Ventilatory supportindications Acute ventilatory insufficiency

Defined by an acute rise in PaCO2 and a significant respiratory acidosis. PaCO2 is directly proportional to the body's CO2 production and inversely proportional to alveolar ventilation (minute ventilation minus dead space ventilation). Causes include:

• Respiratory centre depression, e.g. depressant drugs or intracranial pathology

• Peripheral neuromuscular disease, e.g. Guillain-Barré syndrome, myasthenia gravis or spinal cord pathology

• Therapeutic muscle paralysis, e.g. as part of balanced anaesthesia, for management of tetanus or status epilepticus

• Loss of chest wall integrity, e.g. chest trauma, diaphragm rupture

• High CO2 production, e.g. burns, sepsis or severe agitation

• Reduced alveolar ventilation, e.g. airway obstruction (asthma, acute bronchitis, foreign body), atelectasis, pneumonia, pulmonary oedema (ARDS, cardiac failure), pleural pathology, fibrotic lung disease, obesity

• Pulmonary vascular disease (pulmonary embolus, cardiac failure, ARDS)

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