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Hypercapnia: clinical relevance and mechanisms of action

Masterson, Clairea; Otulakowski, Gailb; Kavanagh, Brian P.b,c

Current Opinion in Critical Care: February 2015 - Volume 21 - Issue 1 - p 7–12
doi: 10.1097/MCC.0000000000000164
RESPIRATORY SYSTEM: Edited by Niall D. Ferguson
Editor's Choice

Purpose of review Multiple clinical and laboratory studies have been conducted to illustrate the effects of hypercapnia in a range of injuries, and to understand the mechanisms underlying these effects. The aim of this review is to highlight and interpret information obtained from these recent reports and discuss how they may inform the clinical context.

Recent findings In the last decade, several important articles have addressed key elements of how carbon dioxide interacts in critical illness states. Among them the most important insights relate to how hypercapnia affects critical illness and include the effects and mechanisms of carbon dioxide in pulmonary hypertension, infection, inflammation, diaphragm dysfunction, and cerebral ischemia. In addition, we discuss molecular insights that apply to multiple aspects of critical illness.

Summary Experiments involving hypercapnia have covered a wide range of illness models with varying degrees of success. It is becoming evident that deliberate hypercapnia in the clinical setting should seldom be used, except wherever necessitated to avoid ventilator-associated lung injury. A more complete understanding of the molecular mechanisms must be established.

aDepartment of Anesthesia, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, University of Toronto

bProgram in Physiology and Experimental Medicine

cDepartments of Critical Care Medicine and Anesthesia, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Correspondence to Dr Brian P. Kavanagh, Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail:

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