Re-examining Permissive Hypercapnia in ARDS: A Narrative review

Tavish Barnes; Vasileios Zochios; Ken Parhar

doi:10.1016/j.chest.2017.11.010

Re-examining Permissive Hypercapnia in ARDS: A Narrative review

Tavish Barnes, Vasileios Zochios, Ken Parhar

Inflammation and Ageing

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Abstract

Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.

Original language	English
Journal	Chest
Early online date	22 Nov 2017
DOIs	https://doi.org/10.1016/j.chest.2017.11.010
Publication status	E-pub ahead of print - 22 Nov 2017

Keywords

ARDS
acute cor pulmonale
mechanical ventilation
permissive hypercapnia
right ventricular dysfunction

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Barnes_et_al_Re-examining_permissive_hypercapnia_CHEST_2017Accepted author manuscript, 727 KBLicence: Creative Commons: Attribution-NonCommercial-NoDerivs (CC BY-NC-ND)

http://www.sciencedirect.com/science/article/pii/S001236921733115XLicence: None: All rights reserved

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title = "Re-examining Permissive Hypercapnia in ARDS: A Narrative review",

abstract = "Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.",

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AU - Barnes, Tavish

AU - Zochios, Vasileios

AU - Parhar, Ken

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Y1 - 2017/11/22

N2 - Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.

AB - Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.

KW - ARDS

KW - acute cor pulmonale

KW - mechanical ventilation

KW - permissive hypercapnia

KW - right ventricular dysfunction

U2 - 10.1016/j.chest.2017.11.010

DO - 10.1016/j.chest.2017.11.010

M3 - Article

SN - 0012-3692

JO - Chest

JF - Chest

ER -

Re-examining Permissive Hypercapnia in ARDS: A Narrative review

Abstract

Keywords

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