Pleural Hypercarbia After Lung Surgery Is Associated With Persistent Alveolopleural Fistulae

Bharat, Ankit; Graf, Nicole; Mullen, Andrew Carter.; Kanter, Jacob A.; Andrei, Adin Cristian; Sporn, Peter H. S.; DeCamp, Malcolm M.; Sznajder, Jacob I.

doi:10.1378/chest.15-1591

Cited by 22 publications

(14 citation statements)

References 29 publications

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“…Intrapleural hypercapnia was associated with delayed resolution of PAL in patients after lobectomy, and reducing pleural CO 2 levels was associated with faster resolution of air leaks (Bharat et al . ). Collectively, hypercapnia appears to impair alveolar epithelial cell proliferation and migration, which is deleterious to alveolar epithelial repair.…”

Section: Introductionmentioning

confidence: 97%

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Effects of hypercapnia on the lung

Shigemura

Lecuona

Sznajder

2017

The Journal of Physiology

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Gases are sensed by lung cells and can activate specific intracellular signalling pathways, and thus have physiological and pathophysiological effects. Carbon dioxide (CO ), a primary product of oxidative metabolism, can be sensed by eukaryotic cells eliciting specific responses via recently identified signalling pathways. However, the physiological and pathophysiological effects of high CO (hypercapnia) on the lungs and specific lung cells, which are the primary site of CO elimination, are incompletely understood. In this review, we provide a physiological and mechanistic perspective on the effects of hypercapnia on the lungs and discuss the recent understanding of CO modulation of the alveolar epithelial function (lung oedema clearance), epithelial cell repair, innate immunity and airway function.

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Section: Introductionmentioning

confidence: 97%

“…; Bharat et al . ). The impairment of these lung physiological functions by hypercapnia probably underlies the negative impacts of hypercapnia in patients with severe acute or chronic lung diseases.…”

Section: Introductionmentioning

confidence: 97%

Effects of hypercapnia on the lung

Shigemura

Lecuona

Sznajder

2017

The Journal of Physiology

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“…However, more recent studies have reported that hypercapnia has harmful effects, including impairment of alveolar epithelial function, cell proliferation, and muscle function as well as of neutrophil function and innate immunity [13–21]. Acute hypercapnia may also have significant hemodynamic consequences and lead to pulmonary hypertension, right ventricular dysfunction, and prolonged bronchopleural leakage [22]. …”

Section: Introductionmentioning

confidence: 99%

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

et al. 2017

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Purpose To analyze the relationship between hypercapnia developing within the first 48 h after the start of mechanical ventilation and outcome in patients with acute respiratory distress syndrome (ARDS). Patients and methods We performed a secondary analysis of three prospective non-interventional cohort studies focusing on ARDS patients from 927 intensive care units (ICUs) in 40 countries. These patients received mechanical ventilation for more than 12 h during 1-month periods in 1998, 2004, and 2010. We used multivariable logistic regression and a propensity score analysis to examine the association between hypercapnia and ICU mortality. Main outcomes We included 1899 patients with ARDS in this study. The relationship between maximum PaCO2 in the first 48 h and mortality suggests higher mortality at or above PaCO2 of ≥50 mmHg. Patients with severe hypercapnia (PaCO2 ≥50 mmHg) had higher complication rates, more organ failures, and worse outcomes. After adjusting for age, SAPS II score, respiratory rate, positive end-expiratory pressure, PaO2/FiO2 ratio, driving pressure, pressure/volume limitation strategy (PLS), corrected minute ventilation, and presence of acidosis, severe hypercapnia was associated with increased risk of ICU mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.32 to 2.81; p = 0.001]. In patients with severe hypercapnia matched for all other variables, ventilation with PLS was associated with higher ICU mortality (OR 1.58, CI 95% 1.04–2.41; p = 0.032). Conclusions Severe hypercapnia appears to be independently associated with higher ICU mortality in patients with ARDS.

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“…Secondly, it inhibits repair of ventilator-induced pulmonary epithelial cell injury likely via inhibition of the NF-κB pathway by reducing cell migration and altering matrix metalloproteinase activity 25 . Recent clinical work lends support to these findings as pleural hypercarbia correlates with persistent alveolar-pleural fistulae post-lung resection 26 . Finally, short-term hypercapnia, independent of pH has been shown to impair alveolar epithelial cell function resulting in decreased alveolar fluid resorption 27 .…”

Section: Inhibition Of Lung Epithelial Cell Repair and Functionmentioning

confidence: 73%

Re-examining Permissive Hypercapnia in ARDS

Barnes

Zochios

Parhar

2018

Chest

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Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO management currently under investigation in patients with moderate to severe ARDS.

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Pleural Hypercarbia After Lung Surgery Is Associated With Persistent Alveolopleural Fistulae

Cited by 22 publications

References 29 publications

Effects of hypercapnia on the lung

Effects of hypercapnia on the lung

Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome

Re-examining Permissive Hypercapnia in ARDS

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