Tracheal gas insufflation is a useful adjunct in permissive hypercapnic management of acute respiratory distress syndrome

American Journal of Surgery
C C BarnettJ B Haenel

Abstract

Despite numerous advances in critical care, the mortality of postinjury acute respiratory distress syndrome (ARDS) remains high. Recently, permissive hypercapnia (PHC) has been shown to be a viable alternative to traditional ventilator management in patients with ARDS. However, lowering tidal volume, as employed in PHC, below 5 cc/kg impinges upon anatomic dead space and precipitates a significant rise in PaCO2 The purpose of this study was to determine if continuous tracheal gas insufflation (cTGI) is a useful adjunct to PHC by lowering PaCO2, thus allowing adequate reduction in minute ventilation to achieve alveolar protection. Over a 5-year period, 68 trauma patients with ARDS were placed on permissive hypercapnia. Nine of these patients additionally received cTGI at 7 L/min. Arterial blood gas determinations and ventilatory parameters were examined immediately prior to the implementation of cTGI and after 6h. The cTGI produced significant improvement in pH (7.25 +/- 0.03 to 7.33 +/- 0.03), PaCO2 (72 +/- 5 to 59 +/- 5 torr), tidal volume (7.9 +/- 0.6 to 7.2 +/- 0.6 cc/kg), and minute ventilation (13 +/- 1 to 11 +/- 1 L/min; P < 0.05). Continuous TGI is a useful adjunct to permissive hypercapnia, allowing maintenance of an ac...Continue Reading

References

May 1, 1991·The American Review of Respiratory Disease·K TsunoT Morioka
Oct 1, 1989·The American Review of Respiratory Disease·E H Bergofsky, A N Hurewitz
Nov 2, 1989·The New England Journal of Medicine·S E WeinbergerJ W Weiss
Sep 1, 1988·The American Review of Respiratory Disease·J F MurrayM R Flick
Sep 1, 1987·The American Review of Respiratory Disease·L GattinoniM Bombino
Nov 1, 1995·The Journal of Trauma·L M GentilelloR V Maier
Aug 1, 1993·The American Review of Respiratory Disease·S A RavenscraftJ J Marini

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Citations

Jan 1, 1997·American Journal of Surgery·F A Moore, J B Haenel
Aug 12, 2005·Current Surgery·Jeffrey C Pence, John C Fitzpatrick
Sep 29, 2000·Critical Care Medicine·R C McIntyreE Abraham
Feb 17, 2006·Anaesthesia·M J BeedK Alagesan
Jan 19, 1999·Critical Care Clinics·C N Sessler

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