Hyperventilation in severe diabetic ketoacidosis.
Hyperventilation in severe diabetic ketoacidosis.
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DOI：
10.1097/01.pcc.0000164343.20418.37
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发表时间：
2005-07-01
期刊：
影响因子：
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通讯作者：
Peters, Mark J
中科院分区：
文献类型：
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作者：
Tasker, Robert C;Lutman, Daniel;Peters, Mark J
目的：探讨糖尿病酮症酸中毒患者血液和脑脊液 (CSF) 中的二氧化碳-碳酸氢盐 (P(CO(2))-HCO(3)) 缓冲系统是否会影响有脑水肿风险的患者的通气方法。 数据来源：Medline 搜索、手动搜索 Medline 搜索中的文章参考文献以及使用 1933 年至 1967 年的历史文献。 设计：临床Vignette 被用来作为讨论综合代谢和血管生理学的基础，该儿童患有严重的糖尿病酮症酸中毒，表现为严重的低碳酸血症，然后病情恶化。 研究选择：研究包括糖尿病酮症酸中毒的报告，其中提供了动脉和脑脊液酸碱数据。可获得同时酸碱、通气、呼吸商和脑血流数据的研究。 数据提取和合成：我们重新审视一个假设，并通过重新评估数据，提出一个基于糖尿病酮症酸中毒中低 [HCO(3)](CSF) 和升高 Pa(CO(2))- 过度通气的重要性以及生存生物学极限的论点；结论：该综述强调了严重糖尿病酮症酸中毒机械通气的潜在问题，并表明 P(CO(2))-HCO(3) 假说与糖尿病酮症酸中毒脑水肿的数据一致。它还表明，在重症监护过程早期避免诱发过度通气的建议可能与适应性生理学的逻辑相反。
OBJECTIVE: To explore whether the carbon dioxide-bicarbonate (P(CO(2))-HCO(3)) buffering system in blood and cerebrospinal fluid (CSF) in diabetic ketoacidosis should influence the approach to ventilation in patients at risk of cerebral edema.DATA SOURCE: Medline search, manual search of references in articles found in Medline search, and use of historical literature from 1933 to 1967.DESIGN: A clinical vignette is used--a child with severe diabetic ketoacidosis who presented with profound hypocapnia and then deteriorated--as a basis for discussion of integrative metabolic and vascular physiology.STUDY SELECTION: Studies included reports in diabetic ketoacidosis where arterial and CSF acid-base data have been presented. Studies where simultaneous acid-base, ventilation, respiratory quotient, and cerebral blood flow data are available.DATA EXTRACTION AND SYNTHESIS: We revisit a hypothesis and, by reassessing data, put forward an argument based on the significance of low [HCO(3)](CSF) and rising Pa(CO(2))- hyperventilation in diabetic ketoacidosis and the limit in biology of survival; repair of severe diabetic ketoacidosis and Pa(CO(2))-and mechanical ventilation.CONCLUSION: The review highlights a potential problem with mechanical ventilation in severe diabetic ketoacidosis and suggests that the P(CO(2))--HCO(3) hypothesis is consistent with data on cerebral edema in diabetic ketoacidosis. It also indicates that the recommendation to avoid induced hyperventilation early in the course of intensive care may be counter to the logic of adaptive physiology.