Respiratory alkalosis in the acute hypoxemic patient during non-invasive mechanical ventilation: troubleshooting and prognostic relevance
https://doi.org/10.4081/ecj.2024.12152
Accepted: 7 March 2024
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Respiratory alkalosis is one of the four basic disturbances to the acid-base equilibrium. Persistent primary respiratory alkalosis during non-invasive mechanical ventilation in patients with hypoxemic respiratory failure could be a risk factor for NIV failure. A 69-year-old man with acute hypoxemic respiratory failure caused by severe COVID-19 pneumonia demonstrated progressive worsening of gas exchange and clinical conditions. Despite a positive response to noninvasive mechanical ventilation, a therapeutic increase in respiratory support was required.
Rochwerg B, Brochard L, Elliott MW , et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50:1602426. DOI: https://doi.org/10.1183/13993003.02426-2016
Kangelaris KN, Ware LB, Wang CY, et al. Timing of Intubation and Clinical Outcomes in Adults With Acute Respiratory Distress Syndrome. Crit Care Med 2016;44:120-9. DOI: https://doi.org/10.1097/CCM.0000000000001359
Oczkowski S, Ergan B, Bos L, et al. ERS clinical practice guidelines: high-flow nasal cannula in acute respiratory failure. Eur Respir J 2022;59:210157. DOI: https://doi.org/10.1183/13993003.01574-2021
Antonelli M, Conti G, Moro ML, et al. Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 2001;27:1718-28. DOI: https://doi.org/10.1007/s00134-001-1114-4
Carteaux G, Millán-Guilarte T, De Prost N, et al. Failure of non-invasive ventilation for de novo acute hypoxemic respiratory failure: role of tidal volume. Crit Care Med 2016;44:282-90. DOI: https://doi.org/10.1097/CCM.0000000000001379
Duan J, Han X, Bai L, et al. Assessment of heart rate, acidosis, consciousness, oxygenation, and respiratory rate to predict noninvasive ventilation failure in hypoxemic patients. Intensive Care Med 2017;43:192-9. DOI: https://doi.org/10.1007/s00134-016-4601-3
Carteaux G, Parfait M, Combet M, et al. Patient-self inflicted lung injury: a practical review. J Clin Med 2021;10:2738. DOI: https://doi.org/10.3390/jcm10122738
Carrillo-Aleman L, Carrasco-Gónzalez E, Araújo MJ, et al. Is hypocapnia a risk factor for non-invasive ventilation failure in cardiogenic acute pulmonary edema? J Crit Care 2022;69:153991. DOI: https://doi.org/10.1016/j.jcrc.2022.153991
De Vuono S, Berisha S, Settimi L, et al. Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia. Emerg Care J 2023;19:11237. DOI: https://doi.org/10.4081/ecj.2023.11237
Capsoni N, Privitera D, Airoldi C, et al. Evaluation of PaCO2 trend in COVID-19 patients undergoing helmet CPAP in the emergency department. Emerg Care J 2023;19:11274. DOI: https://doi.org/10.4081/ecj.2023.11274
Kamat IS, Ramachandran V, Eswaran H, et al. Procalcitonin to distinguish viral from bacterial pneumonia: a systematic review and meta-analysis. Clin Infect Dis 2020;70:538-42. DOI: https://doi.org/10.1093/cid/ciz545
Javaheri S, Sicilian L. Lung function, breathing pattern, and gas exchange in interstitial lung disease. Thorax 1992;47:93-7. DOI: https://doi.org/10.1136/thx.47.2.93
Jonkman AH, de Vries HJ, Heunks LMA. Physiology of the respiratory drive in ICU patients: implications for diagnosis and treatment. Crit Care 2020;24:104. DOI: https://doi.org/10.1186/s13054-020-2776-z
Jareonsettasin P, Zeicu C, Diehl B, et al. Inappropriate ventilatory homeostatic responses in hospitalized COVID-19 patients. Front Neurol 2022;13:909915. DOI: https://doi.org/10.3389/fneur.2022.909915
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