Table of contents
Hypercapnic respiratory failure
Background
Overview
Definition
Hypercapnic respiratory failure (type II respiratory failure) is a state of reduced alveolar ventilation with subsequent respiratory acidosis (PaCO₂ > 50 mmHg).
1
Pathophysiology
Hypercapnic respiratory failure is most frequently caused by drug overdose, COPD, obesity hypoventilation syndrome, obstructive sleep apnea, and the overlap syndrome of COPD and obstructive sleep apnea.
1
Epidemiology
The overall prevalence of hypercapnic respiratory failure in patients with severe COPD is approximately 25%.
2
Disease course
Acute hypercapnic respiratory failure develops rapidly (within minutes to hours). Clinical manifestations include increasing dyspnea, lethargy, hypoxemic, disorientation, tachycardia, altered mental status, hypoventilation, hyperinflation, and need for ventilatory support. The disease decreases the QoL with increased risk of readmission and longer periods of hospital stay.
1
Prognosis and risk of recurrence
Hypercapnic respiratory failure in hospitalized patients is associated with significant mortality (36%).
1
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of hypercapnic respiratory failure are prepared by our editorial team based on guidelines from the European Respiratory Society (ERS 2017) and the British Thoracic Society (BTS/ICS 2016).
1
2
3
4
Classification and risk stratification
Medical management
Patients with COPD exacerbation: as per ERS 2017 guidelines, initiate bilevel noninvasive ventilation for patients with acute respiratory failure due to an acute exacerbation of COPD that leads to respiratory acidosis (pH ≤ 7.35).
A
Show 2 more
More topics in this section
Patients with acute asthma
Patients with bronchiectasis
Patients with cystic fibrosis
Patients with restrictive lung disease
Patients with neuromuscular disease
Patients with obesity hypoventilation syndrome
Inpatient care
General principles: as per BTS/ICS 2016 guidelines, treat the precipitant cause of acute hypercapnic respiratory failure, normalize pH, correct chronic hypercapnia and address fluid overload.
B
More topics in this section
Noninvasive ventilation strategy
Invasive ventilation strategy
Oxygenation targets
Sedative agents (noninvasive ventilation)
Sedative agents (mechanical ventilation)
Volume status optimization
Assessment for extubation
Weaning of ventilatory support
Monitoring for ventilator asynchrony
Therapeutic procedures
Tracheostomy: as per BTS/ICS 2016 guidelines, consider mini-tracheostomy to aid secretion clearance in patients with weak cough due to neuromuscular/chest wall disease, or in patients with excessive airway secretions such as in COPD or cystic fibrosis.
C
More topics in this section
Extracorporeal CO2 removal