How is coexistent hypercapnic respiratory failure and respiratory acidosis managed?

Updated: Apr 07, 2020
  • Author: Ata Murat Kaynar, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Coexistent hypercapnia and respiratory acidosis may have to be addressed. This is done by correcting the underlying cause or providing ventilatory assistance.

While correcting for hypoxemia, the physiologic parameters have to be remembered. One of the concepts relevant to mechanical ventilation is the so-called “driving pressure” or “transmural pressure”. For any hollow structure (be it the heart or lung), the distending pressure is defined by the difference between the cavity pressure—in this case, the airway pressures—and the intrathoracic pressures. The difference between these two pressures is the determinant of the driving pressure and in the case of a stiff chest wall due to blunt trauma, burns, or increased intra-abdominal pressures, the extra-alveolar pressures may overcome the alveolar pressures and decrease the effective distending pressures. To address this concept, work by Talmor and others used an approach to guide the mechanical ventilation with the use of esophageal manometry. [8] In this work, esophageal pressures were used as a surrogate for intrathoracic pressures and these numbers were subtracted from airway pressures to define the actual driving pressures. The study was conducted in patients with ARDS and they were able to show decreased inflammatory cytokines in the intervention group.

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