Hypercapnie controlee: une nouvelle strategie dans le traitement de l'insuffisance respiratoire grave. [Controlled hypercapnia: a new strategy in the treatment of severe respiratory insufficiency]

Détails

ID Serval
serval:BIB_F889AEBC6571
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Hypercapnie controlee: une nouvelle strategie dans le traitement de l'insuffisance respiratoire grave. [Controlled hypercapnia: a new strategy in the treatment of severe respiratory insufficiency]
Périodique
Bulletin de l'Academie Nationale de Médecine
Auteur(s)
Perret  C., Feihl  F.
ISSN
0001-4079 (Print)
Statut éditorial
Publié
Date de publication
01/1995
Volume
179
Numéro
1
Pages
185-95; discussion 195-7
Notes
English Abstract
Journal Article
Review --- Old month value: Jan
Résumé
Permissive hypercapnia (PHY) represents an interesting approach in critically ill ventilated patients, because it allows to ensure adequate gas exchange while avoiding the adverse effects related to excessive airway pressures. Its objective is to improve oxygenation while reducing the risk of barotrauma and circulatory impairment. This concept is all the more important when considering that in majority of lung diseases for which MV is applied, lung involvement is highly inhomogeneous, meaning that the functionally normal or near normal areas are the most exposed to the deleterious effects of overdistension. Undesired physiological effects of non massive respiratory acidosis (PaCO2 < or = 80 mmHg, arterial pH > or = 7.15) are reversible and mostly minor. This good tolerance legitimizes two strategies: firstly to accept hypercapnia in conditions such as acute severe asthma for which enforced normalization of PaCO2 would imply potentially lethal complications, and secondly to deliberately induce respiratory acidosis while using very low airway pressures and alveolar ventilation to limit or prevent overdistension lung damage in injured as well as in normal areas. When the cerebral vasodilation induced by CO2 might aggravate a preexisting intracranial disorder, PHY is obviously contraindicated.
Mots-clé
Humans Hypercapnia/*physiopathology Respiration, Artificial/*methods Respiratory Insufficiency/physiopathology/*therapy
Pubmed
Web of science
Création de la notice
25/01/2008 10:38
Dernière modification de la notice
03/03/2018 22:52
Données d'usage