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PaCO2 as a Possible Treatable Trait in Acute Respiratory Failure: A Scoping Review
Carmelo Dueñas-Castell1,2,3, José Correa-Guerrero4,5,6, Dairo Rodelo-Barrios6,7
1Faculty of Medicine, Universidad Metropolitana de Barranquilla, Barranquilla 080002, Colombia.
Journal of Clinical Medicine
|May 27, 2026
Summary
Arterial carbon dioxide pressure (PaCO2) levels offer valuable insights into acute respiratory failure (ARF) management. Understanding hypocapnia and hypercapnia guides treatment and predicts outcomes during respiratory support.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Precision Medicine
Background:
- Acute respiratory failure (ARF) classification is limited, necessitating advanced approaches.
- Precision medicine utilizes
- treatable traits
- for tailored patient care.
- Arterial carbon dioxide pressure (PaCO2) is a key physiological variable in respiratory support.
Purpose of the Study:
- To review evidence on hypocapnia and hypercapnia as prognostic or stratification variables during respiratory support.
- To summarize the clinical relevance of PaCO2 across different respiratory support modalities.
- To provide a framework for interpreting PaCO2 in ARF management.
Main Methods:
- Scoping review following PRISMA-ScR and JBI guidelines.
- Searched PubMed/MEDLINE, ScienceDirect, and Web of Science (1994-2025).
- Included 34 studies categorized by respiratory support context.
Main Results:
- Hypocapnia correlated with worse outcomes in hypoxemic/cardiogenic ARF.
- Hypercapnia identified patients benefiting from non-invasive ventilation (NIV), especially COPD and obesity hypoventilation.
- PaCO2's impact during invasive mechanical ventilation (IMV) depended on acidosis and duration.
Conclusions:
- PaCO2 is a context-dependent marker in respiratory support, primarily prognostic.
- PaCO2 can inform monitoring and support decisions in specific ARF scenarios.
- Further research is needed for safe and clinically meaningful PaCO2 targets.
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