Hypercapnia Attenuates Mechanical Ventilation-Induced Diaphragm Atrophy And Dysfunction

Schellekens, Wilhelmus J.; Hees, Hieronymus W. van; Acuña, Gilberto L Andrade; Linkels, Marianne; Hoeven, Johannes G. van der; Dekhuijzen, P N.R.; Scheffer, Gert Jan; Heunks, Leo

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4249

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“…Moderate hypercapnic acidosis may also promote the transition from glycolytic, type II fibers to type I fibers after several days of hypercapnic acidosis exposure in an animal model [ 57 ]. Recently and in opposition to normocapnia, moderate hypercapnia (PaCO 2 equal to 75 mm Hg) during an 18-hour period of mechanical ventilation in rats was associated with a higher diaphragmatic force, a decrease in diaphragmatic IL-6 and KC pro-inflammatory cytokines, and an increase in diaphragmatic antiinflammatory cytokine IL-10 level [ 58 ]. Another well-known effect of moderate hypercapnic acidosis is the inhibition of inflammation process related to mechanical ventilation in healthy or acutely injured lungs [ 13 , 38 ].…”

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confidence: 99%

Moderate and prolonged hypercapnic acidosis may protect against ventilator-induced diaphragmatic dysfunction in healthy piglet: an in vivo study

et al. 2013

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IntroductionProtective ventilation by using limited airway pressures and ventilation may result in moderate and prolonged hypercapnic acidosis, as often observed in critically ill patients. Because allowing moderate and prolonged hypercapnia may be considered protective measure for the lungs, we hypothesized that moderate and prolonged hypercapnic acidosis may protect the diaphragm against ventilator-induced diaphragmatic dysfunction (VIDD). The aim of our study was to evaluate the effects of moderate and prolonged (72 hours of mechanical ventilation) hypercapnic acidosis on in vivo diaphragmatic function.MethodsTwo groups of anesthetized piglets were ventilated during a 72-hour period. Piglets were assigned to the Normocapnia group (n = 6), ventilated in normocapnia, or to the Hypercapnia group (n = 6), ventilated with moderate hypercapnic acidosis (PaCO2 from 55 to 70 mm Hg) during the 72-hour period of the study. Every 12 hours, we measured transdiaphragmatic pressure (Pdi) after bilateral, supramaximal transjugular stimulation of the two phrenic nerves to assess in vivo diaphragmatic contractile force. Pressure/frequency curves were drawn after stimulation from 20 to 120 Hz of the phrenic nerves. The protocol was approved by our institutional animal-care committee.ResultsModerate and prolonged hypercapnic acidosis was well tolerated during the study period. The baseline pressure/frequency curves of the two groups were not significantly different (Pdi at 20 Hz, 32.7 ± 8.7 cm H2O, versus 34.4 ± 8.4 cm H2O; and at 120 Hz, 56.8 ± 8.7 cm H2O versus 60.8 ± 5.7 cm H2O, for Normocapnia and Hypercapnia groups, respectively). After 72 hours of ventilation, Pdi decreased by 25% of its baseline value in the Normocapnia group, whereas Pdi did not decrease in the Hypercapnia group.ConclusionsModerate and prolonged hypercapnic acidosis limited the occurrence of VIDD during controlled mechanical ventilation in a healthy piglet model. Consequences of moderate and prolonged hypercapnic acidosis should be better explored with further studies before being tested on patients.

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