Treatment of Metabolic Acidemia in Intubated, Mechanically Ventilated Patients
Clinical Scenario
This protocol addresses metabolic acidemia in a patient who is intubated and on mechanical ventilation — a setting in which spontaneous respiratory compensation is unavailable and ventilator settings must be actively adjusted to manage acid-base status.
Specific Conditions
The patient is under mechanical ventilation with metabolic acidemia present. There are currently no specific data from clinical studies concerning ventilatory management in this population; guidance is based on expert consensus.
Treatment Approach & Clinical Goal
The approach involves ventilatory compensation — adjusting respiratory parameters to partially offset the acidemia while monitoring airway pressures to avoid harm. The clinical target is an arterial pH ≥ 7.15, not normalisation of pH.
The full protocol specifies which parameters to adjust, the safety limits to respect, and the concomitant steps required — see the complete structured regimen below.
References
- As yet there are no specific data concerning ventilatory management of intubated-ventilated patients with metabolic acidosis.
- The experts suggest compensating for acidemia by increasing respiratory frequency without inducing intrinsic positive end-expiratory pressure, with a maximum of 35 cycles/min and/or a tidal volume up to 8 mL/kg of body mass, and by monitoring plateau pressure.
- The aim of ventilation is not to normalize pH.
- A target pH greater than or equal to 7.15 seems reasonable.
- Medical treatment of metabolic acidosis and of its cause should be envisaged concomitantly, as ventilatory compensation can only be symptomatic and temporary (EXPERT OPINION).
DOI: 10.1053/j.ajkd.2019.01.036
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