesia (primary hypothesis) and reduces undesirable cardiorespiratory events. DESIGN: A single-blinded randomised controlled study. SETTING: A single university hospital. PATIENTS: Fifty adult patients undergoing elective abdominal surgery under general anaesthesia using desflurane inhalation and intra-operative epidural anaesthesia. INTERVENTION: The patients were randomly assigned to either the normocapnia or hypercapnia group. MAIN OUTCOME MEASURES: Emergence time from desflurane anaesthesia and comparison of the incidence of 11 predefined undesirable cardiorespiratory events during and after emergence from anaesthesia between the groups. RESULTS: Forty-six patients were included in the analysis. End-tidal carbon dioxide concentrations at cessation of desflurane were 35 ±â€Š6 mmHg (mean ±â€ŠSD) and 52 ±â€Š6 mmHg in normocapnia (n = 23) and hypercapnia groups (n = 23), respectively. Emergence time was significantly faster in the hypercapnia group than the normocapnia group: 9.4 ±â€Š2.4 min, hypercapnia: 5.5 ±â€Š2.6 min, (P < 0.001) with a difference of 3.8 min on average (95% CI: 2.4 to 5.3). Spontaneous breathing established before recovery of consciousness was more evident in hypercapnia patients (normocapnia: 13%, hypercapnia: 96%, P < 0.001). Hypercapnia patients had more episodes of bradypnoea and apnoea before emergence of consciousness. In contrast, after tracheal extubation, incidences of bradypnoea and hypopnoea were more common in the normocapnia group. Undesirable cardiovascular events were not common, and no group differences were observed during emergence and postextubation periods. CONCLUSION: Hypoventilation-induced hypercapnia before desflurane cessation shortens the emergence time without causing additional clinically significant undesirable events. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN000020143) https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&recptno=R000023266&language=E.


Assuntos
Anestésicos Inalatórios , Isoflurano , Adulto , Período de Recuperação da Anestesia , Anestesia por Inalação , Anestésicos Inalatórios/efeitos adversos , Desflurano , Humanos , Hipercapnia , Isoflurano/efeitos adversos
19.
Agri ; 33(3): 190-193, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34318923

RESUMO

According to International Classification of Headache Disorders (ICHD-III Beta version) headache attributed to hypoxia and/or hypercapnia is classified under the 4 title: 10.1.1 High altitude headache, 10.1.2 Airplane travel associated headache, 10.1.3 Diving headache and 10.1.4 Sleep apnoea headache. Headache associated with airplane travel is encountered infrequently in our clinical practice and firstly reported in 2004 as a case in the literature. The pathophysiology of headache associated with airplane travel is not yet clear. We presented this case in the aspect of the patient having both airplane travel and high altitude headaches and seen giant Virchow-Robin spaces in cranial MRI and disappearence of pain with a preventive treatment.


Assuntos
Sistema Glinfático , Viagem , Cefaleia/etiologia , Humanos , Hipercapnia , Hipóxia
20.
J Card Surg ; 36(10): 3921-3923, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34260766

RESUMO

Hemidiaphragm paralysis (HP) is a potential complication of cardiac surgery. While most patients are either asymptomatic or have mild symptoms, some are at risk of developing life-threatening hypercapnia. We present a case of a patient who developed HP after tricuspid valve replacement. Diaphragm plication was deferred due to underlying comorbidities, but over time she developed severe hypercapnic respiratory failure requiring intensive care unit admission. Chronic noninvasive ventilation therapy (NIV) was initiated, which improved her symptoms and hypercapnia and prevented further hospitalizations. For patients with iatrogenic HP unable to undergo diaphragm plication, Pulmonology referral for initiation of NIV should be strongly considered.


Assuntos
Ventilação não Invasiva , Insuficiência Respiratória , Diafragma/cirurgia , Feminino , Humanos , Hipercapnia , Paralisia , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
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