Posthypercapnic syndrome
https://doi.org/10.18093/0869-0189-2023-33-3-420-426
Abstract
Hypercapnic respiratory failure is a common cause of hospitalization and death in patients with chronic obstructive pulmonary disease (COPD).
The aim of this work was to analyze the pathophysiological mechanisms and clinical picture of hypercapnic respiratory failure and to discuss the tactics of managing a patient with COPD and posthypercapnic alkalosis that developed during treatment using a clinical case as an example.
Conclusion. To date, the search for new treatments for posthypercapnic alkalosis is still relevant, but there are few published studies on this topic. Acute problems in mixed metabolic disorders can be solved with an integrated therapeutic approach that includes the use of medical gases.
Keywords
hypercapnia,
hypercapnic respiratory failure,
non-invasive ventilation,
COPD exacerbation,
posthypercapnic alkalosis,
medical gases,
treatment
Supporting agencies: The study had no sponsorship
About the Authors
H. C. Nguyen
Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Hoang Cuong Nguyen - Postgraduate student, Department of Hospital Therapy, Pediatric Faculty.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (967) 203-42-77
Competing Interests:
The authors report that there is no conflict of interest
I. A. Baranova
Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Irina A. Baranova - Doctor of Medicine, Professor, Professor of Hospital Therapy Department, Pediatric Faculty.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (499) 780-08-16
Competing Interests:
The authors report that there is no conflict of interest
A. G. Chuchalin
Federal State Autonomous Educational Institution of Higher Education “N.I. Pirogov Russian National Research Medical University” of the Ministry of Health of the Russian Federation
Russian Federation
Competing Interests:
Russian Federation
Alexander G. Chuchalin - Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of Department of Hospital Internal Medicine, Pediatric Faculty, N.I. Pirogov RNRMU; Chairman of the Executive Board of Russian Respiratory Society.
Ul. Ostrovityanova 1, Moscow, 117997; tel.: (499) 780-08-50
Competing Interests:
The authors report that there is no conflict of interest
References
1. Avdeev S.N. [Gas exchange disorders in chronic obstructive pulmonary disease]. Russkiy meditsinskiy zhurnal. 2013; 21 (7): 353–356. Available at: https://www.rmj.ru/articles/bolezni_dykhatelnykh_putey/Narusheniya_gazoobmena_pri_hronicheskoy_obstruktivnoy_bolezni_legkih%20/ (in Russian).
2. Avdeev S.N. [Intensive care in pulmonology]. Moscow: Atmosfera; 2014 (in Russian).
3. Feller-Kopman D.J., Schwartzstein R.M. Mechanisms, causes, and effects of hypercapnia. UpToDate. 2022. Available at: https://www.uptodate.com/contents/mechanisms-causes-and-effects-of-hypercapnia/print [Accessed: October 10, 2022].
4. Grippi M.A., Tino G. Pulmonary function testing. In: Grippi M.A., Elias J.A., Fishman J.A. et al., eds. Fishman's Pulmonary Diseases and Disorders. 5nd Edn. New York: McGraw-Hill Education; 2015. Available at: https://accessmedicine.mhmedical.com/content.aspx?bookid=1344§ionid=81187235
5. Аvdeev S.N. [Pathologic physiology of exacerbations of chronic obstructive pulmonary disease]. Vestnik anesteziologii i reanimatologii. 2019; 16 (2): 75–82 DOI: 10.1292/2078-5658-2019-16-2-75-82 (in Russian).
6. Csoma B., Vulpi M.R., Dragonieri S. et al. Hypercapnia in COPD: causes, consequences, and therapy. J. Clin. Med. 2022; 11 (11): 3180. DOI: 10.3390/jcm11113180.
7. Chuchalin A.G., Avdeev S.N., Aisanov Z.R. et al. [Chronic obstructive pulmonary disease: Guidelines]. 2021. Available at: https://spulmo.ru/upload/kr/HOBL_2021.pdf?ysclid=lggc7bv4zq255617548 (in Russian).
8. Feller-Kopman D.J., Schwartzstein R.M. The evaluation, diagnosis, and treatment of the adult patient with acute hypercapnic respiratory failure. UpToDate. 2022. Available at: https://www.uptodate.com/contents/the-evaluation-diagnosis-and-treatment-of-the-adult-patient-with-acute-hypercapnic-respiratory-failure [Accessed: October 10, 2022].
9. Mas A., Masip J. Noninvasive ventilation in acute respiratory failure. Int. J. Chron. Obstruct. Pulmon. Dis. 2014; 9 (1): 837–852. DOI: 10.2147/COPD.S42664.
10. Brandis K. Acid-base physiology. 2006. Available at: https://www.anaesthesiamcq.com/AcidBaseBook/ABindex.php [Accessed: October 12, 2022].
11. Kassil' V.L., Leskin G.S., Vyzhigina M.A. [Respiratory support: artificial and assisted ventilation in anesthesiology and intensive care: guide for doctors]. Moscow: Meditsina; 1997 (in Russian).
12. Fontana V., Santinelli S., Internullo M. et al. Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients. Eur. Rev. Med. Pharmacol. Sci. 2016; 20 (1): 37–43. Available at: https://www.europeanreview.org/wp/wp-content/uploads/37-43.pdf
13. Banga A., Khilnani G.C. Post-hypercapnic alkalosis is associated with ventilator dependence and increased ICU stay. COPD. 2009; 6 (6): 437–440. DOI: 10.3109/15412550903341448.
14. Martínez C.S., Macías C.M., Toledo J.S. et al. Alcalosis posthipercápnica en pacientes con enfermedad pulmonar obstructiva crónica exacerbada. Med. Crítica. 2011; 25 (4): 218–225. Available at: https://www.medigraphic.com/pdfs/medcri/ti-2011/ti114f.pdf
15. Emmett M., Szerlip H. Causes of metabolic alkalosis. UpToDate. 2022. Available at: https://pro.uptodatefree.ir/show/2331 [Accessed: October 10, 2022].
16. Tinawi M. Pathophysiology, evaluation, and management of metabolic alkalosis. Cureus. 2021; 13 (1): e12841. DOI: 10.7759/cureus.12841.
17. Do C., Vasquez P.C., Soleimani M. Metabolic alkalosis pathogenesis, diagnosis, and treatment: core curriculum 2022. Am. J. Kidney Dis. 2022; 80 (4): 536–551. DOI: 10.1053/j.ajkd.2021.12.016.
18. Engelking L.R. Chapter 89 – metabolic alkalosis. In: Engelking L.R., ed. Textbook of veterinary physiological chemistry. 3rd Edn. Boston: Academic Press; 2014: 576–583. Available at: https://www.elsevier.com/books/textbook-of-veterinary-physiological-chemistry/engelking/978-0-12-391909-0
19. Hall A.M., Bending M.R. Severe hyperlactaemia in the setting of alkalaemia. NDT Plus. 2009; 2 (5): 408–411. DOI: 10.1093/ndtplus/sfp065.
20. Faisy C., Meziani F., Planquette B. et al. Effect of acetazolamide vs placebo on duration of invasive mechanical ventilation among patients with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA. 2016; 315 (5): 480–488. DOI: 10.1001/jama.2016.0019.
Supplementary files
Review
For citations:
Nguyen H., Baranova I.A., Chuchalin A.G. Posthypercapnic syndrome. PULMONOLOGIYA. 2023;33(3):420-426. (In Russ.) https://doi.org/10.18093/0869-0189-2023-33-3-420-426
Views:
503
Email this article 