Permissive hypercapnia: Difference between revisions
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'''Permissive hypercapnia''' is [[hypercapnia]], (i.e. high concentration of [[carbon dioxide]] in blood), in [[respiratory insufficiency|respiratory insufficient]] patients in which [[oxygenation]] has become so difficult that the optimal mode of [[mechanical ventilation]] (with oxygenation in mind) is not capable of exchanging enough carbon dioxide. Carbon dioxide is a [[gas]]eous product of the [[human body|body's]] [[metabolism]] and is normally expelled through the [[lung]]s. | '''Permissive hypercapnia''' is [[hypercapnia]], (i.e. high concentration of [[carbon dioxide]] in blood), in [[respiratory insufficiency|respiratory insufficient]] patients in which [[oxygenation]] has become so difficult that the optimal mode of [[mechanical ventilation]] (with oxygenation in mind) is not capable of exchanging enough carbon dioxide. Carbon dioxide is a [[gas]]eous product of the [[human body|body's]] [[metabolism]] and is normally expelled through the [[lung]]s. | ||
In acute respiratory distress syndrome (ARDS), permissive hypercapnia (allowing increased CO<sub>2</sub> retention) by decreasing the tidal volume on the ventilator (usually 10-15 mL/kg/min) to 8 mL/kg/min may decrease barotrauma by decreasing ventilatory peak airway pressures and leads to improved respiratory recovery. The permissive hypercapnia leads to respiratory acidosis which has negative side effects, but given that the patient is in ARDS, improving ventilatory function is more important. | In [[acute respiratory distress syndrome]] (ARDS), permissive hypercapnia (allowing increased CO<sub>2</sub> retention) by decreasing the tidal volume on the ventilator (usually 10-15 mL/kg/min) to 8 mL/kg/min may decrease barotrauma by decreasing ventilatory peak airway pressures and leads to improved respiratory recovery. The permissive hypercapnia leads to respiratory acidosis which has negative side effects, but given that the patient is in ARDS, improving ventilatory function is more important. | ||
Since [[Hypoxia (medical)|hypoxemia]] is a major life threatening condition and hypercapnia is not, one might choose to accept the latter. Hence the term, "permissive hypercapnia." | Since [[Hypoxia (medical)|hypoxemia]] is a major life threatening condition and hypercapnia is not, one might choose to accept the latter. Hence the term, "permissive hypercapnia."<ref name="isbn0-7817-3548-3">{{cite book |author=Rippe, James M.; Irwin, Richard S. |title=Irwin and Rippe's intensive care medicine |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2003 |pages= |isbn=0-7817-3548-3 |oclc= |doi= |accessdate=}}</ref><ref name="isbn0-683-05565-8">{{cite book |author=Marino, Paul L. |title=The ICU book |publisher=Williams & Wilkins |location=Baltimore |year=1998 |pages= |isbn=0-683-05565-8 |oclc= |doi= |accessdate=}}</ref><ref name="isbn0-7817-4334-6">{{cite book |author=Irwin, Richard S. |title=Procedures and techniques in intensive care medicine |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2003 |pages= |isbn=0-7817-4334-6 |oclc= |doi= |accessdate=}}</ref> | ||
== Symptoms== | == Symptoms== | ||
Symptoms of early hypercapnia (i.e. where PaCO<sub>2</sub> is elevated but not extremely so) include | Symptoms of early hypercapnia (i.e. where PaCO<sub>2</sub> is elevated but not extremely so) include; | ||
*Flushed skin | |||
*Full [[pulse]] | |||
*[[Extrasystole]]s | |||
*Muscle twitches | |||
*Hand flaps, and possibly a raised [[blood pressure]]. | |||
In severe hypercapnia (generally PaCO<sub>2</sub> greater than 10 [[pascal (unit)|kPa]] or 75 [[mmHg]]), symptomatology progresses to disorientation, [[panic]], [[hyperventilation]], [[convulsions]], [[unconsciousness]], and eventually [[death]]. | |||
==Related Chapters== | ==Related Chapters== | ||
| Line 20: | Line 27: | ||
==References== | ==References== | ||
{{Reflist|2}} | |||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 12:27, 4 April 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Permissive hypercapnia is hypercapnia, (i.e. high concentration of carbon dioxide in blood), in respiratory insufficient patients in which oxygenation has become so difficult that the optimal mode of mechanical ventilation (with oxygenation in mind) is not capable of exchanging enough carbon dioxide. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs.
In acute respiratory distress syndrome (ARDS), permissive hypercapnia (allowing increased CO2 retention) by decreasing the tidal volume on the ventilator (usually 10-15 mL/kg/min) to 8 mL/kg/min may decrease barotrauma by decreasing ventilatory peak airway pressures and leads to improved respiratory recovery. The permissive hypercapnia leads to respiratory acidosis which has negative side effects, but given that the patient is in ARDS, improving ventilatory function is more important.
Since hypoxemia is a major life threatening condition and hypercapnia is not, one might choose to accept the latter. Hence the term, "permissive hypercapnia."[1][2][3]
Symptoms
Symptoms of early hypercapnia (i.e. where PaCO2 is elevated but not extremely so) include;
- Flushed skin
- Full pulse
- Extrasystoles
- Muscle twitches
- Hand flaps, and possibly a raised blood pressure.
In severe hypercapnia (generally PaCO2 greater than 10 kPa or 75 mmHg), symptomatology progresses to disorientation, panic, hyperventilation, convulsions, unconsciousness, and eventually death.
Related Chapters
References
- ↑ Rippe, James M.; Irwin, Richard S. (2003). Irwin and Rippe's intensive care medicine. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-3548-3.
- ↑ Marino, Paul L. (1998). The ICU book. Baltimore: Williams & Wilkins. ISBN 0-683-05565-8.
- ↑ Irwin, Richard S. (2003). Procedures and techniques in intensive care medicine. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4334-6.