Precipitating factors

The most common causes of respiratory acidosis and the time required for their correction are summarized in Table.?. They can be classified into three groups.

L-iSn m

L-iSn m

Table 2 Causes of respiratory acidosis

1. In this group the cause of hypercapnia can be removed easily. If hypoxemia can be corrected by supplemental oxygen administration, it is better, after removal of the precipitating factors, to wait for a spontaneous increase in alveolar ventilation. Hypercapnia does not require any treatment if associated with a stable pH, high HCO3-, and hemodynamic stability in a conscious patient.

2. In this group the correction of the precipitating factors will probably require hours or days. The need for mechanical ventilation should be determined on the basis of a global clinical assessment. In patients in whom hypercapnia is associated with clinical signs of severely increased work of the respiratory muscles, mechanical support should be introduced before the development of respiratory fatigue, which may lead to a sudden deterioration of PCO2 and pH.

3. In the final group the cause cannot be corrected (e.g. late-stage neuromuscular disease). In most cases, the issue is more ethical than medical, and the therapeutic plan should be discussed with the patients and relatives (e.g. planning for home ventilation).

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