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The role of hypercapnia in acute respiratory failure
Intensive Care Medicine Experimental Pub Date : 2019-07-01 , DOI: 10.1186/s40635-019-0239-0
Luis Morales-Quinteros 1 , Marta Camprubí-Rimblas 2, 3 , Josep Bringué 2, 4 , Lieuwe D Bos 5, 6, 7 , Marcus J Schultz 5, 7, 8 , Antonio Artigas 1, 2, 3, 4, 9
Affiliation  

The biological effects and physiological consequences of hypercapnia are increasingly understood. The literature on hypercapnia is confusing, and at times contradictory. On the one hand, it may have protective effects through attenuation of pulmonary inflammation and oxidative stress. On the other hand, it may also have deleterious effects through inhibition of alveolar wound repair, reabsorption of alveolar fluid, and alveolar cell proliferation. Besides, hypercapnia has meaningful effects on lung physiology such as airway resistance, lung oxygenation, diaphragm function, and pulmonary vascular tree. In acute respiratory distress syndrome, lung-protective ventilation strategies using low tidal volume and low airway pressure are strongly advocated as these have strong potential to improve outcome. These strategies may come at a price of hypercapnia and hypercapnic acidosis. One approach is to accept it (permissive hypercapnia); another approach is to treat it through extracorporeal means. At present, it remains uncertain what the best approach is.

中文翻译:

高碳酸血症在急性呼吸衰竭中的作用

人们越来越了解高碳酸血症的生物学效应和生理后果。关于高碳酸血症的文献令人困惑,有时还相互矛盾。一方面,它可能通过减轻肺部炎症和氧化应激而具有保护作用。另一方面,它也可能通过抑制肺泡伤口修复、肺泡液重吸收和肺泡细胞增殖而产生有害作用。此外,高碳酸血症对气道阻力、肺氧合、横膈膜功能和肺血管树等肺生理具有有意义的影响。在急性呼吸窘迫综合征中,强烈提倡使用低潮气量和低气道压力的肺保护性通气策略,因为它们具有改善结果的巨大潜力。这些策略可能以高碳酸血症和高碳酸血症酸中毒为代价。一种方法是接受它(允许性高碳酸血症);另一种方法是通过体外方法对其进行治疗。目前,尚不确定最好的方法是什么。
更新日期:2019-07-01
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