sábado, 28 de marzo de 2015

Hipercapnia

Hipercapnia: ¿es protector en la lesión pulmonar?
Hypercapnia: is it protective in lung injury?
Bautista AF, Akca O1.
Med Gas Res. 2013 Nov 11;3(1):23. doi: 10.1186/2045-9912-3-23
Abstract
Hypercapnic acidosis has been regarded as a tolerated side effect of protective lung ventilation strategies. Various in vivo and ex vivo animal studies have shown beneficial effects in acute lung injury setting, but some recent work raised concerns about its anti-inflammatory properties. This mini-review article aims to expand the potential clinical spectrum of hypercapnic acidosis in critically ill patients with lung injury. Despite the proven benefits of hypercapnic acidosis, further safety studies including dose-effect, level-and-onset of anti-inflammatory effect, and safe applicability period need to be performed in various models of lung injury in animals and humans to further elucidate its protective role.
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Volumen corriente muy bajo asociado con hipercapnia. Efectos sobre el daño pulmonar en un modelo de síndrome de dificultad respiratorio agudo
Very low tidal volume ventilation with associated hypercapnia--effects on lung injury in a model for acute respiratory distress syndrome.
Fuchs H1, Mendler MR, Scharnbeck D, Ebsen M, Hummler HD.
PLoS One. 2011;6(8):e23816. doi: 10.1371/journal.pone.0023816. Epub 2011 Aug 19.
Abstract
BACKGROUND: Ventilation using low tidal volumes with permission of hypercapnia is recommended to protect the lung in acute respiratory distress syndrome. However, the most lung protective tidal volume in association with hypercapnia is unknown. The aim of this study was to assess the effects of different tidal volumes with associated hypercapnia on lung injury and gas exchange in a model for acute respiratory distress syndrome. ..... CONCLUSION: Ventilation with low tidal volumes and associated hypercapnia was lung protective. A tidal volume below 4-5 ml/kg/PaCO(2) 80 mm Hg with concomitant more severe hypercapnic acidosis did not increase lung protection in this surfactant deficiency model. However, even at extremely low tidal volumes in association with severe hypercapnia lung protection and oxygenation were maintained.
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Opiniones opuestas: No se añade beneficio con la hipercapnia permisiva en el tratamiento del síndrome de dificultad respiratorio agudo
CrossTalk opposing view: there is not added benefit to providing permissive hypercapnia in the treatment of ARDS.
Beitler JR1, Hubmayr RD, Malhotra A.
J Physiol. 2013 Jun 1;591(Pt 11):2767-9. doi: 10.1113/jphysiol.2013.252619.
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Opiniones opuestas: Si hay beneficio con la hipercapnia permisiva en el tratamiento del síndrome de dificultad respiratorio agudo
CrossTalk proposal: there is added benefit to providing permissive hypercapnia in the treatment of ARDS.
Curley GF1, Laffey JG, Kavanagh BP. 
J Physiol. 2013 Jun 1;591(Pt 11):2763-5. doi: 10.1113/jphysiol.2013.252601.
 
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Anestesia y Medicina del Dolor
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