1. [Hypercapnic respiratory failure. Pathophysiology, indications for mechanical ventilation and management].
- Author
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Kreppein U, Litterst P, and Westhoff M
- Subjects
- Acidosis, Respiratory physiopathology, Acidosis, Respiratory therapy, Developmental Disabilities physiopathology, Developmental Disabilities therapy, Fingers abnormalities, Fingers physiopathology, Humans, Hypoxia physiopathology, Hypoxia therapy, Intellectual Disability physiopathology, Intellectual Disability therapy, Lung physiopathology, Microcephaly physiopathology, Microcephaly therapy, Muscle Hypotonia physiopathology, Muscle Hypotonia therapy, Myopia physiopathology, Myopia therapy, Noninvasive Ventilation methods, Obesity physiopathology, Obesity therapy, Pulmonary Disease, Chronic Obstructive physiopathology, Pulmonary Disease, Chronic Obstructive therapy, Retinal Degeneration, Hypercapnia physiopathology, Hypercapnia therapy, Respiration, Artificial methods, Respiratory Insufficiency physiopathology, Respiratory Insufficiency therapy
- Abstract
Background: Acute hypercapnic respiratory failure is mostly seen in patients with chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS). Depending on the underlying cause it may be associated with hypoxemic respiratory failure and places high demands on mechanical ventilation., Objective: Presentation of the current knowledge on indications and management of mechanical ventilation in patients with hypercapnic respiratory failure., Material and Methods: Review of the literature., Results: Important by the selection of mechanical ventilation procedures is recognition of the predominant pathophysiological component. In hypercapnic respiratory failure with a pH < 7.35 non-invasive ventilation (NIV) is primarily indicated unless there are contraindications. In patients with severe respiratory acidosis NIV requires a skilled and experienced team and close monitoring in order to perceive a failure of NIV. In acute exacerbation of COPD ventilator settings need a long expiration and short inspiration time to avoid further hyperinflation and an increase in intrinsic positive end-expiratory pressure (PEEP). Ventilation must be adapted to the pathophysiological situation in patients with OHS or overlap syndrome. If severe respiratory acidosis and hypercapnia cannot be managed by mechanical ventilation therapy alone extracorporeal venous CO2 removal may be necessary. Reports on this approach in awake patients are available., Conclusion: The use of NIV is the predominant treatment in patients with hypercapnic respiratory failure but close monitoring is necessary in order not to miss the indications for intubation and invasive ventilation. Methods of extracorporeal CO2 removal especially in awake patients need further evaluation.
- Published
- 2016
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