- Joined
- Aug 23, 2004
- Messages
- 2,934
- Reaction score
- 983
CO2 won't hurt the pt. Think about your ICU rotation. Remember permissive hypercapnea?
I just wanna point out that "permissive hypercapnia" and "hypoventilation is OK" are not the same thing.
Permissive hypercapnia refers to patients with SEVERE lung injury who are, to a degree, failing conventional ventilation. The patient with ARDS who is on "max" ventilation like with RR > 30, FiO2 1.0, PEEP > 15 etc. In THIS patient, the priorities are
1) pseudophysiologic oxygenation: SpO2 88-92%, PaO2 > 55
2) Plateau pressures < 30cmH2O
3) TV = 4-6ml/kg IBW
If, in order to achieve those 3 goals, you have to "permit" hypercapnia, then by all means do so. The acidemia is well tolerated for the most part from a metabolic and cardiovascular standpoint; typically you see some decrease in SVR with acidemia.