From the Guidelines
The treatment for respiratory acidosis should focus on addressing the underlying cause of decreased ventilation and improving breathing, with bilevel noninvasive ventilation (NIV) being recommended for patients with acute respiratory failure leading to acute or acute-on-chronic respiratory acidosis due to COPD exacerbation, as stated in the official ERS/ATS clinical practice guidelines 1.
Key Treatment Strategies
- Providing supplemental oxygen and mechanical ventilation if necessary
- Using bronchodilators such as albuterol (2.5 mg via nebulizer every 4-6 hours) or ipratropium (500 mcg via nebulizer every 6-8 hours) for chronic respiratory acidosis
- Administering corticosteroids like prednisone (40-60 mg daily for 5-7 days during exacerbations) and antibiotics if infection is present
- Implementing noninvasive positive pressure ventilation (NIPPV) with settings typically starting at inspiratory pressure of 8-12 cmH2O and expiratory pressure of 3-5 cmH2O for conditions like COPD
- Considering lifestyle modifications including smoking cessation, pulmonary rehabilitation, and weight loss for obese patients as essential components of long-term management
Location of NIV Treatment
- NIV can be provided in a number of locations including the intensive care unit, a high dependency unit, or a respiratory ward, but each hospital should have a specific designated area with an available cohort of staff with appropriate experience 1
- Patients with more severe acidosis (pH <7.30, H+ >50 nmol/l) should be managed in a higher dependency area such as an HDU or ICU
- Patients with acute hypercapnic respiratory failure from a cause where the role of NIV is not yet clearly established should only receive NIV in an HDU or ICU where facilities for immediate tracheal intubation are available 1
Implementation Considerations
- Bilevel NIV should be considered when the pH is ≤7.35, PaCO2 is >45 mmHg and the respiratory rate is >20–24 breaths·min–1 despite standard medical therapy 1
- The lower the pH, the greater risk of failure, and patients must be very closely monitored with rapid access to endotracheal intubation and invasive ventilation if not improving 1
From the FDA Drug Label
Patient Package Insert Albuterol Sulfate Inhalation Solution, 0.083%* Note: Use only as directed by your physician.
The treatment for respiratory acidosis is not directly addressed in the provided drug label. Albuterol is used to treat bronchospasm, but the label does not provide information on its use for respiratory acidosis.
- The label provides instructions for the use of albuterol sulfate inhalation solution.
- It does not mention respiratory acidosis or its treatment. 2
From the Research
Treatment for Respiratory Acidosis
The treatment for respiratory acidosis may include:
- Invasive or noninvasive ventilatory support 3
- Specific medical therapies directed at the underlying pathophysiology 3
- Supplemental oxygen 4
- Mechanical ventilation 4
- Non-invasive positive pressure ventilation in acute hypercapnic respiratory failure 4
- Domiciliary mechanical ventilation for COPD with chronic hypercapnic respiratory failure 4
Mechanisms and Causes
Respiratory acidosis can result from various mechanisms, including:
- Increased carbon dioxide production 3
- Alveolar hypoventilation 3, 5
- Abnormal respiratory drive 3
- Abnormalities of the chest wall and respiratory muscles 3, 6
- Increased dead space 3
- Disorders affecting gas exchange across the pulmonary capillary 6
- Disorders of the chest wall and the respiratory muscles 6
- Inhibition of the medullary respiratory center 6
Types of Respiratory Acidosis
Respiratory acidosis can be: