Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study

Hickling, Keith G.; Walsh, J.; Henderson, Seton; Jackson, Rod

doi:10.1097/00003246-199410000-00011

Cited by 174 publications

(223 citation statements)

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“…However, many of these techniques have not been demonstrated to be effective, [2][3][4] and in some cases may have resulted in increased mortality. 5 "Permissive hypercapnia", first implemented in neonatal practice by Wung et al, 6 was demonstrated to improve survival in patients with adult respiratory distress syndrome in studies by Hickling et al 7,8 The concept of 'therapeutic hypercapnia', whereby PaCO 2 is deliberately elevated in order to attenuate endorgan injury, has evolved from studies which have demonstrated reduced tissue injury in association with hypercapnia. 9,10 Elevation of PaCO 2 attenuated injury resulting from myocardial ischemia, 11 stroke 12 and lung reperfusion 13 and has been associated with improved neurological outcome following cardiopulmonary bypass.…”

Section: Résultats : La To 2 Tc a Augmenté En Proportion De L'oxygénamentioning

confidence: 99%

“…These observations may help to explain why hypercapnia reduces tissue injury secondary to ischemia and reperfusion [11][12][13] possibly contributing to the observed increase in survival of critically ill patients treated with permissive hypercapnia. 7,8 The ability to exploit the capacity of hypercapnia to augment cerebral tissue oxygenation, and defend tissue against ischemic injury, requires further characterization.…”

Section: Comparison Of Changes In Caudate Pbromentioning

confidence: 99%

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L’hypercapnie augmente la tension en oxygène du tissu cérébral chez des rats anesthésiés

Hare

Kavanagh

Mazer

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To test the hypotheses that deliberate elevation of PaCO 2 increases cerebral tissue oxygen tension (PBrO 2 ) by augmenting PaO 2 and regional cerebral blood flow (rCBF).M Me et th ho od ds s: : Anesthetized rats were exposed to increasing levels of inspired oxygen (O 2 ) or carbon dioxide (CO 2 ; 5%, 10% and 15%, n = 6). Mean arterial blood pressure (MAP), PBrO 2 and rCBF were measured continuously. Blood gas analysis and hemoglobin concentrations were determined for each change in inspired gas concentration. Data are presented as mean ± standard deviation with P < 0.05 taken to be significant. R Re es su ul lt ts s: : The PBrO 2 increased in proportion to arterial oxygenation (PaO 2 ) when the percentage of inspired O 2 was increased. Proportional increases in PaCO 2 (48.7 ± 4.9, 72.3 ± 6.0 and 95.3 ± 15.4 mmHg), PaO 2 (172.2 ± 33.1, 191.7 ± 42.5 and 216.0 ± 41.8 mmHg), and PBrO 2 (29.1 ± 9.2, 49.4 ± 19.5 and 60.5 ± 23.0 mmHg) were observed when inspired CO 2 concentrations were increased from 0% to 5%, 10% and 15%, respectively, while arterial pH decreased (P < 0.05 for each). Exposure to CO 2 increased rCBF from 1.04 ± 0.67 to a peak value of 1.49 ± 0.45 (P < 0.05). Following removal of exogenous CO 2 , arterial blood gas values returned to baseline while rCBF and PBrO 2 remained elevated for over 30 min. The hypercapnia induced increase in PBrO 2 was threefold higher than that resulting from a comparable increase in PaO 2 achieved by increasing the inspired O 2 concentration (34.9 ± 14.5 vs 11.4 ± 5.0 mmHg, P < 0.05).C Co on nc cl lu us si io on n: : These data support the hypothesis that the combined effect of increased CBF, PaO 2 and reduced pH collectively contribute to augmenting cerebral PBrO 2 during hypercapnia. (48,7 ± 4,9, 72,3 ± 6,0 et 95,3 ± 15,4 mmHg), de la PaO 2 (172,2 ± 33,1, 191,7 ± 42,5 et 216,0 ± 41,8 mmHg) et de la TO 2 TC (29,1 ± 9,2, 49,4 ± 19,5 et 60,5 ± 23,0 mmHg) ont été observées avec l'augmentation des concentrations de CO 2 inspiré de 0 % à 5 %, 10 % et 15 %, respectivement, tandis que le pH s'est abaissé (P < 0,05 pour chacune). L'exposition au CO 2 a fait monter la TO 2 TC de 1,04 ± 0,67 à une valeur maximale de 1,49 ± 0,45 (P < 0,05 (34,9 ± 14,5 vs 11,4 ± 5,0 mmHg, P < 0,05 Objectif

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Section: Résultats : La To 2 Tc a Augmenté En Proportion De L'oxygénamentioning

confidence: 99%

Section: Comparison Of Changes In Caudate Pbromentioning

confidence: 99%

L’hypercapnie augmente la tension en oxygène du tissu cérébral chez des rats anesthésiés

Hare

Kavanagh

Mazer

et al. 2003

Can J Anesth/J Can Anesth

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“…These high ventilation pressures, achieved with conventional V T (e.g., 10 to 12 ml/kg), have been related to pulmonary injury in different experimental models (9,10). Despite the wide variations among different animal species, these results can be, at least in part, extrapolated to clinical practice, as shown by some studies that achieved good results with protective strategies during mechanical ventilation (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Ventilation with high tidal volume induces inflammatory lung injury

Bueno

Santos

et al. 2002

Braz J Med Biol Res

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Mechanical ventilation with high tidal volumes (V T ) has been shown to induce lung injury. We examined the hypothesis that this procedure induces lung injury with inflammatory features. Anesthetized male Wistar rats were randomized into three groups: group 1 (N = 12): V T = 7 ml/kg, respiratory rate (RR) = 50 breaths/min; group 2 (N = 10): V T = 21 ml/kg, RR = 16 breaths/min; group 3 (N = 11): V T = 42 ml/kg, RR = 8 breaths/min. The animals were ventilated with fraction of inspired oxygen of 1 and positive end-expiratory pressure of 2 cmH 2 O. After 4 h of ventilation, group 3, compared to groups 1 and 2, had lower PaO 2 [280 (range 73-458) vs 517 (range 307-596), and 547 mmHg (range 330-662), respectively, P<0.05], higher wet lung weight [3.62 ± 0.91 vs 1.69 ± 0.48 and 1.44 ± 0.20 g, respectively, P<0.05], and higher wet lung weight/dry lung weight ratio [18.14 (range 11.55-26.31) vs 7.80 (range 4.79-12.18), and 6.34 (range 5.92-7.04), respectively, P<0.05]. Total cell and neutrophil counts were higher in group 3 compared to groups 1 and 2 (P<0.05), as were baseline TNF-α concentrations [134 (range <10-386) vs 16 (range <10-24), and 17 pg/ml (range <10-23), respectively, P<0.05]. Serum TNF-α concentrations reached a higher level in group 3, but without statistical significance. These results suggest that mechanical ventilation with high V T induces lung injury with inflammatory characteristics. This ventilatory strategy can affect the release of TNF-α in the lungs and can reach the systemic circulation, a finding that may have relevance for the development of a systemic inflammatory response.

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“…[36][37][38][39] A randomized multicenter trial has shown a significant reduction in mortality rates (from 39.8 to 31%) in patients with ARDS managed with a reduced tidal volume strategy. 35 Another randomized trial showed a dramatic decrease in mortality in the intervention group managed with limited inspiratory pressures, reduced tidal volume, lung recruitment maneuvers and the application of adequate levels of PEEP compared to a control group where no attempts were made to avoid VILI (38 vs. 71%, respectively).…”

Section: Conventional Lung Protective Ventilationmentioning

confidence: 99%

“…39,50,51 Amato et al 5 In the multicenter, randomized, controlled trial conducted by the ARDS Network 35 comparing high (12 mL/kg) and low (6 mL/kg) tidal volumes, PEEP levels were similar between the two groups and most patients in the low tidal group did not develop hypercapnia as a result of an observed increase in the respiratory rate. As mentioned previously, the group treated with low tidal volumes had a significantly lower mortality compared to the high tidal volume group, 35 a finding that was originally attributed solely to the effect of reduced lung stretch.…”

Section: Permissive Hypercapniamentioning

confidence: 99%

Ventilação mecânica convencional em pediatria

Rotta¹,

Steinhorn²

2007

J. Pediatr. (Rio J.)

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Objective: To review the various challenges of providing mechanical ventilation to pediatric patients with diseases of increased airway resistance, diseases of abnormal lung compliance or normal lungs. Sources:Original data from our pediatric intensive care unit and animal research laboratory. Relevant articles included in the MEDLINE electronic database during the last 10 years. Also included were book chapters and definitive studies, as judged by the authors, in the fields of asthma, acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury and permissive hypercapnia. Summary of the findings:Mechanical ventilation of patients with diseases of increased airway resistance should center on avoidance of dynamic hyperinflation, allowing complete exhalation prior to the initiation of a subsequent breath and permissive hypercapnia. Positive end-expiratory pressure should be used sparingly to prevent atelectasis and facilitate synchrony in spontaneously breathing patients. Mechanical ventilation of patients with diseases of abnormal lung compliance should take into consideration the inhomogeneous distribution of lung disease. Focus should be on avoidance of volutrauma and atelectrauma that could result in ventilator-associated lung injury. Conclusions:The last decade was marked by significant advances in the management of pediatric respiratory failure. The choice of mechanical ventilation strategy can significantly influence the subsequent course of lung injury.Mechanical ventilation can no longer be viewed simply as a harmless support modality that is employed to keep patients alive while disease-specific treatments are used to ameliorate the underlying pathology.J Pediatr (Rio J). 2007;83(2 Suppl):S100-108: Mechanical ventilation, acute lung injury, acute respiratory distress syndrome, status asthmaticus, permissive hypercapnia.

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Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: A prospective study

Cited by 174 publications

References 0 publications

L’hypercapnie augmente la tension en oxygène du tissu cérébral chez des rats anesthésiés

L’hypercapnie augmente la tension en oxygène du tissu cérébral chez des rats anesthésiés

Ventilation with high tidal volume induces inflammatory lung injury

Ventilação mecânica convencional em pediatria

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