Approach to respiratory acidosis

In patients presenting with hypercapnia, acidosis, and hypoxemia, two lines of action are required:

1. identification of the causes of respiratory acidosis, with particular focus on the correction of precipitating factors which may be reversible;

2. treatment of the symptoms if they are themselves a possible cause of unfavorable outcome.

These two actions should be pursued together, as correction of the precipitating factors may lead to almost immediate resolution of the respiratory acidosis. However, the first goal in intensive care is maintenance of homeostasis, and correction of life-threatening symptoms is the priority. Thus the indications for symptomatic treatment will be discussed first.

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