Efekat primene kiseonika na visinu kapnije kod bolesnika sa pogoršanjem hronične respiratorne insuficijencije.

Background/Aim. Oxygen therapy is a necessary therapeutic method in treatment of severe chronic respiratory failure (CRF), especially in phases of acute worsening. Risks which are to be taken into consideration during this therapy are: unpredictable increase of carbon dioxide in blood, carbonarcosis, respiratory acidosis and coma. The aim of this study was to show the influence of oxygen therapy on changes of arterial blood carbon dioxide partial pressure. Methods. The study included 93 patients in 104 admittances to the hospital due to acute exacerbation of CFR. The majority of the patients (89.4%) had chronic obstructive pulmonary disease (COPD), while other causes of respiratory failure were less common. The effect of oxygenation was controlled through measurement of PaO2 and PaCO2 in arterial blood samples. To analyse the influence of oxygen therapy on levels of carbon dioxide, greatest values of change of PaO2 and PaCO2 values from these measurements, including corresponding PaO2 values from the same blood analysis were taken. Results. The obtained results show that oxygen therapy led to the increase of PaO2 but also to the increase of PaCO2. The average increase of PaO2 for the whole group of patients was 2.42 kPa, and the average increase of PaCO2 was 1.69 kPa. There was no correlation between the initial values of PaO2 and PaCO2 and changes of PaCO2 during the oxygen therapy. Also, no correlation between the produced increase in PaO2 and change in PaCO2 during this therapy was found. Conclusion. Controlled oxygen therapy in patients with severe respiratory failure greately reduces the risk of unwanted increase of PaCO2, but does not exclude it completely. The initial values of PaO2 and PaCO2 are not reliable parameters which could predict the response to oxygen therapy. [ABSTRACT FROM AUTHOR]

Uvod/Cilj. Primena kiseonika spada u red neophodnih terapijskih mera koje se preduzimaju u lečenju teške hronične respiratorne insuficijencije (HRI), posebno u fazama njenog akutnog pogoršanja. Opasnost koja se pri ovoj terapiji javlja jeste nepredvidiv porast ugljendioksida u krvi, razvoj karbonarkoze, respiratorne acidoze i kome. Cilj rada bio je da pokaže uticaj primene kiseonika na promenu parcijalnog pritiska ugljendioksida (PaCO2) u arterijskoj krvi. Metode. Ukupno je posmatrano 93 bolesnika kod 104 prijema zbog akutnog pogoršanja HRI. Najveći broj bolesnika (89,4%) imao je hroničnu opstruktivnu bolest pluća (HOBP), dok je učešće drugih tipova oštećenja bilo znatno manje. Efekat oksigenacije kontrolisan je merenjem parcijalnog pritiska kiseonika (PaO2) i PaCO2 u uzorcima arterijske krvi. Za analizu uticaja oksigenoterapije na visinu kapnije uzimane su najveće vrednosti promena PaCO2 iz ovih merenja, uključujući pripadajući PaO2 iz iste analize krvi. Rezultati. Posmatrajući grupu ispitivanih u celini, primena kiseonika dovela je do porasta PaO2, ali, takođe, i do porasta PaCO2. Prosečno povećanje PaO2 za ćelu grupu ispitanika iznosilo je 2,42 kPa, a PaCO2 1,69 kPa. Nije utvrđena povezanost između početnih vrednosti PaO2 i PaCO2 sa promenama PaCO2 u toku primene kiseonika. Takođe, nije pokazana povezanost između proizvedenog porasta PaO2 i promena PaCO2 u toku ove terapije. Zaključak. Kontrolisana primena kiseonika kod bolesnika s teškom respiratornom insuficijencijom u velikoj meri smanjuje rizik od nepoželjnog porasta PaCO2, ali ga ne isključuje sasvim. Početne vrednosti PaCO2 i PaCO2 nisu pouzdani pokazatelji načina reagovanja bolesnika na primenu kiseonika. [ABSTRACT FROM AUTHOR]