미숙아에서 최적의 환기 요법: 고탄산혈증 허용
Optimal Ventilatory Strategies in Preterm Infants: Permissive Hypercapnia
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초록
폐손상과 관련된 기관지폐 이형성증(bronchopulmonary dysplasia)은 초극소 저체중 출생아 (extremely low birth weighinfants)에서 중요한 이환율의 하나로 알려져 있는데, 기계환기 동안에 폐손상이 발생하는 기전으로 높은 일회호흡량(tidal volume)과 높은 흡기말폐용량(end expiratory volume)과 관련되어 있다. 일부 연구에서는 고탄산혈증 허용(permissive hypercapnia)과 같은 기계환기 전략이 폐손상과 기관지폐 이형성증을 예방할 수 있는 것으로 되어 있는데이에 미숙아에서 폐손상의 병태 생리적 영향과 폐손상을 감소시키기 위한 고탄산혈증 허용과 같은 최신 치료에 대한이해가 필요할 것이다.
Abstract
Bronchopulmonary dysplasia associated with lung injury is an important morbidityin extremely low birth weight infants. Lung injury during mechanical ventilationis associated with high tidal volume and high end-inspiratory lung volume. Lunginjury and bronchopulmonary dysplasia may be prevented with ventilatorystrategies using optimal gas exchange such as permissive hypercapnia. Thisarticle will review the pathophysiologic background of lung injury and the currenttherapeutic ventilatory strategies such as permissive hypercapnia to reduce lunginjury in preterm infants.
참고문헌 (55)
- Doyle LW, "Growth and respiratory health in adolescence of the extremely low-birth weight survivor", Clin Perinatol, 27, pp.421~432 (2000)
- Thome UH, "Permissive hypercapnia", Semin Neonatol, 7, pp.409~419 (2002)
- Dreyfuss D, "Ventilator-induced lung injury: lesson from experimental studies", Am J Respir Crit Care Med, 157, pp.294~233 (1998)
- Parker JC, "Mechanism of ventilatorinduced lung injury", Crit Care Med, 21, pp.131~143 (1993)
- Muscedere JG, "Tidal ventilation at low airway pressure can augment lung injury", Am J Respir Crit Care Med, 149, pp.1327~1334 (1994)
- Taskar V, "Surfactant dysfunction makes lungs vulnerable to repetitive collapse and reexpansion", Am J Respir Crit Care Med, 155, pp.313~320 (1997)
- Frank L, "Fetal and neonatal physiology", pp.1175~1188 (1998), WB Saunders
- Carlton DP, "Lung overexpansion increases pulmonary microvascular protein permeability in young lambs", J Appl Physiol(1985), 69, pp.577~583 (1990)
- Zaher TE, "Hyperoxia-induced signal transduction pathways in pulmonary epithelial cells", Free Radic Biol Med, 42, pp.897~908 (2007)
- Li LF, "Hyperoxia increases ventilator-induced lung injury via mitogen-activated protein kinase: a prospective, controlled animal experiment", Crit Care, 11, pp.25~ (2007)
- Speer CP, "New insight into the pathogenesis of pulmonary inflammation in preterm infants", Biol Neonate, 79, pp.205~209 (2001)
- Kotecha S, "Cytokines in chronic lung disease of prematuriy", Eur J Pediatr, 155, pp.S14~S17 (1996)
- Ambalavanan N, "Ventilatory strategies in the prevention and management of bronchopulmonary dysplasia", Semin Perinatol, 30, pp.192~199 (2006)
- Thome UH, "Permissive hypercapnia to decrease lung injury in ventilated preterm neonates", Semin Fetal Neonatal Med, 14, pp.21~27 (2009)
- Greenough A, "Synchronized mechanical ventilation for respiratory support in newborn infant", Cochrane Database Syst Rev, pp.Cd000456~ (2004)[DOI]
- Kraybill EN, "Risk factors for chronic lung disease in infants with birth weights of 751 to 1000 grams", J Pediatr, 115, pp.115~120 (1989)
- Garland JS, "Hypocarpnia before surfactant therapy appears to increase bronchopulmonary dysplasia risk in infants with respiratory distress syndrome", Arch Pediatr Adolesc Med, 149, pp.617~622 (1995)
- Ambalavanan N, "Hypocapnia and hypercapnia in respiratory management of newborn infants", Clin Perinatol, 28, pp.517~531 (2001)
- Laffey JG, "Carbon dioxide and the critically ill -too little of a good thing?", Lancet, 354, pp.1283~1286 (1999)
- Komori M, "Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits", Crit Care Med, 35, pp.2171~2175 (2007)
- Tang WC, "Reversible impairment of myocardial contractility due to hypercarbic acidosis in the isolated perfused rat heart", Crit Care Med, 19, pp.218~224 (1991)
- Walley KR, "Acute respiratory acidosis decrease left ventricular contractility but increase cardiac output in dogs", Circ Res, 67, pp.628~635 (1990)
- Brogan TV, "Carbon dioxide added late in inspiration reduces ventilationperfusion heterogeneity without causing respiratory acidosis", J Appl Physiol (1985), 96, pp.1894~1898 (2004)
- Kondo T, "Ventilatory response to hypercapnia and hypoxia following chronic hypercapnia in the rat", Respir Physiol, 122, pp.35~43 (2000)
- Mariani G, "Randomized trial of permissive hypercapnia in preterm infants", Pediatrics, 104, pp.1082~1088 (1999)
- Feihe F, "Permissive hypercapnia impairs pulmonary gas exchange in the acute respiratory distress syndrome", Am J Respir Crit Care Med, 162, pp.209~215 (2000)
- McIntyre RC Jr, "Cardiopulmonary effects of permissive hypercapnia in the management of adult respiratory distress syndrome", J Trauma, 37, pp.433~438 (1994)
- Ramirez J, "Oxyegn-carrying capacity during 10 hours of hypercapnia in ventilated dogs", Crit Care Med, 28, pp.1918~1923 (2000)
- Shibata K, "Hypercapnic acidosis may attenuate acute lung injury by inhibition of endogenous xanthine oxidase", Am J Respir Crit Care Med, 158, pp.1578~1584 (1998)
- Coakley RJ, "Ambient pCo2 modulates intracellular pH, intracellular oxidant generation, and interleukin-8 secretion in human neutrophils", J Leukoc Biol, 71, pp.603~610 (2002)
- B activation, "Am J Respir Cell Mol Biol", 2003, 124~132
- Lang JD Jr, "Hypercapnia induces injury to alveolar epithelial cells via a nitric oxide-dependent pathway", Am J Physiol Lung Cell Mol Physiol, 279, pp.994~1002 (2000)
- Najarian T, "Prolonged hypercapnia-evoked cerebral hyperemia via K(+) channel- and prostaglandin E(2)-dependent endothelial nitric oxide synthase induction", Circ Res, 87, pp.1149~1156 (2000)
- Doerr CH, "Hypercapnic acidosis impairs plasma membrane wound resealing in ventilator-injured lungs", Am J Respir Crit Care Med, 171, pp.1371~1377 (2005)
- Laffey JG, "Hypercapnic acidosis attenuates endotoxininduced acute lung injury", Am J Respir Crit Care Med, 169, pp.46~56 (2004)
- Cardenas VJ Jr, "Correction of blood pH attenuates changes in hemodynamics and organ blood flow during permissive hypercapnia", Crit Care Med, 24, pp.827~834 (1996)
- Xu Y, "Tolerance of low cerebral intracellular pH in rats during hyperbaric hypercapnia", Stroke, 22, pp.1303~1308 (1991)
- Wilson DF, "Effect of hyperventilation on oxygenation of the brain cortex of newborn", Adv Exp Med Biol, 316, pp.341~346 (1992)
- Hansen NB, "Alterations in cerebral blood flow and oxygen consumption during prolonged hypocarbia", Pediatr Res, 20, pp.147~150 (1986)
- Rosenberg AA, "Response of the cerebral circulation to profound hypocarbia in neonatal lambs", Stroke, 19, pp.1365~1370 (1988)
- Graham EM, "Modification of the N-methyl-D-aspartate (NMDA)receptor in the brain of newborn piglets following hyperventilation induced ischemia", Neurosci Lett, 218, pp.29~32 (1996)
- Collins MP, "Hypocapnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants", Pediatr Res, 50, pp.712~719 (2001)
- Tombaugh GC, "Mild acidosis delays hypoxic spreading depression and improves neuronal recovery in hippocampal slices", J Neurosci, 14, pp.5635~5643 (1994)
- Vannucci RC, "Carbon dioxide protects the perinatal brain from hypoxic-ischemic damage: an experimental study in the immature rat", Pediatrics, 95, pp.868~874 (1995)
- Vannucci RC, "Effect of extreme hypercapnia on hypoxic-ischemic brain damage in the immature rat", Pediatr Res, 49, pp.799~803 (2001)
- van Hulst RA, "Intracranial pressure, brain PCO2, PO2, and pH during hypo- and hyperventilation at constant mean airway pressure in pigs", Intensive Care Med, 28, pp.68~73 (2002)
- Fabres J, "Both extremes of arterial carbon dioxide pressure and the magnitude of fluctuations in arterial carbon dioxide pressure are associated with severe intraventricular hemorrhage in preterm infants", Pediatrics, 119, pp.299~305 (2007)
- Wallin LA, "Neonatal intracranial hemorrhage: II. Risk factor analysis in an inborn population", Early Hum Dev, 23, pp.129~137 (1990)
- Thome UH, "Outcome of extremely preterm infants randomized at birth to different PaCO2 targets during the first seven days of life", Biol Neonate, 90, pp.218~225 (2006)
- Subramanian S, "Association of bronchopulmonary dysplasia and hypercarbia in ventilated infants with birth weights of 500-1,499 g", Matern Child Health J, 15(1), pp.S17~S26 (2011)
- Vela-Huerta MM, "Factors associated with early severe intraventricular haemorrhage in very low birth weight infants", Neuropediatrics, 40, pp.224~227 (2009)
- Carlo WA, "Minimal ventilation to prevent bronchopulmonary dysplasia in extremely-low-birth-weight infants", J Pediatr, 141, pp.370~374 (2002)
- Ryu J, "Clinical effectiveness and safety of permissive hypercapnia", Clin Perinatol, 39, pp.603~612 (2012)
- Miller JD, "Safety and effectiveness of permissive hypercapnia in the preterm infant", Curr Opin Pediatr, 19, pp.142~144 (2007)
- Kregenow DA, "Hypercapnic acidosis and mortality in acute lung injury", Crit Care Med, 34, pp.1~7 (2006)
