The effect of lung-protective permissive hypercapnia in intracerebral pressure in patients with subarachnoid haemorrhage and ARDS.
Pros and cons of permissive hypercapnia in patients with subarachnoid haemorrhage and ARDS.
Sasidhar adds that when determining how far a clinician will go in sustaining permissive hypercapnia
, the possibility for significant lung injury is often weighed against the harm that may or may not occur when attempting to maintain a "normal" carbon dioxide (CCb) level.
is the intentional reduction of mechanical ventilation for the avoidance of alveolar overdistension, i.
Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia
in severe adult respiratory distress syndrome.
Hickling et al, in their non-comparative observational study, reported improved survival in patients with ARDS where lung-protective ventilation was used with permissive hypercapnia
Several of the key elements to patient management include: 1) During mechanical ventilation, target tidal volume at 6mL/Kg per ideal body weight or less, 2) maximize plateau pressure at 30 cm H20 or less to prevent volume induced lung injury, 3) allow for permissive hypercapnia
to achieve the pressure and volume targets, 5) set PEEP to avoid alveolar collapse since alveolar de-recruitment leads to high alveolar opening pressures and lung damage, 6) minimize the use of pulmonary artery catheters due to no evidence based benefit, 6) use bicarbonate therapy if pH is < 7.
Minute ventilation must be lowered, and allowing permissive hypercapnia
is not a useful option in the setting of metabolic acidosis.
ventilation (PHV) is another strategy used with ARDS.