The Effect of High-Flow Nasal Oxygen on Carbon Dioxide Accumulation in Apneic or Spontaneously Breathing Adults During Airway Surgery

High-flow nasal cannula (HFNC) is a new effective device, which is able to deliver oxygen-therapy at a reliable FiO2 but also a certain amount of respiratory assistance; however HFNC could not be defined as a mechanical ventilator. The main physiologic advantage as compared to conventional oxygen therapy (COT) is the capability of HFNC to meet the increased ventilator demand in patients with respiratory distress and therefore reduce the amount of respiratory muscle’s workload. The main clinical advantage over both COT and noninvasive ventilation (NIV) is the greater comfort and acceptability reported by patients. So far there are several indications for HFNC use both in and outside ICU especially for milder hypoxemic spontaneously breathing patients and prevention of extubation failure in intubated patients, as well as palliative care in end stage neoplastic and nonneoplastic respiratory diseases. A large proportion of potential HFNC candidates belongs to advanced age people. Caution should be taken in the selection of the patients, monitoring, escalating treatment and setting of aplication.

Download Full-text

Carbon Dioxide Accumulation and Oxygen Depletion as Limiting Factors In Convulsive Activity

Acta Physiologica Scandinavica ◽

10.1111/j.1748-1716.1952.tb00855.x ◽

1952 ◽

Vol 25 (1) ◽

pp. 15-23 ◽

Cited By ~ 2

Author(s):

GUN BELFRAGE

Keyword(s):

Carbon Dioxide ◽

Oxygen Depletion ◽

Limiting Factors ◽

Convulsive Activity ◽

Carbon Dioxide Accumulation

Download Full-text

Severe portal and systemic acidosis during CO2-laparoscopy compared to helium or gasless laparoscopy and laparotomy in a rodent model: an experimental study

Surgical Endoscopy ◽

10.1007/s00464-021-08810-6 ◽

2021 ◽

Author(s):

Devdas T. Inderbitzin ◽

Tobias U. Mueller ◽

Grischa Marti ◽

Simone Eichenberger ◽

Benoît Fellay ◽

...

Keyword(s):

Carbon Dioxide ◽

Experimental Study ◽

Vena Cava ◽

Blood Gas ◽

Central Venous ◽

Gasless Laparoscopy ◽

Insufflation Pressure ◽

Arterial Ph ◽

Peripheral Arterial ◽

Spontaneously Breathing

Abstract Background and aims This experimental study assesses the influence of different gases and insufflation pressures on the portal, central-venous and peripheral-arterial pH during experimental laparoscopy. Methods Firstly, 36 male WAG/Rij rats were randomized into six groups (n = 6) spontaneously breathing during anaesthesia: laparoscopy using carbon dioxide or helium at 6 and 12 mmHg, gasless laparoscopy and laparotomy. 45 and 90 min after setup, blood was sampled from the portal vein, vena cava and the common femoral artery with immediate blood gas analysis. Secondly, 12 animals were mechanically ventilated at physiological arterial pH during 90 min of laparotomy (n = 6) or carbon dioxide laparoscopy at 12 mmHg (n = 6) with respective blood gas analyses. Results Over time, in spontaneously breathing rats, carbon dioxide laparoscopy caused significant insufflation pressure-dependent portal acidosis (pH at 6 mmHg, 6.99 [6.95–7.04] at 45 min and 6.95 [6.94–6.96] at 90 min, pH at 12 mmHg, 6.89 [6.82–6.90] at 45 min and 6.84 [6.81–6.87] at 90 min; p < 0.05) compared to laparotomy (portal pH 7.29 [7.23–7.30] at 45 min and 7.29 [7.20–7.30] at 90 min; p > 0.05). Central-venous and peripheral-arterial acidosis was significant but less severely reduced during carbon dioxide laparoscopy. Laparotomy, helium laparoscopy and gasless laparoscopy showed no comparable acidosis in all vessels. Portal and central-venous acidosis during carbon dioxide laparoscopy at 12 mmHg was not reversible by mechanical hyperventilation maintaining a physiological arterial pH (pH portal 6.85 [6.84–6.90] (p = 0.004), central-venous 6.93 [6.90–6.99] (p = 0.004), peripheral-arterial 7.29 [7.29–7.31] (p = 0.220) at 90 min; Wilcoxon–Mann–Whitney test). Conclusion Carbon dioxide laparoscopy led to insufflation pressure-dependent severe portal and less severe central-venous acidosis not reversible by mechanical hyperventilation.

Download Full-text