IBCC Episode 122 - Respiratory Acidosis

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam Thomas discuss respiratory acidosis, also known as hypercapnia. They emphasize that managing and interpreting hypercapnia is highly contextual, with symptoms varying based on whether it's acute or chronic. They challenge the traditional rules taught in medical school for determining the acuity of hypercapnia, noting that blood gas analysis alone is insufficient without clinical context. The hosts break down hypercapnia into three categories: "won't breathe" (respiratory drive problems), "can't breathe" (neuromuscular or obstructive issues), and "breathing isn't working" (parenchymal dead space problems). They stress the importance of physical examination, bedside pulmonary function tests, and imaging to identify the underlying cause. The discussion also covers the consequences of hypercapnia, such as pulmonary vasoconstriction and increased intracranial pressure, and underscores that management should target the underlying etiology rather than simply applying BIPAP to every patient.