An 80 year old with respiratory failure. Blood gas shows:Severe acute compensated respiratory acidosis or acute on chronic partially compensated respiratory acidosis

Type I and type II resp failure

Significantly large A-a gradient which suggests VQ mismatch, shunt or diffusion defect

High Hb – COPD, dehydration

High Glucose – poorly controlled diabetes, stress response, steroids

Causes:

Infective

non infective

Pneumothorax

CCF

Management:

respiratory support

reduce Oxygen to prevent worsening CO2, consider urgent NIV

Resuscitate

Treat underlying cause

ICU/HDU level care after establishing boundaries of care