Abstract
Acidosis is associated with poor outcome in critical illness. However, acidosis - both hypercapnic and metabolic - has direct effects that can limit tissue injury induced by many causes. There is also a clear potential for off-target harm with acute exposure (for example, raised intracranial pressure, pulmonary hypertension), and with exposure for prolonged periods (for example, increased risk of infection) or at high doses. Ongoing comprehensive determination of molecular, cellular and physiologic impact across a range of representative pathologies will allow us to understand better the risks and benefits of hypercapnia and acidosis during critical illness.
Highlights
Acidosis is associated with poor outcome in critical illness
Conventional protective ventilation strategies that minimize lung stretch increase the prevalence of hypercapnic acidosis (HCA) in the critically ill, and have been clearly demonstrated to save lives in patients with acute respiratory distress syndrome
They found that acute HCA or metabolic acidosis (MAC) reduced cardiac contractility, but that cardiac output was maintained as a result of increased heart rate and, in the case of HCA, reduced systemic vascular resistance
Summary
Acidosis is associated with poor outcome in critical illness. acidosis - both hypercapnic and metabolic - has direct effects that can limit tissue injury induced by many causes. Conventional protective ventilation strategies that minimize lung stretch increase the prevalence of hypercapnic acidosis (HCA) in the critically ill, and have been clearly demonstrated to save lives in patients with acute respiratory distress syndrome. They found that acute HCA or MAC reduced cardiac contractility, but that cardiac output was maintained as a result of increased heart rate and, in the case of HCA, reduced systemic vascular resistance.
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