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Effects of Therapeutic Hypercapnia on Mesenteric Ischemia–Reperfusion Injury

The Lung Biology Programme and the Departments of Critical Care Medicine, Paediatrics and Physiology, The Research Institute, The Hospital for Sick Children; and The University of Toronto, Canada

Correspondence and requests for reprints should be addressed to Brian P. Kavanagh, M.D., Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8 Canada. E-mail: brian.kavanagh{at}sickkids.ca

Hypercapnic acidosis protects against direct lung injury in in vivo and ex vivo models, however, lung injury/acute respiratory distress syndrome commonly occurs after a nonpulmonary etiology. We investigated whether therapeutic hypercapnia (TH)—deliberate elevation of carbon dioxide (CO₂) tension—would protect against lung injury after splanchnic ischemia–reperfusion injury in an in vivo model. TH was associated with preservation of lung mechanics, attenuation of protein leakage, and improved oxygenation compared with control conditions. Lung protection was therapeutic as well as prophylactic. Protection was dose-dependent, but inspired CO₂ concentrations above 5.0% were associated with little additional lung protection. Before lung injury, increasing FI_CO2 resulted in a dose-dependent increase in Pa_O2. Lung protection with hypercapnia occurred despite pulmonary artery pressures that were greater than observed with normocapnia. Reperfusion increased lipid peroxidation (tissue 8-isoprostane concentration) in the bowel, liver, and lung, and caused histologically apparent bowel injury; however, none of these effects was altered by TH. Therefore, TH—induced by adding CO₂ to inspired gas—provides consistent protection against lung injury in terms of lung permeability, oxygenation, and lung mechanics after mesenteric ischemia–reperfusion. These data further support the emerging evidence for ongoing physiologic study of TH at the bedside.

Key Words: carbon dioxide • ischemia • reperfusion • acute lung injury

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