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Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO₂ response and acetazolamide treatment effects.

Abstract：

OBJECTIVE:In obesity-hypoventilation-syndrome patients mechanically ventilated for hypercapnic respiratory failure we investigated the relationship between CO₂ response, body mass index, and plasma bicarbonate concentration, and the effect of acetazolamide on bicarbonate concentration and CO₂ response. METHODS:CO₂ response tests and arterial blood gas analysis were performed in 25 patients ready for a spontaneous breathing test, and repeated in a subgroup of 8 patients after acetazolamide treatment. CO₂ response test was measured as (1) hypercapnic drive response (the ratio of the change in airway occlusion pressure 0.1 s after the start of inspiratory flow to the change in P(aCO₂)), and (2) hypercapnic ventilatory response (the ratio of the change in minute volume to the change in P(aCO₂)). RESULTS:We did not find a significant relationship between CO₂ response and body mass index. Patients with higher bicarbonate concentration had a more blunted CO₂ response. Grouping the patients according to the first, second, and third tertiles of the bicarbonate concentration, the hypercapnic drive response was 0.32 ± 0.17 cm H₂O/mm Hg, 0.22 ± 0.15 cm H₂O/mm Hg, and 0.10 ± 0.06 cm H₂O/mm Hg, respectively (P = .01), and hypercapnic ventilatory response was 0.46 ± 0.23 L/min/mm Hg, 0.48 ± 0.36 L/min/mm Hg, and 0.22 ± 0.16 L/min/mm Hg, respectively (P = .04). After acetazolamide treatment, bicarbonate concentration was reduced by 8.4 ± 3.0 mmol/L (P = .01), and CO₂ response was shifted to the left, with an increase in hypercapnic drive response, by 0.14 ± 0.16 cm H₂O/mm Hg (P = .02), and hypercapnic ventilatory response, by 0.11 ± 0.22 L/min/mm Hg (P = .33). CONCLUSIONS:Patients with obesity-hypoventilation syndrome and higher bicarbonate concentrations had a more blunted CO₂ response. Body mass index was not related to CO₂ response. Acetazolamide decreased bicarbonate concentration and increased CO₂ response.

journal_name

Respir Care

journal_title

Respiratory care

authors

Raurich JM,Rialp G,Ibáñez J,Llompart-Pou JA,Ayestarán I

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

1442-8

issue

eissn

0020-1324

issn

1943-3654

journal_volume

pub_type

杂志文章

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Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO₂ response and acetazolamide treatment effects.