by "Grog" (Alan W. Grogono), Professor Emeritus, Tulane University Department of Anesthesiology

Acid-Base Therapy: Respiratory Correction

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Respiratory Treatment

Treating Acid-base Disturbances.

Emergency therapy: The body's metabolism produces respiratory (carbonic) acid and, in cardiorespiratory failure also produces metabolic (lactic) acid. In emergencies, therefore, it is usual to find that correction is required for metabolic or respiratory acidosis.

For this reason, and in the interest of simplification, the following paragraphs primarily discuss acidosis and its correction:

Treating Respiratory Acidosis.

Respiratory Treatment

Respiratory acidosis. A physician decides to ventilate a patient to reduce the PCO2 level based on exhaustion, prognosis, prospect of improvement from concurrent therapy and, only in part, on the PCO2 level. Once the clinical decision is made, the PCO2 helps calculate the appropriate correction.

The PCO2 reflects the balance between the production of carbon dioxide and its elimination. Unless the metabolic rate changes, the amount of carbon dioxide produced is roughly constant and determines the amount of ventilation required and the level of PCO2.

Calculating Required Ventilation.

The Constant Where VT equals tidal volume and f equals frequency of ventilation:

PCO2   x   Ventilation   =   Constant

PCO2   x     f     x   VT     =     K            

This equation means that the same number of carbon dioxide molecules are eliminated by high ventilation at a low PCO2 as by low ventilation at a high PCO2,

The Target The Target Ventilation is calculated by dividing k by the target PCO2:

New Ventilation   =   K / Target PCO2                                 

                                =   PCO2   x   f   x   VT   / Target PCO2

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Acid-Base Correction

Illustrations (Click on Picture on Right):

1) Pure Respiratory Acidosis: This patient has a pure (acute) respiratory acidosis with a PCO2 = 70 mmHG (9.8 kPa) and is ventilating at 4 L/min. The constant is 4 x 70 = 280. To obtain a PCO2 of 40, the ventilation required would be 280 / 40 = 7 L/min. This should correct the PCO2 to 40 mmHg (5.7 kPa). For an acute distubance, it is usually safe and appropriate to return the PCO2 to normal.

Acid-Base Correction

2) Chronic Respiratory Failure (Click on Picture on Left): This chronic bronchitic patient nomally has a PCO2 of 50 mmHg, but acute respiratory failure due to pneumonia has raised his PCO2 to 70 mmHg (9.8 kPa) despite his ventilating at 8 L/min. His constant is 70 x 8 = 560. The target is to return him to his customary PCO2. The required ventilation is 560 / 50 = 11.2 L/min. Note that this returns him to the level typical for chronic respiratory failure with the characteristic metabolic alkalosis.

Metabolic level does not change: Note that in both these cases, the change in ventilation alters the PCO2 but the the level of the Metabolic Acidosis (- SBE) does not change. The patient moves horizontally as the ventilation is increased.

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Acid-Base Tutorial
Alan W. Grogono
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All Rights Reserved
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