Document Detail


Air leaks during mechanical ventilation as a cause of persistent hypercapnia in neuromuscular disorders.
MedLine Citation:
PMID:  12589533     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study investigated whether air leaks from the upper airway during assisted ventilatory support are associated with persistent hypercapnia (PaCO(2) >45 mmHg) in patients with neuromuscular disorders. SETTING: A rehabilitation hospital. PATIENTS: The study was performed in 95 neuromuscular patients; 52 were tracheostomized with a cuffless tracheostomy tube (invasive ventilation), and 43 received noninvasive ventilation. MEASUREMENTS AND RESULTS: The volume of air leaked (VL) and arterial carbon dioxide (PaCO(2)) were routinely measured during mechanical ventilation; PaCO(2) was also measured during spontaneous breathing. VL, expressed as a percentage of tidal volume, was higher in the hypercapnic group (32+/-14%, n=20) than the nonhypercapnic group ( vs. 20+/-14%). PaCO(2) during mechanical ventilation was correlated with both VL and the duration of ventilatory support per day; PaCO(2) during spontaneous breathing was correlated only with the volume of air leaked. In stepwise multiple regression analysis, air leaks contributed to 8% of the variance in PaCO(2) during mechanical ventilation, and daily duration of ventilatory support contributed 5%. In addition, reduction in VL with normalization of PaCO(2) was achieved in five of the noninvasively ventilated patients with persistent hypercapnia by using a chin strap. CONCLUSIONS: Air leaks during wakefulness are an important cause of persistent hypercapnia in both invasively and noninvasively ventilated neuromuscular patients. However, simple practical measures to reduce the volume of air leaks improve the efficacy of ventilation in these patients.
Authors:
Jesus Gonzalez; Tarek Sharshar; Nicholas Hart; Karim Chadda; Jean Claude Raphaël; Frédéric Lofaso
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-02-13
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-16     Completed Date:  2003-10-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  596-602     Citation Subset:  IM    
Affiliation:
Service de Réanimation Médicale, Hôpital Raymond Poincaré, AP-HP, 92380, Garches, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Carbon Dioxide / metabolism
Female
Humans
Hypercapnia / etiology*,  physiopathology
Linear Models
Male
Middle Aged
Neuromuscular Diseases / physiopathology*
Respiration, Artificial / adverse effects*
Respiratory Function Tests
Tidal Volume
Tracheostomy
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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