Rebuttal from Gerard F. Curley, John G. Laffey and Brian P. Kavanagh

摘要

Beitler et fl/.'s (2013) review of the benefits and mechanisms of avoiding high tidal volume are right on the mark. In addition, they provide a sound biophysical basis for our concern about increasing respiratory rate to offset hypercapnic acidosis (HCA). However, the parallels drawn from other clinical contexts are problematic. For example, the trial of intravenous salbutamol for acute lung injury - stopped early due to harm - is a poor choice. Key concerns regarding salbutamol in that study are rare with moderate hyper-capnia such as arrhythmia (Amato et al. 1998; Stewart et al. 1998; Brower et al. 1999), lactic acidosis (hypercapnia reduces it) (Higgins et al. 2009), and impaired oxygen supply-demand balance (hypercapnia improves it) (Wang etal. 2008).