Nardelli Liliane, Rocco Patricia Rieken Macedo, Garcia Cristiane Sousa Nascimento Baez
Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
Rev Bras Ter Intensiva. 2009 Dec;21(4):404-15.
Acute respiratory distress syndrome is characterized by a diffuse inflammatory reaction of lung parenchyma induced by a direct insult to the alveolar epithelium (pulmonary acute respiratory distress syndrome) or an indirect lesion through the vascular endothelium (extrapulmonary acute respiratory distress syndrome). The main therapeutic strategy for acute respiratory distress syndrome is the ventilatory support. However, mechanical ventilation can worsen lung injury. In this context, a protective ventilatory strategy with low tidal volume has been proposed. The use of low tidal volume reduced the mortality rate of acute respiratory distress syndrome patients, but result in hypercapnic acidosis. The current article presents a review of literature on the effects of permissive hypercapnia in acute respiratory distress syndrome. To that end, we carried out a systematic review of scientific literature based on established criteria for documental analysis including clinical and experimental articles, using as data bases MedLine, LILACS, SciELO, PubMed, Cochrane. Hypercapnic acidosis has been considered by some authors as a modulator of the inflammatory process of acute respiratory distress syndrome. However, clinical and experimental studies on the effects of hypercapnic acidosis have shown controversial results. Therefore it is important to better elucidate the role of hypercapnic acidosis in acute respiratory distress syndrome.
急性呼吸窘迫综合征的特征是由肺泡上皮直接损伤（肺源性急性呼吸窘迫综合征）或通过血管内皮的间接损伤（肺外源性急性呼吸窘迫综合征）引起的肺实质弥漫性炎症反应。急性呼吸窘迫综合征的主要治疗策略是通气支持。然而，机械通气会加重肺损伤。在此背景下，提出了低潮气量的保护性通气策略。使用低潮气量降低了急性呼吸窘迫综合征患者的死亡率，但导致了高碳酸血症性酸中毒。本文对有关允许性高碳酸血症在急性呼吸窘迫综合征中作用的文献进行了综述。为此，我们根据既定的文献分析标准，对包括临床和实验文章在内的科学文献进行了系统综述，使用的数据库有MedLine、LILACS、SciELO、PubMed、Cochrane。一些作者认为高碳酸血症性酸中毒是急性呼吸窘迫综合征炎症过程的调节因子。然而，关于高碳酸血症性酸中毒作用的临床和实验研究结果存在争议。因此，更好地阐明高碳酸血症性酸中毒在急性呼吸窘迫综合征中的作用很重要。
