| Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO₂ response and acetazolamide treatment effects. | |
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MedLine Citation:
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PMID: 20979670 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: In obesity-hypoventilation-syndrome patients mechanically ventilated for hypercapnic respiratory failure we investigated the relationship between CO₂ response, body mass index, and plasma bicarbonate concentration, and the effect of acetazolamide on bicarbonate concentration and CO₂ response. METHODS: CO₂ response tests and arterial blood gas analysis were performed in 25 patients ready for a spontaneous breathing test, and repeated in a subgroup of 8 patients after acetazolamide treatment. CO₂ response test was measured as (1) hypercapnic drive response (the ratio of the change in airway occlusion pressure 0.1 s after the start of inspiratory flow to the change in P(aCO₂)), and (2) hypercapnic ventilatory response (the ratio of the change in minute volume to the change in P(aCO₂)). RESULTS: We did not find a significant relationship between CO₂ response and body mass index. Patients with higher bicarbonate concentration had a more blunted CO₂ response. Grouping the patients according to the first, second, and third tertiles of the bicarbonate concentration, the hypercapnic drive response was 0.32 ± 0.17 cm H₂O/mm Hg, 0.22 ± 0.15 cm H₂O/mm Hg, and 0.10 ± 0.06 cm H₂O/mm Hg, respectively (P = .01), and hypercapnic ventilatory response was 0.46 ± 0.23 L/min/mm Hg, 0.48 ± 0.36 L/min/mm Hg, and 0.22 ± 0.16 L/min/mm Hg, respectively (P = .04). After acetazolamide treatment, bicarbonate concentration was reduced by 8.4 ± 3.0 mmol/L (P = .01), and CO₂ response was shifted to the left, with an increase in hypercapnic drive response, by 0.14 ± 0.16 cm H₂O/mm Hg (P = .02), and hypercapnic ventilatory response, by 0.11 ± 0.22 L/min/mm Hg (P = .33). CONCLUSIONS: Patients with obesity-hypoventilation syndrome and higher bicarbonate concentrations had a more blunted CO₂ response. Body mass index was not related to CO₂ response. Acetazolamide decreased bicarbonate concentration and increased CO₂ response. |
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Authors:
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Joan-Maria Raurich; Gemma Rialp; Jordi Ibáñez; Juan Antonio Llompart-Pou; Ignacio Ayestarán |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Respiratory care Volume: 55 ISSN: 0020-1324 ISO Abbreviation: Respir Care Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-28 Completed Date: 2010-12-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7510357 Medline TA: Respir Care Country: United States |
Other Details:
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Languages: eng Pagination: 1442-8 Citation Subset: IM |
Affiliation:
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Intensive Care Unit, Hospital Universitari Son Dureta, Andrea Doria 55, 07014, Palma de Mallorca, Illes Balears, Spain. joan.raurich@ssib.es |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acetazolamide
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diagnostic use* Aged Alkalosis / physiopathology Bicarbonates / blood, metabolism* Blood Gas Analysis Carbon Dioxide / blood, metabolism* Carbonic Anhydrase Inhibitors / diagnostic use* Female Humans Hypercapnia / physiopathology*, therapy Male Middle Aged Obesity Hypoventilation Syndrome / physiopathology*, therapy Respiration, Artificial Respiratory Center / physiology* Ventilator Weaning / methods |
| Chemical | |
Reg. No./Substance:
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0/Bicarbonates; 0/Carbonic Anhydrase Inhibitors; 124-38-9/Carbon Dioxide; 59-66-5/Acetazolamide |
| Comments/Corrections | |
Comment In:
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Respir Care. 2010 Nov;55(11):1504-5
[PMID:
20979680
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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