L’ipercapnia da iperossigenazione nel paziente con insufficienza respiratoria ipercapnica (tipo 2)

31 Ott

Fin dagli inizi della pratica clinica il messaggio che tutti abbiamo ricevuto sulla somministrazione di O2 nel paziente BPCO era: bassi flussi basse FiO2, rischio di ipercapnia e di carbonarcosi.

Alla richiesta di spiegazioni fisiopatologiche la risposta era (ed è scommetterei): è colpa del drive ipossico che stimola i centri respiratori del BPCO e che, quando viene alterato con la somministrazione “selvaggia” di O2, induce ipoventilazione e quindi ipercapnia.

Approfondendo, da grande, ho scoperto che il famoso “drive ipossico” è in gran parte una leggenda metropolitana, e soprattutto non è assolutamente responsabile dell’ipercapnia nell’insufficiente repiratorio cronico.

Possiamo imputare tale condizione a due meccanismi fisiopatologici:

  1. Vasocostrizione ipossica polmonare
  2. Effetto Haldane

L’iperossigenazione rende meno “efficiente” la normale vasocostrizione ipossica che, escludendo le zone meno ventilate del polmone, permette il mantenimento di  un rapporto ventilazione perfusione ottimale. E’ quindi il mismatch tra ventilazione e perfusione il maggior responsabile dell’ipercapnia da iperossigenzaione del paziente con IR ipercapnica.

Take home point per la pratica clinica: Nel paziente con IR cronica tipo 2 (ipercapnica)FiO2 massimo del 35% per raggiungere target di saturazione tra 88 e 92%.

References
Oxygen_induced hypercapnia in COPD myths and facts
Guideline for Emergency Oxygen Use in Adult Patients: Executive Summary

Tag:, , , ,

Rispondi

Inserisci i tuoi dati qui sotto o clicca su un'icona per effettuare l'accesso:

Gravatar
Logo WordPress.com

Stai commentando usando il tuo account WordPress.com. ( Chiudi sessione /  Modifica )

Google+ photo

Stai commentando usando il tuo account Google+. ( Chiudi sessione /  Modifica )

Foto Twitter

Stai commentando usando il tuo account Twitter. ( Chiudi sessione /  Modifica )

Foto di Facebook

Stai commentando usando il tuo account Facebook. ( Chiudi sessione /  Modifica )

w
Annulla

Connessione a %s...

Triggerlab

Nurse and ventilator waveforms

thinking critical care

a blog for thinking docs: blending good evidence, physiology, common sense, and applying it at the bedside!

urgentcareultrasound

More definitive diagnosis, better patient care

My CPD

For WMAS clinicians

MariaLuisaRuberto.com

Storie di 118

Critical Care Northampton

Reviewing Critical Care, Journals and FOAMed

OHCA research

Prehospital critical care for out-of-hospital cardiac arrest

SonoStuff

Education and entertainment for the ultrasound enthusiast

phemcast

A UK PREHOSPITAL PODCAST

First10EM

Emergency medicine resuscitation - When minutes matter...

Songs or Stories

Sharing the Science and Art of Paediatric Anaesthesia

airwayNautics

"Live as if you will die tomorrow; Learn as if you will live forever"

resusNautics

Navigating resuscitation

EMSPOCUS

Taking the hocus out of pocus and bringing hospital care to the streets.

LITFL • Life in the Fast Lane Medical Blog

Emergency medicine and critical care medical education blog

emDOCs.net - Emergency Medicine Education

Our goal is to inform the global EM community with timely and high yield content about what providers like YOU are seeing and doing everyday in your local ED.

The Collective

A Hive Mind for Prehospital and Retrieval Med

Dave on Airways

Thoughts and opinions on airways and resuscitation science

FOAMcast

A Free Open Access Medical Education Emergency Medicine Core Content Mash Up

Broome Docs

Rural Generalist Doctors Education

St.Emlyn's

Emergency Medicine #FOAMed

BoringEM

Bringing the Boring to EM

"CardioOnline"Basic and Advanced Cardiovascular medicine" Cariology" concepts and Review -Dr.Nabil Paktin,MD.FACC.دکتـور نبــــیل "پاکطــــین

این سایت را به آن دکتوران و محصلین طب که شب و روز برای رفاه نوع انسان فداکاری می کنند ، جوانی و لذایذ زندگی را بدون چشمداشت به امتیاز و نفرین و آفرین قربان خدمت به بشر می کنند و بار سنگین خدمت و اصلاح را بدوش می کشند ، اهداء می کنم This site is dedicated to all Doctors and students that aver the great responsibility of People’s well-being upon their shoulders and carry on their onerous task with utmost dedication and Devotionاولین سایت و ژورنال انتــرنتی علـــمی ،تخـصصی ، پــژوهشــی و آمــوزشــی طبـــی در افغــانســـتان

DOWNSTAIRS CARE OUT THERE BLOG

PHARM, #FOAMed

EmergencyPedia

Free Open Access Medical Education

Little Medic

Learning everything I can from everywhere I can. This is my little blog to keep track of new things medical, paramedical and pre-hospital from a student's perspective.

Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds

In memory of Dr John Hinds

Prehospital Emergency Medicine Blog

All you want to know about prehospital emergency medicine

Italy Customized Travel Blog

Local Travel Agent, sommelier, food & wine expert in Florence, Italy

GoogleFOAM

The FOAM Search Engine

EM Lyceum

where everything is up for debate . . .

Pediatric EM Morsels

Pediatric Emergency Medicine Education

Academic Life in Emergency Medicine

ALiEM

EM Pills

curiosità-novità-aggiornamenti in medicina d'urgenza

AmboFOAM

Free Open Access Medical Education for Paramedics

FOAM4GP

Free Open Access Meducation 4 General Practice

Rural Doctors Net

useful resources for rural clinicians

Auckland HEMS

Unofficial site for prehospital care providers of the Auckland HEMS service

ECHOARTE

L'ECOGRAFIA: ENTROPIA DELL'IMMAGINE

MEDEST

Prehospital Emergency Medicine

ruralflyingdoc

Just another WordPress.com site

EM Basic

Your Boot Camp Guide to Emergency Medicine

KI Doc

WE HAVE MOVED - VISIT WWW.KIDOCS.ORG FOR NEW CONTENT

Emergency Live

Prehospital Emergency Medicine

AMP EM

Academic Medicine Pearls in Emergency Medicine from THE Ohio State University Residency Program

ERCAST Emergency Medicine Podcasts

Emergency medicine, podcasts, reviews, opinion and curbside consults

Prehospital Emergency Medicine

 Academic Life in Emergency Medicine

Prehospital Emergency Medicine

Comments on: Homepage

Prehospital Emergency Medicine

Greater Sydney Area HEMS

The Pre-hospital & Retrieval Medicine Team of NSW Ambulance

%d blogger hanno fatto clic su Mi Piace per questo: