DR Medhat MRCP

o Treatment of acute respiratory acidosis :
- Depends on severity of the condition:
Management of patient in extremis & about to die
(acute resuscitation):
1. Ensure patent airway insert nasopharyngeal or oropahryngeal airway if
conscious level is depressed
2. Apply an O2 saturation pulse oxymetry.
3. Give high flow O2
Hypoxia kills , hypercapnoea merely intoxicates
- Even if the pt. is known to have COPD,we should give high flow O2 if the
pt. is in extremis as the O2 may buy you enough time to institute other
treatments & the pt. can then slowly weaned from it according to ABG.
4. Call for anaesthetic assistance soon for mechanical ventilation if the pt.
didn`t respond to the upper measures & continued to be worse.
- Indications of non-invasive ventilation (BIPAP):
‣ pH 7.25-7.35 in conscious ,hemodynamically stable
patient.
- Indications of invasive ventilation (intubation):
‣ Disturbed level of consciousness (GCS < 8).
‣ Hemodynamically unstable patient.
‣ Severe life threatening hypoxemia (PO2 < 6.7 Kpa)
‣ Severe respiratory acidosis (Ph < 7.25 & PCO2 > 7.5
Kpa (i.e > 50 mmHg)
‣ Copious respiratory secretions.
‣ Vomiting.
‣ Facial trauma or burn.
Management of less severe pt (not about to die):
1. Humidified Oxygen (humidification of O2 helps to decrease mucous blug) :
- Prior to the availability of blood gases, use a 28% Venturi mask at 4
L/min and aim for an oxygen saturation of 88-92% for patients with risk
factors for hypercapnia but no prior history of respiratory acidosis
- NB :If the pCO2 is normal ,adjust target range to 94-98% .
2. Treatment of underlying cause .
3. Mechanical ventilation if no response to O2 therapy & ttt of underlying
cause (invasive vs non-invasive ventilation indications as mentioned above)
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