title: Tracheal gas insufflation is a useful adjunct in permissive hypercapnic management of acute respiratory distress syndrome.
abstract: BACKGROUND
  Despite numerous advances in critical care, the mortality of postinjury acute respiratory distress syndrome (ARDS) remains high. Recently, permissive hypercapnia (PHC) has been shown to be a viable alternative to traditional ventilator management in patients with ARDS. However, lowering tidal volume, as employed in PHC, below 5 cc/kg impinges upon anatomic dead space and precipitates a significant rise in PaCO2 The purpose of this study was to determine if continuous tracheal gas insufflation (cTGI) is a useful adjunct to PHC by lowering PaCO2, thus allowing adequate reduction in minute ventilation to achieve alveolar protection.
  
  
  METHODS
  Over a 5-year period, 68 trauma patients with ARDS were placed on permissive hypercapnia. Nine of these patients additionally received cTGI at 7 L/min. Arterial blood gas determinations and ventilatory parameters were examined immediately prior to the implementation of cTGI and after 6h.
  
  
  RESULTS
  The cTGI produced significant improvement in pH (7.25 +/- 0.03 to 7.33 +/- 0.03), PaCO2 (72 +/- 5 to 59 +/- 5 torr), tidal volume (7.9 +/- 0.6 to 7.2 +/- 0.6 cc/kg), and minute ventilation (13 +/- 1 to 11 +/- 1 L/min; P < 0.05).
  
  
  CONCLUSIONS
  Continuous TGI is a useful adjunct to permissive hypercapnia, allowing maintenance of an acceptable pH and PaCO2 while allowing further reduction in tidal volume and minute ventilation.
authors.affiliation: Department of Surgery, Denver General Hospital, Colorado, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Barnett
authors.forename: F A
authors.initials: FA
authors.lastname: Moore
authors.forename: E E
authors.initials: EE
authors.lastname: Moore
authors.forename: D A
authors.initials: DA
authors.lastname: Partrick
authors.forename: J
authors.initials: J
authors.lastname: Goodman
authors.forename: J M
authors.initials: JM
authors.lastname: Burch
authors.forename: J B
authors.initials: JB
authors.lastname: Haenel
mesh_terms: D000293:Adolescent; D000328:Adult; D002245:Carbon Dioxide / Q000097:blood*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007327:Insufflation / Q000379:methods*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014132:Trachea; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D002245:Carbon Dioxide