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Pathophysiologic role of hypocarbia in post-traumatic pulmonary insufficiency

1971; Elsevier BV; Volume: 122; Issue: 5 Linguagem: Inglês

10.1016/0002-9610(71)90291-1

1879-1883

Cleve Trimble, David E. Smith, Myer H. Rosenthal, Richard G. Fosburg,

Cardiac Arrest and Resuscitation

Post-traumatic pulmonary insufficiency (PTPI) is characterized by hypoxemia, hypocarbia, and respiratory alkalosis. The roles of hypocarbia and respiratory alkalosis in aggravating pulmonary dysfunction have been investigated in five patients with PTPI by sequential volume ventilation under paralysis both with 100 per cent oxygen and with 97 per cent oxygen plus 3 per cent carbon dioxide. When normocarbia was produced by supplemental carbon dioxide, arterial oxygenation improved, alveolar-arterial gradients diminished, airways resistance reduced, and cardiac output and pulmonary perfusion pressures increased. Hypocarbia aggravates PTPI by inducing bronchoconstriction which may cause maldistribution of ventilation, heightened airways resistance, and increased work of breathing. Additionally, alkalosis unfavorably affects oxyhemoglobin dissociation and regional (pulmonary, coronary, and cerebral) blood flows. Rationale is provided for more attentive regulation of alveolar carbon dioxide tensions in such patients.