Hypercarbia

: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology

Neus Fabregas, Juan Fernández-Candil, in Complications in Neuroanesthesia, 2016 Hypercapnia and Pulmonary Circulation Hypercapnia increases pulmonary vascular resistance mainly by the coexisting acidosis. This effect is one of the measurable signs of a venous air embolism and can provoke acute right ventricle dysfunction. In sleep apnea patients, the chronic hypercapnia develops adaptive mechanisms to diminish the hypoxic negative effects. 11 Plausible explanations to this effect are hyperventilation, increases in the ventilation–perfusion relationship, improvements in tissue oxygen delivery changing the hemoglobin oxygen affinity, increases in CBF due to vasodilation, and so forth. Brain oxygenation can improve when hypercapnia and hypoxemia are combined; nevertheless, this is a controversial topic. 12–15 Jiaxi HE, ... Edmond Cohen, in Cohen's Comprehensive Thoracic Anesthesia, 2022 Hypercapnia Hypercapnia is seen during hypoventilation, especially in patients with COPD or neuromuscular disease (myasthenia gravis). In several studies, transient hypercapnia is reported as permissive, and conversion to general anesthesia is unnecessary. Partial pressure of CO2 usually increases after thoracotomy and remains stable (<55 mm Hg) during the surgical process. It would return to normal gradually after wound closure. Most COPD cases can successfully be treated with mild assisted ventilation. 71 , 72 During long-lasting surgeries, periodical gentle assisted ventilation is recommend...

Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn't comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence (1). Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that. Fundamental concepts Cautions: • Inadequate monitoring: Techniques described here are designed for an environment with close monitoring and staff available to intubate 24 hours a day. • Multi-organ failure: Noninvasive respiratory support works best in patients with single-organ respiratory failure. Pathophysiology of failure: why do patients require intubation for respiratory failure? To avoid intubation, we must first understand why patients require intubation: • Hypercapneic encephalopathy (“CO2 narcosis”). These are patients with extremely high CO2 levels (usually pCO2 > 100 mm) causing obtundation. • Refractory hypoxemia: Inability to oxygenate despite HFNC or BiPAP. • Respiratory muscle exhaustion: This is the most common reason for intubation, because it represents a final common pathway of respiratory failure. Any type of respiratory failure increases the work of breathing. Eventually, respiratory muscles fatigue and fail. As the diaphragm fails, the ability to cough and clear secretions is lost. This may lead to mucus plugging, which causes acute deterioration. Given the importance of respiratory musc...

Hypercapnia, Hypercarbia, & Hypoxia - Chapter Summary The human body needs oxygen, and our bodies have been designed to breathe oxygen in and exhale carbon dioxide out, but sometimes our bodies misuse oxygen and carbon dioxide. When these misuses occur, it can lead to such conditions as hypercapnia, hypercarbia, or hypoxia. In these lessons, you will discover the definitions for these conditions, their causes, and potential treatments. You have absolute control over how you go through the lessons, so you can read all of them in order, or you can pick and choose the lessons that you need to review. Almost all of our lessons can each be completed in less than 10 minutes, so getting through the chapter won't take as long as you may think. Topics covered in this chapter will teach you: • How to define hypercapnia and identify the causes • What are the symptoms and description of hypercarbia • To compare hypercapnia and hypercarbia • To explain hypoxia • The differences between hypercapnia and hypoxia • What treatment options are available for hypercapnia and hypercarbia Earning College Credit Did you know… We have over 220 college courses that prepare you to earn credit by exam that is accepted by over 1,500 colleges and universities. You can test out of the first two years of college and save thousands off your degree. Anyone can earn credit-by-exam regardless of age or education level. To learn more, visit our Other Chapters Other chapters within the First Aid & CPR Training...

: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology

Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn't comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence (1). Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that. Fundamental concepts Cautions: • Inadequate monitoring: Techniques described here are designed for an environment with close monitoring and staff available to intubate 24 hours a day. • Multi-organ failure: Noninvasive respiratory support works best in patients with single-organ respiratory failure. Pathophysiology of failure: why do patients require intubation for respiratory failure? To avoid intubation, we must first understand why patients require intubation: • Hypercapneic encephalopathy (“CO2 narcosis”). These are patients with extremely high CO2 levels (usually pCO2 > 100 mm) causing obtundation. • Refractory hypoxemia: Inability to oxygenate despite HFNC or BiPAP. • Respiratory muscle exhaustion: This is the most common reason for intubation, because it represents a final common pathway of respiratory failure. Any type of respiratory failure increases the work of breathing. Eventually, respiratory muscles fatigue and fail. As the diaphragm fails, the ability to cough and clear secretions is lost. This may lead to mucus plugging, which causes acute deterioration. Given the importance of respiratory musc...

Hypercapnia, Hypercarbia, & Hypoxia - Chapter Summary The human body needs oxygen, and our bodies have been designed to breathe oxygen in and exhale carbon dioxide out, but sometimes our bodies misuse oxygen and carbon dioxide. When these misuses occur, it can lead to such conditions as hypercapnia, hypercarbia, or hypoxia. In these lessons, you will discover the definitions for these conditions, their causes, and potential treatments. You have absolute control over how you go through the lessons, so you can read all of them in order, or you can pick and choose the lessons that you need to review. Almost all of our lessons can each be completed in less than 10 minutes, so getting through the chapter won't take as long as you may think. Topics covered in this chapter will teach you: • How to define hypercapnia and identify the causes • What are the symptoms and description of hypercarbia • To compare hypercapnia and hypercarbia • To explain hypoxia • The differences between hypercapnia and hypoxia • What treatment options are available for hypercapnia and hypercarbia Earning College Credit Did you know… We have over 220 college courses that prepare you to earn credit by exam that is accepted by over 1,500 colleges and universities. You can test out of the first two years of college and save thousands off your degree. Anyone can earn credit-by-exam regardless of age or education level. To learn more, visit our Other Chapters Other chapters within the First Aid & CPR Training...

Neus Fabregas, Juan Fernández-Candil, in Complications in Neuroanesthesia, 2016 Hypercapnia and Pulmonary Circulation Hypercapnia increases pulmonary vascular resistance mainly by the coexisting acidosis. This effect is one of the measurable signs of a venous air embolism and can provoke acute right ventricle dysfunction. In sleep apnea patients, the chronic hypercapnia develops adaptive mechanisms to diminish the hypoxic negative effects. 11 Plausible explanations to this effect are hyperventilation, increases in the ventilation–perfusion relationship, improvements in tissue oxygen delivery changing the hemoglobin oxygen affinity, increases in CBF due to vasodilation, and so forth. Brain oxygenation can improve when hypercapnia and hypoxemia are combined; nevertheless, this is a controversial topic. 12–15 Jiaxi HE, ... Edmond Cohen, in Cohen's Comprehensive Thoracic Anesthesia, 2022 Hypercapnia Hypercapnia is seen during hypoventilation, especially in patients with COPD or neuromuscular disease (myasthenia gravis). In several studies, transient hypercapnia is reported as permissive, and conversion to general anesthesia is unnecessary. Partial pressure of CO2 usually increases after thoracotomy and remains stable (<55 mm Hg) during the surgical process. It would return to normal gradually after wound closure. Most COPD cases can successfully be treated with mild assisted ventilation. 71 , 72 During long-lasting surgeries, periodical gentle assisted ventilation is recommend...

Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn't comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence (1). Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that. Fundamental concepts Cautions: • Inadequate monitoring: Techniques described here are designed for an environment with close monitoring and staff available to intubate 24 hours a day. • Multi-organ failure: Noninvasive respiratory support works best in patients with single-organ respiratory failure. Pathophysiology of failure: why do patients require intubation for respiratory failure? To avoid intubation, we must first understand why patients require intubation: • Hypercapneic encephalopathy (“CO2 narcosis”). These are patients with extremely high CO2 levels (usually pCO2 > 100 mm) causing obtundation. • Refractory hypoxemia: Inability to oxygenate despite HFNC or BiPAP. • Respiratory muscle exhaustion: This is the most common reason for intubation, because it represents a final common pathway of respiratory failure. Any type of respiratory failure increases the work of breathing. Eventually, respiratory muscles fatigue and fail. As the diaphragm fails, the ability to cough and clear secretions is lost. This may lead to mucus plugging, which causes acute deterioration. Given the importance of respiratory musc...

Neus Fabregas, Juan Fernández-Candil, in Complications in Neuroanesthesia, 2016 Hypercapnia and Pulmonary Circulation Hypercapnia increases pulmonary vascular resistance mainly by the coexisting acidosis. This effect is one of the measurable signs of a venous air embolism and can provoke acute right ventricle dysfunction. In sleep apnea patients, the chronic hypercapnia develops adaptive mechanisms to diminish the hypoxic negative effects. 11 Plausible explanations to this effect are hyperventilation, increases in the ventilation–perfusion relationship, improvements in tissue oxygen delivery changing the hemoglobin oxygen affinity, increases in CBF due to vasodilation, and so forth. Brain oxygenation can improve when hypercapnia and hypoxemia are combined; nevertheless, this is a controversial topic. 12–15 Jiaxi HE, ... Edmond Cohen, in Cohen's Comprehensive Thoracic Anesthesia, 2022 Hypercapnia Hypercapnia is seen during hypoventilation, especially in patients with COPD or neuromuscular disease (myasthenia gravis). In several studies, transient hypercapnia is reported as permissive, and conversion to general anesthesia is unnecessary. Partial pressure of CO2 usually increases after thoracotomy and remains stable (<55 mm Hg) during the surgical process. It would return to normal gradually after wound closure. Most COPD cases can successfully be treated with mild assisted ventilation. 71 , 72 During long-lasting surgeries, periodical gentle assisted ventilation is recommend...