Uncontrolled Oxygen Administration and Respiratory Failure in Acute Asthma
| Autor: | Russell Ciufo, E. R. McFADDEN, Ronald Novak, Mary Skowronski, JoAnn Nelson, Albert Coreno, Jason W. Chien |
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| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_treatment Critical Care and Intensive Care Medicine Hypoxemia Hypercapnia Risk Factors Haldane effect Forced Expiratory Volume Oxygen therapy medicine Humans Lung Diseases Obstructive Prospective Studies Pulmonary Gas Exchange business.industry Airway Resistance Respiratory disease Oxygen Inhalation Therapy Middle Aged Airway obstruction medicine.disease Asthma Respiratory failure Anesthesia Respiratory alkalosis Acute Disease Arterial blood Female Blood Gas Analysis medicine.symptom Emergency Service Hospital Respiratory Insufficiency Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 117:728-733 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.117.3.728 |
| Popis: | Study objectives To determine if 100% oxygen administration adversely influences gas exchange in acutely ill asthmatic subjects. Design Prospective preinterventional and postinterventional comparison. Setting University hospital emergency department. Patients Thirty-seven asthmatic subjects seeking care for symptomatic exacerbations. Interventions Twenty minutes of 100% oxygen administration by face mask. Measurements and results Arterial blood gases and FEV 1 were measured before and during the last minute of oxygen administration. On presentation, the subjects had moderately severe airway obstruction (FEV 1 , 49.1 ± 3.6% of predicted); hypocarbia (Pa co 2 , 36.8 ± 1.1 mm Hg); hypoxemia (Pa o 2 , 70.2 ± 2.5 mm Hg); and respiratory alkalosis (pH, 7.43 ± 0.01). During oxygen breathing, 25 patients (67.6%) experienced elevations in Pa co 2 ranging from 1 to 10 mm Hg (mean, 4.1 ± 0.6 mm Hg; p = 0.0003). The increase was considered to be a physiologic manifestation of the Haldane effect ( ie ,≤ 2 mm Hg) in 10 subjects, but in the remaining 15 subjects (40.5% of the total studied), the elevation represented worsening gas exchange. In seven of these patients (46.7%), hypercapnic respiratory failure developed (Pa co 2 before oxygen, 39.6 ± 0.6; during oxygen, 44.7 ± 0.7 mm Hg; p = 0.005), and in six patients (40%), it worsened (Pa co 2 before oxygen, 46.8 ± 1.9; during oxygen, 52.0 ± 3.1 mm Hg; p = 0.03). In general, the tendency toward hypercarbia was the greatest in the participants with the most severe airway obstructions. Conclusions Our data demonstrate that the administration of 100% oxygen to acutely ill asthmatics may adversely influence carbon dioxide elimination. |
| Databáze: | OpenAIRE |
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