PaCO₂: a treatable trait in acute respiratory failure

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Personalized Medicine

Background:

• Arterial carbon dioxide tension (PaCO2) is a key physiological parameter in acute respiratory failure.
• Personalized (precision) medicine emphasizes targeting treatable traits for tailored patient care.
• The role of PaCO2 as a treatable trait requires further investigation.

Purpose of the Study:

• To determine if PaCO2 can be considered a treatable trait in patients experiencing acute respiratory failure.
• To synthesize evidence on the clinical utility and prognostic value of PaCO2 in respiratory insufficiency.

Main Methods:

• Systematic electronic literature search for studies on hypercapnia and hypocapnia.
• Snowball sampling (citation tracking) to identify additional relevant articles.
• Narrative synthesis of evidence to frame PaCO2 as a treatable trait.

Main Results:

• PaCO2 aids in classifying acute respiratory failure (hypercapnic vs. non-hypercapnic).
• It informs prognosis and guides non-invasive ventilation and high-flow nasal cannula management.
• PaCO2 monitoring is crucial for ventilatory strategies, interpreting outcomes, and guiding post-extubation support to reduce reintubation.

Conclusions:

• PaCO2 functions as a treatable trait throughout the continuum of acute respiratory failure care.
• Further research is necessary to define specific, clinically actionable PaCO2 targets and safety margins for diverse patient subgroups.