Arterial carbon dioxide tension after cardiac arrest: too little, too much, or just right?
Arterial carbon dioxide tension after cardiac arrest: too little, too much, or just right?
复制标题
心脏骤停后动脉二氧化碳张力：太少、太多还是恰到好处？
DOI：
10.1016/j.resuscitation.2013.04.022
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发表时间：
2013
期刊：
影响因子：
6.5
通讯作者：
Fink,ErickaL
中科院分区：
文献类型：
--
作者：
Manole,MioaraD;Fink,ErickaL
越来越多的证据表明，目标导向的复苏后患者护理应包括靶向氧合和通气，以优化结局。最初的重点放在氧合策略上，因为实验研究证明了心脏骤停后高氧的有害影响。1类似地，在初始ABG检查中，从高氧（PaO2> 300 mm Hg）心脏骤停中复苏的成年人的预后比缺氧或正常氧的人更差。2最近，最佳的治疗策略被重新研究，沿着二氧化碳对缺血后心脏和神经功能的影响。心肺复苏和心血管急救科学国际共识认识到，应避免复苏后常规过度通气，以防止因低碳酸血症引起的脑血流量减少而导致脑缺血。3然而，在低碳酸血症和高碳酸血症如何与心脏骤停复苏患者的神经系统结局相关方面，人们认识到了重要的知识差距。
Evidence is accumulating that goal-directed post-resuscitation patient care should include targeting oxygenation and ventilation for outcome optimization. Emphasis was initially placed on the oxygenation strategy, as experimental studies demonstrated detrimental effects of hyperoxia post-cardiac arrest. 1 Similarly, adults resuscitated from cardiac arrest with hyperoxia (PaO2> 300 mm Hg) on initial ABG had worse outcomes than those with hypoxia or normoxia. 2More recently, the optimal ventilatory strategy was reexamined, along with the effects of carbon dioxide on cardiac and neurological function after ischemia. International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science recognizes that routine hyperventilation after resuscitation should be avoided to prevent cerebral ischemia due to decreased cerebral blood flow that occurs with hypocapnia. 3 Important knowledge gaps were realized, however, in how hypo-and hypercapnia relate to neurological outcome in patients resuscitated from cardiac arrest.