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Pre-existing acidosis and mechanical ventilation
- Not surprisingly, many critically ill ED patients often develop a metabolic acidosis.
- To compensate, patients hyperventilate, thereby producing a respiratory alkalosis.
- When these patients require intubation and mechanical ventilation, be sure to provide the same level of respiratory compensation when setting the ventilator.
- Failing to provide a rate sufficient to compensate for the pre-intubation acidosis leads to a rapid drop in pH, bradycardia and eventually asystole.
- In general, rates can be increased to about 30-35 breaths per minute, after which auto-PEEP becomes problematic.
References
Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation. JEM 2010; 38:622-31.