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Hypercapnia and acidosis in sepsis: a double-edged sword?
- Source :
-
Anesthesiology [Anesthesiology] 2010 Feb; Vol. 112 (2), pp. 462-72. - Publication Year :
- 2010
-
Abstract
- Acute respiratory distress syndrome is a devastating disease that causes substantial morbidity and mortality. Mechanical ventilation can worsen lung injury, whereas ventilatory strategies that reduce lung stretch, resulting in a "permissive" hypercapnic acidosis (HCA), improve outcome. HCA directly reduces nonsepsis-induced lung injury in preclinical models and, therefore, has therapeutic potential in these patients. These beneficial effects are mediated via inhibition of the host immune response, particularly cytokine signaling, phagocyte function, and the adaptive immune response. Of concern, these immunosuppressive effects of HCA may hinder the host response to microbial infection. Recent studies suggest that HCA is protective in the earlier phases of bacterial pneumonia-induced sepsis but may worsen injury in the setting of prolonged lung sepsis. In contrast, HCA is protective in preclinical models of early and prolonged systemic sepsis. Buffering of the HCA is not beneficial and may worsen pneumonia-induced injury.
- Subjects :
- Acidosis immunology
Acidosis microbiology
Critical Illness
Humans
Hypercapnia immunology
Hypercapnia microbiology
Lung Diseases microbiology
Lung Diseases pathology
Pneumonia microbiology
Pneumonia pathology
Sepsis immunology
Sepsis microbiology
Acidosis etiology
Hypercapnia etiology
Sepsis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1175
- Volume :
- 112
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Anesthesiology
- Publication Type :
- Academic Journal
- Accession number :
- 20068449
- Full Text :
- https://doi.org/10.1097/ALN.0b013e3181ca361f