Apresentação

Influence of inspired oxygen concentration on arterial partial pressure of carbon dioxide during noninvasive ventilation in patients with acute exacerbation of COPD

JUCARA GASPARETTO MACCARI, EUBRANDO SILVESTRE OLIVEIRA, TULIO FREDERICO TONIETTO, PAULO JOSE ZIMERMANN TEIXEIRA, NILTON BRANDAO DA SILVA, ROSELAINE PINHEIRO DE OLIVEIRA, CASSIANO TEIXEIRA, AUGUSTO SAVI, MARCELO DE MELLO RIEDER, JULIANA MACHADO ZIGNANI

Em: ESICM 22nd Annual Congress, 2009, Viena. (Poster Eletrônico)

Motivo: Produção Colaborador HMV

Setor HMV: CTI Adulto

Área da saúde: Medicina Intensiva

Resumo: INTRODUCTION. The administration of a high fraction of inspired oxygen concentration (FIO2) to chronic obstructive pulmonary disease (COPD) patients breathing spontaneously may result in hypercapnia; this fact may be due to the reversal of preexisting regional hypoxic pulmonary vasoconstriction resulting in a greater dead space. To date this issue was not studied during noninvasive ventilation (NIV). OBJECTIVE. To investigate the response of the arterial partial pressure of carbon dioxide (PaCO2) to a high inspired FIO2 during NIV. METHODS. xperimental prospective study in an 18-bed medical-ICU in a university teaching hospital. MEASUREMENTS AND MAIN RESULTS. Seventeen NIV-ventilated CO2-retaining COPD patients were studied both at their baseline FIO2 (0.25 to 0.50), and following a 40 minutes period of exposure to an FIO2 of 1.0. No other parameter was changed. Following 40 minutes at an FIO2 of 1.0, the VT, RR, VE, ABG, and SaO2 were again recorded, as well as changes in mental status (evaluating Glasgow coma score [GCS]) . The patients were then returned to their baseline FIO2. They were not aware of the changes made to their FIO2. Mean (±SD) baseline findings were: PaO2 of 101.4 ± 21.7 mmHg, PaCO2 of 52.6 ±10.4 mmHg, respiratory rate (RR) of 17.8 ±3.7breaths/min, tidal volume (VT) of 601 ±8mL, and Glasgow coma scale (GCS) of 14.8 ±0.3. Statistical analysis using the paired Student´s t-test showed that the PaO2 (290.5 ±35.7 mmHg; p < 0.001) increased significantly when the FIO2 was increased to 1.0, but there was no significant change in PaCO2 (51.5 ±12.3mmHg), RR (17.5 ±2.8breaths/min), VT (608 ±8mL) and GCS (14.8 ±0.3). CONCLUSION. These results show that during noninvasive ventilation with an FIO2 sufficient to maintain a normal PaO2, a further increase in FIO2 for forty minutes does not result in an increased PaCO2 in this group of CO2-retaining COPD patients.

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