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Can ‘Permissive’ Hypercapnia Modulate the Severity of Sepsis-induced ALI/ARDS?

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Annual Update in Intensive Care and Emergency Medicine 2011

Part of the book series: Annual Update in Intensive Care and Emergency Medicine 2011 ((AUICEM,volume 1))

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Abstract

Ventilatory strategies that reduce lung stretch by reducing tidal and minute ventilation, which results in a ‘permissive’ hypercapnic acidosis, improve outcome in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) [1], [2]. Reassuringly, evidence from clinical studies attests to the safety and lack of detrimental effects of hypercapnic acidosis [2]. Of particular importance, a secondary analysis of data from the ARDSnet tidal volume study [1] demonstrated that the presence of hypercapnic acidosis at the time of randomization was associated with improved patient survival in patients who received high tidal volume ventilation [3]. These findings have resulted in a shift in paradigms regarding hypercapnia — from avoidance to tolerance — with hypercapnia increasingly permitted in order to realize the benefits of low lung stretch. Consequently, low tidal and minute volume ventilation and the accompanying ‘permissive’ hypercapnia are now the standard of care for patients with ALI/ARDS, and are increasingly used in the ventilatory management of a diverse range of diseases leading to acute severe respiratory failure, including asthma and chronic obstructive pulmonary disease.

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Author information

Authors and Affiliations

  1. Department of Anesthesia Clinical Sciences Institute, National University, Galway, Ireland

    G. Curley, M. Hayes & J. G. Laffey

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  1. G. Curley
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  2. M. Hayes
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  3. J. G. Laffey
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Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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Curley, G., Hayes, M., Laffey, J.G. (2011). Can ‘Permissive’ Hypercapnia Modulate the Severity of Sepsis-induced ALI/ARDS?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2011. Annual Update in Intensive Care and Emergency Medicine 2011, vol 1. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18081-1_15

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  • DOI: https://doi.org/10.1007/978-3-642-18081-1_15

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-18080-4

  • Online ISBN: 978-3-642-18081-1

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