Introduction

Hypercapnia with acidosis and with or without hypoxemia is common in the intensive care unit (ICU). There are many etiologies which may lead to respiratory acidosis. Some are immediately reversible, some can be corrected in hours or days, and some are irreversible. We will discuss the indications for respiratory support in these conditions, and how and to what degree hypercapnia, acidosis, and hypoxemia should be corrected. As mechanical ventilation may cause further complications, the disadvantages of introducing such a dangerous symptomatic treatment must be weighed against the benefits expected in relieving hypercapnia, acidosis, and hypoxemia. The therapeutic strategy is to design, for each patient, an appropriate plan of care, in which mechanical ventilation is probably the most important symptomatic treatment.

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