Acute hypercapnic respiratory failure

Unfortunately, teaching on CO2 retention as described above has been misunderstood so that many doctors persist in reducing the oxygen concentration in any patient who has a high PaCO2. This is illogical and can be harmful. The most common reason for a high PaCO2 is a problem with ventilation. This occurs when the load on the respiratory muscles is too great or there is respiratory muscle weakness (Figure 2.4).

Excessive load results from increased resistance (for example, upper or lower airway obstruction), reduced compliance (for example, infection, oedema, rib fractures, or obesity), and increased respiratory rate. Respiratory muscle weakness can be caused by a problem in any part of the neurorespiratory pathway starting in the brain and working down (for example, drug overdose, motor neurone disease, Guillain-Barré syndrome, myasthenia gravis, and electrolyte abnormalities - low potassium, magnesium, phosphate or calcium).

Figure 2.4 Hypercapnic respiratory failure and the balance between load and muscle strength

Figure 2.4 Hypercapnic respiratory failure and the balance between load and muscle strength

Hypercapnia as a result of ventilatory failure is important to recognise. Reducing the oxygen concentration in order to "treat" a high CO2 is entirely the wrong thing to do in this situation. High concentrations of oxygen do not depress ventilation in patients with a high CO2 caused by an imbalance between respiratory muscle load and strength. Correct treatment is of the underlying cause and assistance with ventilation.

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