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Chest
Published in Henry J. Woodford, Essential Geriatrics, 2022
Long-term oxygen (more than 15 hours per day) increases survival in people with severe resting hypoxaemia (not exercise-induced desaturation alone). It is recommended when arterial blood gas analysis shows PaO2 < 7.3 kPa or 7.3 to 8.0 if there is evidence of pulmonary hypertension, peripheral oedema or polycythaemia.28 There is a risk of burns/fire if there is a current smoker within the residence (i.e. not recommended of people who continue to smoke). There is a risk that the person may trip over the oxygen tubing. Long-term non-invasive ventilation may be considered for people with hypercapnia. People with COPD should maintain or increase physical activity where possible. Pulmonary rehabilitation is beneficial in moderate to advanced disease; especially if there is evidence of deconditioning, weight loss, depression and social isolation. It can result in increased muscle mass and exercise tolerance, with reduced breathlessness, which can improve quality of life, functional capacity and reduce anxiety and depression. The effects in older people seem to be similar to those seen in younger age groups.56 An optimal benefit is obtained with programmes lasting six to eight weeks, occurring at least twice weekly.
The patient with acute respiratory problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The anatomical structure of the thorax is designed so that the lungs can effectively ‘pump’ air in and out (i.e. ventilate). This requires the chest wall, ribs, nerves and muscles to work together in order that this can be achieved. There are a number of disorders that can affect this mechanism, which will result in the inability of the lungs to function as a ventilatory pump. When this occurs, carbon dioxide cannot be removed from the lungs effectively, and therefore levels become elevated in arterial blood (hypercapnia). As a result, arterial oxygen levels will also start to fall.
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
7.2. Arterial hypoxaemia in acute asthmamay be unchanged despite improvement in FEV[ in the acute phase.is usually associated with hypercapnia.may occur in the absence of rhonchi on auscultation.may worsen after intravenous aminophylline.need not be associated with cyanosis.
Hypoxemia and not hyperoxemia predicts worse outcome in severe COPD exacerbations - an observational study
Published in European Clinical Respiratory Journal, 2023
Charlotte Sandau, Ejvind Frausing Hansen, Lars Pedersen, Jens Ulrik Stæhr Jensen
Furthermore, gas exchange in the lungs is complex with hypoxemia, hypercapnia and acidosis influenced by a number of processes such as hypoxic pulmonary vasoconstriction, increased ventilation/perfusion-mismatch, the Haldane effect, resorption atelectasis, and inhibition of hypoxic drive, making therapy is equally complex [28]. It is known that hypercapnia and/or acidosis develops at a slower rate than hypoxemia. Despite this, literature indicates that between 10–20% of AECOPD admitted in hospitals present with type 2 respiratory failure by arrival [29,30], these patients are not included in our study, making it hard to compare our risk estimates with previous literature. However, it has been shown, that patients who develop acidosis during admission and initiate NIV after 24 hours of admission, have a higher mortality rate than those who arrive at the hospital with acidosis [31,32]. These patients, susceptible for hypercapnia and known for their need of close monitoring, are presented in our data. However, the high rate of hyperoxemic episodes reported in our study is associated with a relatively low risk of hypercapnia. This indicates that the complex clinical procedure of monitoring oxygen administration via observations, algorithms, and Arteria Blood Gas (ABG) values have better conditions in hospital settings as opposed to pre-hospital settings and stress the importance of it.
Research progress of portable extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2023
Yuansen Chen, Duo Li, Ziquan Liu, Yanqing Liu, Haojun Fan, Shike Hou
The Novalung system (Xenios AG, Germany) is an extracorporeal assisted system that is designed based on pECLA [34]. The size of the system is only 135 mm ×135 mm× 400 mm because of the lack of a blood pump. The system uses polymethylpentene(PMP) membranes to reduce plasma leakages, and it also uses heparin coating technology to optimize blood compatibility and reduce the risk of thrombosis. The short piping of the system allows negligible heat loss and therefore does not require a heater, the preload volume of the entire system is only 240 ml. The system has been shown to be effective in supporting the treatment of patients with acute respiratory failure and severe hypercapnia. Although the limited oxygenation capacity it provides compared to conventional ECMO is not suitable for patients with cardiac insufficiency. However, conventional ECMO requires high operational and nursing staff and may also be limited by the available equipment resources. The Novalung system has a potentially wide and potential application as a new respiratory-assisted support system and has been used in several scenarios such as the war on terror [35].
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Acute hypercapnia can have many etiologies, commonly including acute respiratory distress syndrome (ARDS). Acute hypercapnia can cause severe renal and cardiovascular consequences.90 As a FLS, acute hypercapnia may be a sign of increased ICP, which increases the diffusion rate of CO2 across the blood brain barrier causing a sharp drop in CSF pH; this in turn inhibits post-synaptic glutamate receptors.80 The most prominent clinical symptom is drowsiness advancing into coma; other symptoms include headaches, confusion, papilledema, tremor of outstretched hands, and seizures.80 Lumbar puncture can be done in patients with acute hypercapnia presenting with such symptoms to diagnose increased ICP. Acute hypercapnia has been associated with increased ICU mortality; therefore, prompt and careful diagnosis is critical.91