Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management.

Jeffrey, A A; Warren, P.M.; Flenley, D. C.

doi:10.1136/thx.47.1.34

Cited by 193 publications

(122 citation statements)

References 10 publications

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“…Accordingly, when patients with longstanding hypercapnia experience an acute exacerbation of COPD, their only option is to maximally recruit their inspiratory muscles, or to face lifethreatening hypoxaemia. Thirdly, mortality secondary to an exacerbation is not linked to the absolute level of hypercapnia but to the degree of acidosis [37,38]. These observations suggest that the inability to maintain an adequate alveolar ventilation by almost complete respiratory muscle recruitment may contribute to mortality.…”

Section: Discussionmentioning

confidence: 98%

The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD

2001

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The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD. A. Topeli, F. Laghi, M.J. Tobin. #ERS Journals Ltd 2001. ABSTRACT: How do the respiratory centres of patients with chronic obstructive pulmonary disease (COPD) and hypercapnia respond to acute increases in inspiratory load? A depressed respiratory motor output has long been postulated, but studies on this issue have yielded inconsistent results, partly due to limitations of investigative techniques. Many of these limitations can be overcome by the twitch interpolation technique, which is capable of accurately quantifying the degree of diaphragmatic activation, termed the voluntary drive to breathe. The hypothesis that patients with COPD and hypercapnia compensate for an acute increase in mechanical load on the inspiratory muscles with a lower voluntary drive to breathe than is the case with normocapnic patients was tested.Measurements were obtained in 15 patients with COPD, six of whom displayed hypercapnia and nine normocapnia. The maximum degree of diaphragmatic activation, expressed as a voluntary activation index (mean¡SEM), was higher in hypercapnic than in normocapnic patients (98.7¡0.7 versus 94.5¡0.9% (p~0.006)), as was the mean value (94.5¡0.7 versus 88.5¡1.9% (p~0.01)). Within-patient values of the index were also less variable in the hypercapnic patients (coefficients of variation, 3.4¡0.3 versus 6.1¡0.9%, p~0.01). Multiple regression analysis revealed the ratio of dynamic elastance to maximum transdiaphragmatic pressure, an index of inspiratory muscle loading, and pH as the only variables that correlated with maximum voluntary activation index (r 2~0 .69, p~0.02 for each variable). Contrary to the hypothesis, it was concluded that voluntary activation of the diaphragm was greater and less variable in hypercapnic patients than normocapnic patients with severe chronic obstructive pulmonary disease during an acute increase in inspiratory mechanical load. Whether greater diaphragmatic recruitment during episodes of a severe exacerbation of chronic obstructive pulmonary disease provides a survival advantage for hypercapnic patients with chronic obstructive pulmonary disease remains to be determined.

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Section: Discussionmentioning

confidence: 98%

The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD

2001

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“…1). The fact that, in some patients, hypercapnia resolves during the course of an episode of acute respiratory failure has been recognised since the 1960s [9], but the Irish investigators9 study is the only one to date that has provided any information about the prognostic value of this change. It also emphasises the difficulty of making therapeutic decisions, e.g.…”

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confidence: 99%

Respiratory failure in chronic obstructive pulmonary disease

Calverley¹

2003

Eur Respir J

107

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Respiratory failure in chronic obstructive pulmonary disease. P.M.A. Calverley. #ERS Journals Ltd 2003. ABSTRACT: Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality.The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation/perfusion mismatching with a relative increase in the physiological dead space leads to hypercapnia and hence acidosis. This is largely the result of a shift to a rapid shallow breathing pattern and a rise in the dead space/tidal volume ratio of each breath. This breathing pattern results from adaptive physiological responses which lessen the risk of respiratory muscle fatigue and minimise breathlessness.Treatment is directed at reducing the mechanical load applied to each breath, correcting specific precipitating factors, e.g. bacterial infection, and maintaining gas exchange. Both bronchodilators and oral corticosteroids can improve spirometric results in exacerbations of COPD and should be routinely offered to patients with respiratory failure. Controlled oxygen is still not always prescribed appropriately and high inspired oxygen concentrations can lead to severe acidosis by either worsening ventilation/perfusion mismatching and/or inducing a degree of hypoventilation. Ventilatory support using noninvasive ventilation has revolutionised the approach to these patients.Acute respiratory failure due to chronic obstructive pulmonary disease remains a common medical emergency that can be effectively managed. More attention should be focused on the prevention of these episodes and identifying the factors which cause early relapse. Eur Respir J 2003; 22: Suppl. 47, 26s-30s.

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“…Each can be encountered alone, as a simple disorder, or can be a part of a mixed disorder, defined as the simultaneous presence of two or more simple, acid-base disturbances. Mixed acid-base disorders are frequently observed in hospitalized patients, especially in the critically ill [13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…Total admission rates fall in the summer but the rate of respiratory acidosis was more constant at 18 per month (range [10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Variability In Admission Rates Within and Between Yearsmentioning

confidence: 99%

One and half year prevalence study of respiratory acidosis in acute exacerbation of chronic obstructive pulmonary disorders

Mane¹

2016

SJAMS

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Abstract:Maintenance of acid-base homeostasis is a vital function of the living organism. Deviations of systemic acidity in either direction can impose adverse consequences and when severe can threaten life itself. The present study was done to assess the prevalence rate of the respiratory acidosis among the admitted patients of SMBT medical college and hospital, Ghoti, Nasik. One and half year prospective prevalence study was carried out at SMBT medical college, Ghoti, Nasik. Patients were identified with a respiratory diagnosis or symptoms from the hospital by the two expert researchers. Patients were of the age group of 40 to 75 years. Age, sex, date of admission, and the first arterial blood gas tension were recorded. The date of discharge, intensive care (ICU), use and in hospital mortality were obtained retrospectively from the hospital patient administration system and the ICU computer databases in combination with note retrieval. Statistical analysis was performed with the help of IBM SPSS statistics version 20. All patients admitted are assessed and the details were recorded. Total of 1001 patients were admitted for the complaint of COPD or asthma. Out of these 172 patients (17.18%) had developed respiratory acidosis. There is need to develop the various preventive strategies to control the development of the respiratory acidosis.

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Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management.

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Cited by 193 publications

References 10 publications

The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD

The voluntary drive to breathe is not decreased in hypercapnic patients with severe COPD

Respiratory failure in chronic obstructive pulmonary disease

One and half year prevalence study of respiratory acidosis in acute exacerbation of chronic obstructive pulmonary disorders

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