Tiruvoipati Ravindranath, Gupta Sachin, Pilcher David, Bailey Michael
Department of Intensive Care medicine, Frankston Hospital, Frankston, Vic, Australia.
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Crit Care Resusc. 2018 Jun;20(2):94-100.
Mortality related to sepsis among critically ill patients remains high. Recent literature suggests that hypercapnia may affect the pathophysiology of sepsis. The effects of hypercapnia on sepsis are largely related to the direct effect of hypercapnic acidosis on immune function and, as a consequence, of increased cardiac output that subsequently leads to improved tissue oxygenation. Appropriate management of hypercapnia may aid in improving the outcomes of sepsis. Our aim was to review the effects of compensated hypercapnia and hypercapnic acidosis on sepsis, with a specific focus on critically ill patients. Hypercapnic acidosis has been extensively studied in various in vivo animal models of sepsis and ex vivo studies. Published data from animal experimental studies suggest that the effects of hypercapnic acidosis are variable, with benefit shown in some settings of sepsis and harm in others. The effects may also vary at different time points during the course of sepsis. There are very few clinical studies investigating the effects of hypercapnia in prevention of sepsis and in established sepsis. It appears from these very limited clinical data that hypercapnia may be associated with adverse outcomes. There are no clinical studies investigating clinical outcomes of hypercapnic acidosis or compensated hypercapnia in sepsis and septic shock in critical care settings, thus extrapolation of the experimental results to guide critical care practice is difficult. Clinical studies are needed, especially in critically ill patients, to define the effects of compensated hypercapnia and hypercapnic acidosis that may aid clinicians to improve the outcomes in sepsis.
重症患者中与脓毒症相关的死亡率仍然很高。最近的文献表明，高碳酸血症可能会影响脓毒症的病理生理学。高碳酸血症对脓毒症的影响很大程度上与高碳酸血症酸中毒对免疫功能的直接作用有关，进而与心输出量增加有关，随后心输出量增加会改善组织氧合。对高碳酸血症进行适当管理可能有助于改善脓毒症的预后。我们的目的是综述代偿性高碳酸血症和高碳酸血症酸中毒对脓毒症的影响，特别关注重症患者。高碳酸血症酸中毒已在各种脓毒症体内动物模型和体外研究中得到广泛研究。动物实验研究发表的数据表明，高碳酸血症酸中毒的影响各不相同，在某些脓毒症情况下显示有益，而在其他情况下则有害。在脓毒症病程的不同时间点，其影响也可能有所不同。很少有临床研究调查高碳酸血症在预防脓毒症和已确诊脓毒症中的作用。从这些非常有限的临床数据来看，高碳酸血症可能与不良结局相关。在重症监护环境中，没有临床研究调查高碳酸血症酸中毒或代偿性高碳酸血症在脓毒症和脓毒性休克中的临床结局，因此将实验结果外推以指导重症监护实践很困难。需要进行临床研究，尤其是针对重症患者，以明确代偿性高碳酸血症和高碳酸血症酸中毒的影响，这可能有助于临床医生改善脓毒症的预后。
