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hypercapnia

Abnormally increased arterial carbon dioxide tension (pCO2). Physiology: - a normal response to hypercapnia is an increase in ventilation Pathology: - hypercapnia without respiratory acidosis (compensated respiratory acidosis) is not associated with increased mortality in mechanically-ventilated patients with traumatic brain injury [2] Management: - increase ventilation by increasing respiratory rate &/or tidal volume - avoid or minimize use of opioids - opioids can cause severe respiratory depression by suppressing feedback mechanisms that increase ventilation in response to hypercapnia [3] - paroxetine in combination with oxycodone further decreases ventilatory response to hypercapnia vs oxycodone alone [3] - quetiapine in combination with oxycodone does not further decrease ventilatory response [3]

Related

lung protective ventilation; low tidal volume ventilation; permissive hypercapnia

General

sign/symptom

References

  1. Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
  2. Tiruvoipati R, Pilcher D, Botha J et al Association of Hypercapnia and Hypercapnic Acidosis With Clinical Outcomes in Mechanically Ventilated Patients With Cerebral Injury. JAMA Neurol. Published online March 19, 2018 PMID: 29554187 https://jamanetwork.com/journals/jamaneurology/fullarticle/2675293 - Hemphill JC 3rd. Arterial Partial Pressure of Carbon Dioxide and Secondary Brain Injury - 6 Degrees of Separation? JAMA Neurol. Published online March 19, 2018. PMID: 29554181 https://jamanetwork.com/journals/jamaneurology/fullarticle/2675290
  3. Florian J, van der Schrier R, Gershuny V et al Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During HypercapniaA Randomized Clinical Trial. JAMA. 2022;328(14):1405-1414. PMID: 36219407 https://jamanetwork.com/journals/jama/fullarticle/2797225