J Trauma
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Clinical Trial Controlled Clinical Trial
Permissive hypercapnia in trauma patients.
The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS). ⋯ The duration of mechanical ventilation was greater in PH patients [49.2 +/- 15.2 vs. 20.8 +/- 10 days (p < 0.01)]. Survival was also greater in the PH group [91% vs. 48% (p < 0.01)]. A reduction in intensity of mechanical ventilation is associated with a prolongation of ventilatory support and an improved outcome from ARDS.
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Traditional practice of mechanical ventilation includes tactics to reduce lung injury, such as avoidance of excessive airway pressure, patient distress, and tidal volume. Gas exchange objectives have received priority, however, and a degree of lung injury has been accepted as inevitable. The current trend toward increasing use of permissive hypercapnia is based on the recognition that lung injury induced by mechanical ventilation may be reduced by compensated hypercapnia with few serious adverse effects and contraindications.