Document Detail


Tromethamine buffer modifies the depressant effect of permissive hypercapnia on myocardial contractility in patients with acute respiratory distress syndrome.
MedLine Citation:
PMID:  11029345     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients with acute respiratory distress syndrome (ARDS), permissive hypercapnia is a strategy to decrease airway pressures to prevent ventilator-induced lung damage by lowering tidal volumes and tolerating higher arterial carbon dioxide tension. However, in experimental studies hypercapnia impairs myocardial contractility and hemodynamic function. We investigated the effect of short-term permissive hypercapnia on myocardial contractility and hemodynamics in patients with ARDS. We hypothesized that the administration of tromethamine (THAM), a buffer which does not increase carbon dioxide production, would modify these changes. In 12 patients with ARDS, permissive hypercapnia was implemented for 2 h with a target Pa(CO(2))of 80 mm Hg. Patients were randomized to have respiratory acidosis corrected by THAM (pH-corrected group), or not corrected (pH-uncorrected group). Hemodynamic responses were measured, and transesophageal echocardiography (TEE) was used to determine myocardial contractility. Permissive hypercapnia resulted in significant decreases in systemic vascular resistance (SVR) and increases in cardiac output (Q). Myocardial contractility decreased in both groups but significantly less in the pH-corrected group (approximately 10%) than in the pH-uncorrected group (approximately 18%, p < 0.05). Mean arterial pressure decreased and mean pulmonary arterial pressure increased significantly only in the pH-uncorrected group. All values returned to baseline conditions 1 h after permissive hypercapnia was terminated. Our study demonstrates a reversible depression of myocardial contractility and hemodynamic alterations during rapid permissive hypercapnia which were attenuated by buffering with THAM. This may have applicability to the clinical strategy of permissive hypercapnia and allow the benefit of decreased airway pressures to be realized while minimizing the adverse hemodynamic effects of hypercapnic acidosis.
Authors:
T Weber; H Tschernich; C Sitzwohl; R Ullrich; P Germann; M Zimpfer; R N Sladen; G Huemer
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  162     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-11-15     Completed Date:  2000-11-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1361-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.
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MeSH Terms
Descriptor/Qualifier:
Acid-Base Equilibrium / drug effects,  physiology
Adult
Aged
Buffers
Carbon Dioxide / blood
Critical Care
Echocardiography / drug effects
Female
Hemodynamics / drug effects,  physiology
Humans
Hypercapnia / drug therapy*,  physiopathology
Male
Middle Aged
Myocardial Contraction / drug effects*,  physiology
Respiration, Artificial
Respiratory Distress Syndrome, Adult / drug therapy*,  physiopathology
Tromethamine / administration & dosage*
Chemical
Reg. No./Substance:
0/Buffers; 124-38-9/Carbon Dioxide; 77-86-1/Tromethamine

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


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