Respiratory acidosis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
==Medical Therapy== | The mainstay of treatment for [[respiratory acidosis]] is treating the underlying disorder which is responsible for the condition.While correcting [[hypercapnia]] extra care should be taken because rapid correction of the [[hypercapnia]] can result in [[metabolic]] [[Alkali|alkalemia]] and can result in [[Seizure|seizures]] especially when [[cerebrospinal fluid]] (CSF) becomes [[alkaline]].Indications for admitting the patient in [[intensive care unit]] (ICU) when a patient presents with a low [[pH]] of (< 7.25), [[confusion]], [[lethargy]] and [[respiratory]] [[muscle]] weakness. | ||
==Medical Therapy == | |||
* Pharmacologic medical therapy is recommended for patients who are taking [[Sedative|sedatives]].<ref name="pmid3690240">{{cite journal |vauthors=Belghiti J, Wind P, Bernades P, Fékété F |title=Acute pancreatitis associated with carcinoma of the ampulla of Vater |journal=Br J Surg |volume=74 |issue=11 |pages=1067–8 |date=November 1987 |pmid=3690240 |doi= |url=}}</ref><ref name="pmid11262556">{{cite journal |vauthors=Epstein SK, Singh N |title=Respiratory acidosis |journal=Respir Care |volume=46 |issue=4 |pages=366–83 |date=April 2001 |pmid=11262556 |doi= |url=}}</ref> | |||
* For patients who are suspected of drug overdose administration of antidote is considered when the physician think it safe. | |||
** Preferred regimen (1): [[Naloxone]] 0.05 mg [[Intravenous therapy|intravenously]] ([[IV]]) as an initial | |||
** In [[Apnea|apneic]] patients give [[Naloxone]] 0.2 to 1 mg as an initial dose. | |||
** In cardiorespiratory arrest give [[Naloxone]] 2 mg as an initial dose. | |||
** Preferred regimen (2): [[Flumazenil]] 0.2 mg given IV over 30 seconds as an initial dose. | |||
** 0.2 mg to a [[maximum]] dose of 1 mg of [[Flumazenil]] should be considered but not more than that for an initial dose in an adult. | |||
** Overall not more than 3 mg of [[flumazenil]] should be given. | |||
'''Bag-valve mask ventilation<ref name="pmid36902402">{{cite journal |vauthors=Belghiti J, Wind P, Bernades P, Fékété F |title=Acute pancreatitis associated with carcinoma of the ampulla of Vater |journal=Br J Surg |volume=74 |issue=11 |pages=1067–8 |date=November 1987 |pmid=3690240 |doi= |url=}}</ref>''' | |||
* Supportive therapy for [[respiratory acidosis]] includes [[Bag valve mask|bag-valve-mask]] [[Ventilation (physiology)|ventilation]]. | |||
* The major use of using [[Bag-Valve-Mask Ventilation|bag-valve-mask ventilation]] maneuvers are to a reduction in the [[partial pressure]] of arterial carbon dioxide ([[PaCO2]]). | |||
* Once [[Bag valve mask|bag-valve-mask]] ventilation fails to do the job patients with respiratory acidosis or [[hypercapnia]] should undergo [[endotracheal intubation]]. | |||
* '''Patients who are suitable for NIV''' '''medical therapy''': | |||
** Patients who are having moderate [[Acute (medicine)|acute]] [[acidosis]] when pH <7.3. | |||
** Patients who are having a [[respiratory rate]] of more than 25 per min | |||
* '''Patients who are not suitable for NIV''' '''medical therapy''': | |||
** Patients who are [[hemodynamically]] unstable. | |||
** Patients who are in severe cardiorespiratory distress. | |||
** Patients who are having Impaired [[consciousness]]. | |||
** Patients who underwent [[esophageal]] surgery. | |||
** Patients who undergo [[Gastric bypass surgery|gastric bypass]] surgery. | |||
'''Oxygen'''<ref name="pmid70692">{{cite journal |vauthors=Rudolf M, Banks RA, Semple SJ |title=Hypercapnia during oxygen therapy in acute exacerbations of chronic respiratory failure. Hypothesis revisited |journal=Lancet |volume=2 |issue=8036 |pages=483–6 |date=September 1977 |pmid=70692 |doi= |url=}}</ref><ref name="pmid28507176">{{cite journal |vauthors=O'Driscoll BR, Howard LS, Earis J, Mak V |title=BTS guideline for oxygen use in adults in healthcare and emergency settings |journal=Thorax |volume=72 |issue=Suppl 1 |pages=ii1–ii90 |date=June 2017 |pmid=28507176 |doi=10.1136/thoraxjnl-2016-209729 |url=}}</ref><ref name="pmid15955796">{{cite journal |vauthors=Durrington HJ, Flubacher M, Ramsay CF, Howard LS, Harrison BD |title=Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease |journal=QJM |volume=98 |issue=7 |pages=499–504 |date=July 2005 |pmid=15955796 |doi=10.1093/qjmed/hci084 |url=}}</ref> | |||
* In patients with severe [[hypoxemia]] it is necessary to administer oxygen to avoid life threatening [[complications]]. | |||
* Goals to administer [[oxygen]]: | |||
** 1)The primary goal is to treat [[hypoxemia]]. | |||
** 2) The second goal is to prevent worsening of [[hypercapnia]]. | |||
==References== | ==References== | ||
Latest revision as of 01:56, 5 March 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
The mainstay of treatment for respiratory acidosis is treating the underlying disorder which is responsible for the condition.While correcting hypercapnia extra care should be taken because rapid correction of the hypercapnia can result in metabolic alkalemia and can result in seizures especially when cerebrospinal fluid (CSF) becomes alkaline.Indications for admitting the patient in intensive care unit (ICU) when a patient presents with a low pH of (< 7.25), confusion, lethargy and respiratory muscle weakness.
Medical Therapy
- Pharmacologic medical therapy is recommended for patients who are taking sedatives.[1][2]
- For patients who are suspected of drug overdose administration of antidote is considered when the physician think it safe.
- Preferred regimen (1): Naloxone 0.05 mg intravenously (IV) as an initial
- In apneic patients give Naloxone 0.2 to 1 mg as an initial dose.
- In cardiorespiratory arrest give Naloxone 2 mg as an initial dose.
- Preferred regimen (2): Flumazenil 0.2 mg given IV over 30 seconds as an initial dose.
- 0.2 mg to a maximum dose of 1 mg of Flumazenil should be considered but not more than that for an initial dose in an adult.
- Overall not more than 3 mg of flumazenil should be given.
Bag-valve mask ventilation[3]
- Supportive therapy for respiratory acidosis includes bag-valve-mask ventilation.
- The major use of using bag-valve-mask ventilation maneuvers are to a reduction in the partial pressure of arterial carbon dioxide (PaCO2).
- Once bag-valve-mask ventilation fails to do the job patients with respiratory acidosis or hypercapnia should undergo endotracheal intubation.
- Patients who are suitable for NIV medical therapy:
- Patients who are having moderate acute acidosis when pH <7.3.
- Patients who are having a respiratory rate of more than 25 per min
- Patients who are not suitable for NIV medical therapy:
- Patients who are hemodynamically unstable.
- Patients who are in severe cardiorespiratory distress.
- Patients who are having Impaired consciousness.
- Patients who underwent esophageal surgery.
- Patients who undergo gastric bypass surgery.
- In patients with severe hypoxemia it is necessary to administer oxygen to avoid life threatening complications.
- Goals to administer oxygen:
- 1)The primary goal is to treat hypoxemia.
- 2) The second goal is to prevent worsening of hypercapnia.
References
- ↑ Belghiti J, Wind P, Bernades P, Fékété F (November 1987). "Acute pancreatitis associated with carcinoma of the ampulla of Vater". Br J Surg. 74 (11): 1067–8. PMID 3690240.
- ↑ Epstein SK, Singh N (April 2001). "Respiratory acidosis". Respir Care. 46 (4): 366–83. PMID 11262556.
- ↑ Belghiti J, Wind P, Bernades P, Fékété F (November 1987). "Acute pancreatitis associated with carcinoma of the ampulla of Vater". Br J Surg. 74 (11): 1067–8. PMID 3690240.
- ↑ Rudolf M, Banks RA, Semple SJ (September 1977). "Hypercapnia during oxygen therapy in acute exacerbations of chronic respiratory failure. Hypothesis revisited". Lancet. 2 (8036): 483–6. PMID 70692.
- ↑ O'Driscoll BR, Howard LS, Earis J, Mak V (June 2017). "BTS guideline for oxygen use in adults in healthcare and emergency settings". Thorax. 72 (Suppl 1): ii1–ii90. doi:10.1136/thoraxjnl-2016-209729. PMID 28507176.
- ↑ Durrington HJ, Flubacher M, Ramsay CF, Howard LS, Harrison BD (July 2005). "Initial oxygen management in patients with an exacerbation of chronic obstructive pulmonary disease". QJM. 98 (7): 499–504. doi:10.1093/qjmed/hci084. PMID 15955796.