Decrease In PCO2 Research Articles

Early Miocene expansion of C4 vegetation on the northern Tibetan Plateau

Abstract The proliferation of C4 photosynthesis in land plants marks the most important ecological shift in tropical and subtropical terrestrial ecosystems during the Cenozoic. Despite the wealth of geochemical data indicating an increased C4 biomass in the paleovegetation since the Late Miocene spatial and temporal variations of C4 plants abundance are not well known. The driving force for their expansion such as CO2 starvation, aridification and fire frequency are controversially discussed. Here we present an integrated review of the stable isotope stratigraphy, trace elements, palynology, lithological and phytolith record from early-middle Miocene lacustrine sediments in the Hoh Xil Basin. We report the first known silicified wood fossils from the genus Picea and indicate the Hoh Xil region might have already reached an elevation above 2500 m at least in the early Miocene, representing the early uplift stage of northern Tibetan Plateau. Our results show that the expansion of C4 vegetation and the appearance of Picea in the interior of the Tibet during the early Miocene may be related to early uplift of the northern Tibetan Plateau and the consequent cooling event, PCO2 decrease, and aridification. We suggest that the C4 signal in vertebrate faunas predating the early Miocene is due to the ecology of the herbivores (who preferred plants with C3 metabolism) rather than the lack of C4 plants in the vegetation.

An abrupt decrease in Southern Hemisphere terrestrial temperature during the Eocene–Oligocene transition

Earth's climate transitioned from the greenhouse conditions of the Eocene to the icehouse of the Oligocene ∼34 million years ago. Global cooling was triggered by a decrease in atmospheric pCO2 and is associated with the first appearance of large, permanent ice-sheets on Antarctica. The Eocene–Oligocene transition (EOT) is marked by a large two-step increase in the δ18O of benthic foraminifera, reflecting a combination of cooler global temperatures and continental ice growth. We measured the hydrogen isotope composition of hydrated volcanic glasses deposited in Patagonia during the EOT to reconstruct stable isotope hydrology and associated changes in temperature during this critical climate transition. These data show changes in stable hydrogen isotope ratios that are consistent with Patagonian terrestrial mean annual temperature decreasing by ∼5°C during the EOT before returning to 2°C below pre-EOT values by the Early Oligocene. This is approximately synchronous with Northern Hemisphere cooling during the EOT, and indicates close coupling of temperature and atmospheric pCO2.

Daily pCO2 and CO2 flux variations in a subtropical mesotrophic shallow lake

Carbon dioxide (CO2) emissions from lakes have been proven to be an important component of the continental carbon balance, but most CO2 evasion estimates ignore daily variability of partial pressure of CO2 (pCO2). To discern the variability of pCO2 and its effect on CO2 outgassing estimations, we conducted in-situ biweekly pCO2 measurements during daylight from November 2017 to June 2018 at 7:00, 10:00, 14:00, and 17:00 Central Standard Time of the United States (CST) in a subtropical shallow lake in Louisiana, USA. Daytime pCO2 varied largely from 154 to 1698 μatm with an average of 736 μatm, while daytime CO2 flux ranged from −43 to 284 mmol m2 h−1 averaging at 44 mmol m2 h−1. Significant decreases in pCO2 and CO2 fluxes from mornings to late afternoons were observed throughout the study period. Specifically, in morning hours average pCO2 and CO2 fluxes were 940 μatm and 83 mmol m2 h−1, respectively, while in afternoon hours average pCO2 and CO2 fluxes were only 410 μatm and 6 mmol m2 h−1, respectively. Relationships between pCO2 and ambient factors reveal that solar radiation, lake trophic status and water temperature play a major role in pCO2 and CO2 dynamics in lake water. We argue that uncertainties may exist in the current regional and global CO2 evasion estimates due to this high daily pCO2 variability.

Response of Atmospheric pCO2 to Glacial Changes in the Southern Ocean Amplified by Carbonate Compensation

AbstractAtmospheric carbon dioxide concentration (pCO2) varies by about 100ppm during glacial‐interglacial cycles. Previous studies suggest that the strongly stratified Southern Ocean at the Last Glacial Maximum increases the oceanic storage of carbon, but the glacial reduction of atmospheric pCO2 simulated by ocean general circulation models (OGCMs) does not reach 100ppm. One candidate for the underestimation is that carbonate compensation is not explicitly incorporated in the previous OGCM simulations. Therefore, we quantitatively evaluate the impact of carbonate compensation on the glacial atmospheric pCO2 by using an OGCM coupled with an ocean sediment model. As suggested by previous box model studies, our OGCM simulations show that the enhanced Southern Ocean stratification amplifies the decrease in atmospheric pCO2 due to carbonate compensation. Considering the enhanced stratification in the Southern Ocean, we obtain a 26‐ppm drawdown of atmospheric pCO2 by carbonate compensation, and the full reduction from our pre‐industrial simulation reaches 73ppm. Both the increase in ventilation ages in the deep Atlantic and Southern Oceans and the growth of export production in the subantarctic region reduce the bottom‐water carbonate ion and promote deposited carbonate dissolution. Consequently, a greater imbalance between the river inflow and burial loss of carbonate rises ocean alkalinity, lowering atmospheric pCO2. We suggest that the reproducibility of the Southern Ocean process is essential for controlling the magnitude of atmospheric pCO2 decline due to carbonate compensation.

Longitudinal discontinuities in riverine greenhouse gas dynamics generated by dams and urban wastewater

Abstract. Surface water concentrations of CO2, CH4, and N2O have rarely been measured simultaneously in river systems modified by human activities, contributing to large uncertainties in estimating global riverine emissions of greenhouse gases (GHGs). Basin-wide surveys of the three GHGs were combined with a small number of measurements of C isotope ratios in dissolved organic matter (DOM), CO2, and CH4 in the Han River basin, South Korea, to examine how longitudinal patterns of the three gases and DOM are affected by four cascade dams along a middle section of the North Han River (hereafter termed “middle reach”) and treated wastewater discharged to the lower Han River (“lower reach”) traversing the Seoul metropolitan area. Monthly monitoring and two-season comparison were conducted at 6 and 15 sites, respectively, to measure surface water gas concentrations and ancillary water quality parameters including concentrations of dissolved organic carbon (DOC) and optical properties of DOM. The basin-wide surveys were complemented with a sampling cruise along the lower reach and synoptic samplings along an urban tributary delivering effluents from a large wastewater treatment plant (WWTP) to the lower reach. The levels of pCO2 were relatively low in the middle reach (51–2465 µatm), particularly at the four dam sites (51–761 µatm), compared with those found in the largely forested upper basin with scattered patches of croplands (163–2539 µatm), the lower reach (78–11298 µatm), and three urban tributaries (2120–11970 µatm). The upper and middle reaches displayed generally low concentration ranges of CH4 and N2O, with some local peaks influenced by agricultural runoff and impoundments. By comparison, the lower reach exhibited exceptionally high concentrations of CH4 (1.2–15766 nmol L−1) and N2O (7.5–1396 nmol L−1), which were significantly correlated with different sets of variables such as DO and PO43- for CH4 and NH4+ and NO3- for N2O. Downriver increases in the levels of DOC and optical properties such as fluorescence index (FI) and protein-like fluorescence indicated an increasing DOM fraction of anthropogenic and microbial origin. The concentrations of the three GHGs and DOC were similar in magnitude and temporal variation at a WWTP discharge and the receiving tributary, indicating a disproportionate contribution of the WWTP effluents to the tributary gas and DOC exports to the lower reach. The values of δ13C in surface water CO2 and CH4 measured during the sampling cruise along the lower reach, combined with δ13C and Δ14C in DOM sampled across the basin, implied a strong influence of the wastewater-derived gases and aged DOM delivered by the urban tributaries. The downstream enrichment of 13C in CO2 and CH4 suggested that the spatial distribution of these gases across the eutrophic lower reach may also be constrained by multiple concomitant processes including outgassing, photosynthesis, and CH4 oxidation. The overall results suggest that dams and urban wastewater may create longitudinal discontinuities in riverine metabolic processes leading to large spatial variations in the three GHGs correlating with different combinations of DOM properties and nutrients. Further research is required to evaluate the relative contributions of anthropogenic and in-stream sources of the three gases and DOM in eutrophic urbanized river systems and constrain key factors for the contrasting impoundment effects such as autotrophy-driven decreases in pCO2 and in-lake production of CH4 and N2O.

Dominant Biological Control Over Upwelling on pCO2 in Sea East of Sri Lanka

AbstractUpwelling enhances pCO2 levels due to injection of carbon‐rich water to the surface despite the removal of carbon due to increase in primary production supported by enhanced nutrients. It is hypothesized that in the Bay of Bengal, upwelling may decrease pCO2 due to existence of low saline and pCO2‐poor waters in the subsurface layer. In order to test this hypothesis, a high‐resolution state‐of‐the‐art ocean biogeochemical model (Regional Ocean Modeling System) runs are examined at the sea east of Sri Lanka (SESL) where intense upwelling occurs during summer monsoon (May to August). Upwelling enhances pCO2 by 34 μatm, whereas decrease in surface temperature and increase in surface salinity reduce pCO2 by 24 μatm. The estimated net effect of upwelling is an increase in pCO2 by 10 μatm. In contrast, soft and hard tissues together contribute to a decrease in pCO2 by 21 μatm suggesting that the biological effect dominates over upwelling, resulting in a net decrease of pCO2 by 11 μatm in the SESL. This striking contrast between the increase in pCO2 due to physical dynamics (upwelling) and the removal of pCO2 due to biological processes is caused by shallow (deep) nitracline (dissolved inorganic carbon‐isoline) in the SESL.

Effects of Biological Production and Vertical Mixing on Sea Surface pCO2 Variations in the Changjiang River Plume During Early Autumn: A Buoy‐Based Time Series Study

AbstractA monthlong, high‐resolution buoy time series from the surface ocean of the Changjiang River plume in early autumn 2013 (30‐min sampling frequency) shows great variability in the partial pressure of carbon dioxide (pCO2) and other physical and biogeochemical parameters. Early in the deployment, surface pCO2 decreased by ~117 μatm in a single day (11–12 September, from an initial value of ~527 μatm); a similar decline of 62 μatm occurred five days later (to ~378 μatm). Both drawdown events were associated with strong vertical stratification, high chlorophyll a concentrations, and oxygen supersaturation. A one‐dimensional mass balance model suggests that biological production was responsible for more than half the pCO2 decrease observed during 10–23 September. Subsequently, in association with strong winds, the mixed layer rapidly deepened and surface pCO2 increased sharply (by about 108 μatm in late September and again in early October). Vertical mixing accounted for more than half of this pCO2 increase, which offset more than the earlier biologically driven CO2 drawdown. In the presence of such strong temporal variations of pCO2, sampling frequency exerts a substantial influence on air‐sea CO2 flux calculations for the Changjiang River plume and similar coastal areas. Compared to daily sampling, even weekly sampling would result in a bias of up to ±4.7 mmol C · m−2 · day−1 or ±63% error.

Short-term variability of carbon chemistry in two contrasting seagrass meadows at Dongsha Island: Implications for pH buffering and CO2 sequestration

The diurnal cycles of carbon chemistry parameters, i.e., dissolved inorganic carbon (DIC), total alkalinity (TA), partial pressure of CO2 (pCO2), and pH, were investigated in two hydrodynamically contrasting seagrass meadows at Dongsha Island in the northern South China Sea in August 2015. The results show that the pH and TA were higher and that the pCO2 was lower in the semi-enclosed inner lagoon (IL) than on the open north shore (NS). The analyses of carbon chemistry parameters vs. dissolved oxygen and TA vs. DIC relationships reveal that the CO2 dynamics was dominated by photosynthesis/respiration (P/R) alone on the NS but by the combined effect of P/R and sedimentary anaerobic pathways in the IL. We suggest that the observed divergent behaviors in carbon chemistry between the two sites could be attributed to differences in hydrodynamic regimes. The less energetic hydrodynamics and longer residence time in the IL would be favorable for the occurrence of sedimentary anaerobic TA generation and the subsequent TA accumulation in the overlying waters. The elevated TA may lead to a pH increase and a pCO2 decrease, thus providing a buffering effect against ocean acidification (OA) and enhancing atmospheric CO2 sequestration at local scales. The present results demonstrate that hydrodynamic regime may play an important role in regulating biogeochemical processes in seagrass meadows, and thereby modulating their capacities in OA buffering and CO2 uptaking.

Early Wuchiapingian cooling linked to Emeishan basaltic weathering?

The last glaciation during the late Paleozoic ice age commenced at around the Guadalupian–Lopingian (G–L) boundary and is synchronous with the emplacement of the Emeishan large igneous province. Using CA-TIMS zircon U–Pb dating, we obtained an age of 259.51 ± 0.21 Ma for the uppermost tuff from the Puan volcanic sequence in the eastern Emeishan large igneous province, constraining the timing of Emeishan volcanism and providing another candidate age for the G–L boundary. In addition, we determined an age of 259.69 ± 0.72 Ma for a basal claystone in the immediately overlying Longtan Formation from a drill core section in southwest South China. These ages, along with source weathering trends of mudstones from the lower Longtan Formation, and compiled paleotemperature records, indicate an earliest Wuchiapingian cooling coinciding with the onset of the last Permian glaciation. This global cooling is associated with positive shifts in both organic and carbonate carbon isotopic records and likely a decrease in atmospheric pCO2. A hypothesised causal linkage is proposed in which the rapid post-eruptive basaltic weathering of the Emeishan province in an equatorial humid belt may accelerate the atmospheric CO2 consumption and lead to climate cooling. Our work supports the long-term climate cooling effects of large igneous provinces.

Angiosperm leaves and cuticles from the uppermost Cretaceous of Patagonia, biogeographic implications and atmospheric paleo-CO2 estimates

The study of plant material from localities of Late Cretaceous age from southern latitudes is fundamental to improve our understanding of global patterns of angiosperm evolution, diversity, paleoecology, and biogeography. Herein, angiosperm leaf fossils of the recently discovered Cañadón del Loro locality, from the Maastrichtian portion of the Lefipán Formation, Patagonia, Argentina are studied. Leaf architecture was used to differentiate morphotypes, to describe them, and to make comparisons with other southern latitudes floras of similar age. Six angiosperm leaf morphotypes were described from 132 collected specimens; one of them, with exceptional preservation, was named Lefipania padillae gen. et sp. nov. and its cuticle anatomy and insect damage were also described. The Cañadón del Loro fossils represent a local assemblage of low diversity deposited in an upper delta plain. Biogeographically, L. padillae was widespread throughout the southern hemisphere during the Late Cretaceous, possibly favored by a warm climate and the geographical proximity of these southern landmasses. The morphotype with well-preserved cuticles clearly shows four insect damage types attributed to feeding. This morphotype was also used for estimating paleo-atmospheric CO2 concentration (pCO2), using a stomatal-proxy gas exchange model, which resulted in approximately 464 ppm. The estimated pCO2 is in agreement with previous estimations for this time interval and supports the hypothesis of a decrease of pCO2 towards end of the Cretaceous.

Carbon dioxide degassing at the groundwater-stream-atmosphere interface: isotopic equilibration and hydrological mass balance in a sandy watershed

Streams and rivers emit significant amounts of CO2 and constitute a preferential pathway of carbon transport from terrestrial ecosystems to the atmosphere. However, the estimation of CO2 degassing based on the water-air CO2 gradient, gas transfer velocity and stream surface area is subject to large uncertainties. Furthermore, the stable isotope signature of dissolved inorganic carbon (δ13C-DIC) in streams is strongly impacted by gas exchange, which makes it a useful tracer of CO2 degassing under specific conditions. For this study, we characterized the annual transfers of dissolved inorganic carbon (DIC) along the groundwater-stream-river continuum based on DIC concentrations, stable isotope composition and measurements of stream discharges. We selected a homogeneous, forested and sandy lowland watershed as a study site, where the hydrology occurs almost exclusively through drainage of shallow groundwater (no surface runoff). We observed the first general spatial pattern of decreases in pCO2 and DIC and an increase in δ13C-DIC from groundwater to stream orders 1 and 2, which was due to the experimentally verified faster degassing of groundwater 12C-DIC compared to 13C-DIC. This downstream enrichment in 13C-DIC could be modelled by simply considering the isotopic equilibration of groundwater-derived DIC with the atmosphere during CO2 degassing. A second spatial pattern occurred between stream orders 2 and 4, consisting of an increase in the proportion of carbonate alkalinity to the DIC accompanied by the enrichment of 13C in the stream DIC, which was due to the occurrence of carbonate rock weathering downstream. We could separate the contribution of these two processes (gas exchange and carbonate weathering) in the stable isotope budget of the river network. Thereafter, we built a hydrological mass balance based on drainages and the relative contribution of groundwater in streams of increasing order. After combining with the dissolved CO2 concentrations, we quantified CO2 degassing for each stream order for the whole watershed. Approximately 75% of the total CO2 degassing from the watershed occurred in first- and second-order streams. Furthermore, from stream order 2–4, our CO2 degassing fluxes compared well with those based on stream hydraulic geometry, water pCO2, gas transfer velocity, and stream surface area. In first-order streams, however, our approach showed CO2 fluxes that were twice as large, suggesting that a fraction of degassing occurred as hotspots in the vicinity of groundwater resurgence and was missed by conventional stream sampling.

Approach to Acid-Base Disorders

This review on the approach to acid-base disorders uses the physiologic approach to assessing acid-base status, namely that based on the H2CO3/[HCO3–] buffer pair. A simple acid-base disorder is characterized by a primary abnormality in either carbon dioxide tension (Pco2) or serum [HCO3–] accompanied by the appropriate secondary response in the other component. The four cardinal, simple acid-base disorders are categorized into respiratory disorders and metabolic disorders. Respiratory disorders are expressed as primary changes in Pco2 and include respiratory acidosis or primary hypercapnia (primary increase in Pco2) and respiratory alkalosis or primary hypocapnia (primary decrease in Pco2). Metabolic disorders are expressed as primary changes in serum [HCO3–]) and include metabolic acidosis (primary decrease in serum [HCO3–]) and metabolic alkalosis (primary increase in serum [HCO3–]). A mixed acid-base disorder denotes the simultaneous occurrence of two or more simple acid-base disorders. Arriving at an accurate acid-base diagnosis rests with assessment of the accuracy of the acid-base variables, calculation of the serum anion gap, and identification of the dominant acid-base disorder and whether a simple or mixed disorder is present. Identifying the cause of the acid-base disorder depends on a detailed history and physical examination as well as obtaining additional testing, as appropriate. Key words: acid-base disorders; simple disorders; mixed disorders; anion gap; physiologic approach; physicochemical approach; base-excess approach

Approach to Acid-Base Disorders

This review on the approach to acid-base disorders uses the physiologic approach to assessing acid-base status, namely that based on the H2CO3/[HCO3–] buffer pair. A simple acid-base disorder is characterized by a primary abnormality in either carbon dioxide tension (Pco2) or serum [HCO3–] accompanied by the appropriate secondary response in the other component. The four cardinal, simple acid-base disorders are categorized into respiratory disorders and metabolic disorders. Respiratory disorders are expressed as primary changes in Pco2 and include respiratory acidosis or primary hypercapnia (primary increase in Pco2) and respiratory alkalosis or primary hypocapnia (primary decrease in Pco2). Metabolic disorders are expressed as primary changes in serum [HCO3–]) and include metabolic acidosis (primary decrease in serum [HCO3–]) and metabolic alkalosis (primary increase in serum [HCO3–]). A mixed acid-base disorder denotes the simultaneous occurrence of two or more simple acid-base disorders. Arriving at an accurate acid-base diagnosis rests with assessment of the accuracy of the acid-base variables, calculation of the serum anion gap, and identification of the dominant acid-base disorder and whether a simple or mixed disorder is present. Identifying the cause of the acid-base disorder depends on a detailed history and physical examination as well as obtaining additional testing, as appropriate. Key words: acid-base disorders; simple disorders; mixed disorders; anion gap; physiologic approach; physicochemical approach; base-excess approach

Respiratory Acidosis and Alkalosis

Respiratory acid-base disorders are those disturbances in acid-base equilibrium that are expressed by a primary change in CO2 tension (Pco2) and reflect primary changes in the body’s CO2 stores (i.e., carbonic acid). A primary increase in Pco2 (and a primary increase in the body’s CO2 stores) defines respiratory acidosis or primary hypercapnia and is characterized by acidification of the body fluids. By contrast, a primary decrease in Pco2 (and a primary decrease in the body’s CO2 stores) defines respiratory alkalosis or primary hypocapnia and is characterized by alkalinization of the body fluids. Primary changes in Pco2 elicit secondary physiologic changes in plasma [HCO3ˉ] that are directional and proportional to the primary changes and tend to minimize the impact on acidity. This review presents the pathophysiology, secondary physiologic response, causes, clinical manifestations, diagnosis, and therapeutic principles of respiratory acidosis and respiratory alkalosis. This review contains 4 figures, 3 tables, and 59 references. Key words: Respiratory acidosis, respiratory alkalosis, primary hypercapnia, primary hypocapnia, hypoxemia, pseudorespiratory alkalosis

Respiratory Acidosis and Alkalosis

Respiratory acid-base disorders are those disturbances in acid-base equilibrium that are expressed by a primary change in CO2 tension (Pco2) and reflect primary changes in the body’s CO2 stores (i.e., carbonic acid). A primary increase in Pco2 (and a primary increase in the body’s CO2 stores) defines respiratory acidosis or primary hypercapnia and is characterized by acidification of the body fluids. By contrast, a primary decrease in Pco2 (and a primary decrease in the body’s CO2 stores) defines respiratory alkalosis or primary hypocapnia and is characterized by alkalinization of the body fluids. Primary changes in Pco2 elicit secondary physiologic changes in plasma [HCO3ˉ] that are directional and proportional to the primary changes and tend to minimize the impact on acidity. This review presents the pathophysiology, secondary physiologic response, causes, clinical manifestations, diagnosis, and therapeutic principles of respiratory acidosis and respiratory alkalosis. This review contains 4 figures, 3 tables, and 59 references. Key words: Respiratory acidosis, respiratory alkalosis, primary hypercapnia, primary hypocapnia, hypoxemia, pseudorespiratory alkalosis

Mathematical modeling of extracorporeal CO2 removal therapy : A validation carried out on ten pigs.

The extracorporeal CO2 removal device (ECCO2RD) is used in clinics to treat patients suffering from respiratory failures like acute respiratory distress syndrome (ARDS) or chronic obstructive pulmonary disease (COPD). The aim of this device is to decarboxylate blood externally with low blood flow. A mathematical model is proposed to describe protective ventilation, ARDS, and an extracorporeal CO2 removal therapy (ECCO2RT). The simulations are compared with experimental data carried out on ten pigs. The results show a good agreement between the mathematical simulations and the experimental data, which provides a nice validation of the model. This model is thus able to predict the decrease of PCO2 during ECCO2RT for different blood flows across the extracorporeal lung support.

P146 The patients with acute exacerbation of COPD maybe benefit from autotitrating EPAP during noninvasive ventilation: a prospective study

Introduction To determine whether the patients with acute exacerbation of COPD benefit from noninvasive ventilation, which EPAP is required for a varying range rather than a fixed level. Methods A randomized,prospective and controlled study, 30 elderly patients in AECOPD were divided into three groups: S/T(spontaneous/time) mode group, AVAPS(average volume assured pressure support) mode group and AVAPS-AE(average volume assured pressure support auto-EPAP) mode group. Each group was accepted noninvasive ventilation therapy (NIV via total face mask), for a period of 48 hours. Parameters in three NIV modes: S/T group(IPAP=18 cmH2O, EPAP =5cmH2O,tidal volume depending on individual BMI); the same adopted in AVAPS mode; AVAPS-AE mode(maximum EPAP=8cmH2O,minimum EPAP=4cmH2O, tidal volume depending on individual BMI) .The arterial blood gas analysis was observed at different time(the 0.5th, 1 st, 2 nd, 24 th and 48 th hour).During the NIV, RR, HR and Borg score were monitored and recorded continuosly. Degree of patients' comfort was measured by the VAS (Visual Analog Scale,0～10). Results 1. The 0.5th, 1st, and 2nd hours after NIV treatment, there was a greater decrease in PCO2 and increase in PO2 and PH during AVAPS-AE mode than two other modes(p< 0.05). RR, HR and Borg score in AVAPS-AE mode had a greater changes than others(p< 0.05). Compared with the S/T and AVAPS group, the recovery duration of shortness in AVAPS-AE group was significantly shorter than two others (p< 0.05). 2. During the whole NIV period, the main result was a higher VAS score in AVAPS-AE mode than others (p< 0.05). 3 cases with patient-ventilator asynchrony occurred in S/T group, 3 cases and 1 case happened in AVAPS group and AVAPS-AE group respectively. Conclusions Autotitrating EPAP during noninvasive ventilation support could be adjust to changing levels of PEEP in AECOPD patients. AVAPS-AE mode maybe more likely to relieve shortness quickly,especially in synchronization and comfort,worthy of promotion, and it may play an important role in improving dynamic hyperinflation of patients with AECOPD.

Approach to Acid-Base Disorders

This review on the approach to acid-base disorders uses the physiologic approach to assessing acid-base status, namely that based on the H2CO3/[HCO3–] buffer pair. A simple acid-base disorder is characterized by a primary abnormality in either carbon dioxide tension (Pco2) or serum [HCO3–] accompanied by the appropriate secondary response in the other component. The four cardinal, simple acid-base disorders are categorized into respiratory disorders and metabolic disorders. Respiratory disorders are expressed as primary changes in Pco2 and include respiratory acidosis or primary hypercapnia (primary increase in Pco2) and respiratory alkalosis or primary hypocapnia (primary decrease in Pco2). Metabolic disorders are expressed as primary changes in serum [HCO3–]) and include metabolic acidosis (primary decrease in serum [HCO3–]) and metabolic alkalosis (primary increase in serum [HCO3–]). A mixed acid-base disorder denotes the simultaneous occurrence of two or more simple acid-base disorders. Arriving at an accurate acid-base diagnosis rests with assessment of the accuracy of the acid-base variables, calculation of the serum anion gap, and identification of the dominant acid-base disorder and whether a simple or mixed disorder is present. Identifying the cause of the acid-base disorder depends on a detailed history and physical examination as well as obtaining additional testing, as appropriate. Key words: acid-base disorders; simple disorders; mixed disorders; anion gap; physiologic approach; physicochemical approach; base-excess approach

Hypocapnic hypothesis of Leigh disease

Leigh syndrome (LS) is a neurogenetic disorder of children caused by mutations in at least 75 genes which impair mitochondrial bioenergetics. The changes have typical localization in basal ganglia and brainstem, and typical histological picture of spongiform appearance, vascular proliferation and gliosis. ATP deprivation, free radicals and lactate accumulation are suspected to be the causes.Hypocapnic hypothesis proposed in the paper questions the energy deprivation as the mechanism of LS. We assume that the primary harmful factor is hypocapnia (decrease in pCO2) and respiratory alkalosis (increase in pH) due to hyperventilation, permanent or in response to stress. Inside mitochondria, the pH signal of high pH/low bicarbonate ion (HCO−3) is transmitted by soluble adenyl cyclase (sAC) through cAMP dependent manner. The process can initiate brain lesions (necrosis, apoptosis, hypervascularity) in OXPHOS deficient cells residing at the LS area of the brain. The major message of the article is that it is not the ATP depletion but intracellular alkalization (and/or hyperoxia?) which seem to be the cause of LS.The paper includes suggestions concerning the methodology for further research on the LS mechanism and for therapeutic strategy.

Noninvasive Neurally Adjusted Ventilatory Assist in Premature Infants Postextubation.

Background Neurally adjusted ventilatory assist (NAVA) has distinct advantages when used invasively compared with conventional ventilation techniques. Evidence supporting the use of noninvasive NAVA is less robust, especially in the very low birth weight (VLBW) population. Objective To determine whether synchronized noninvasive ventilation via neurally adjusted ventilatory assist (NIV NAVA) supports ventilation postextubation in premature infants. Methods A retrospective analysis of a cohort of twenty-four former VLBW (<1.5 kg) infants from July 2011 to October 2012. Decreased or unchanged capillary pCO2 after increasing NAVA support was used as a marker for adequately supported noninvasive ventilation. The Wilcoxon signed-rank test was used to compare pre- and post-NAVA intervention (α = 0.05). Results Ventilation improved after an increase in NIV NAVA level in 83% of the premature infants studied (20/24) with a decrease in median pCO2 by 5 mm Hg (p = 0.0001). Conclusion NIV NAVA can provide synchronized postextubation ventilatory support as measured by decreased pCO2 in premature infants.