Severe Respiratory Acidosis

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Specializes in Trauma/Surgical ICU.

I am an ICU RN and currently my father is in ICU following right upper lobectomy for cancer. A little history on my father is that he is a ex-smoker with a 1 ppd x 35 years, has COPD. Doctors stated that the surgery went well, minimal blood loss. They woke him up in the OR he opened his eyes sat up and looked around a little then went back to sleep (According to the Doctor's). He was extubated in the OR and sent to the recovery room. 15-20 minutes after being in the recovery room they couldn't arouse him. Blood gases were obtained which indicated the following ph 6.9, pco2 143, po2 112. Other labs were obtained and the only abnormal was a K+ that wasn't critically high. He was reintubated at this time. Few minutes later he went into PEA and ACLS was performed. Throughout the day he coded a total of 5 times. He was placed on levophed, epinephrine, vasopressin, all of which were maxed out trying to keep a MAP bp of >65. Throughout the day MI profiles have been obtained mulptiple times with no indicating evidence of an MI but was taken to the cath lab anyways. Heart cath was negative. About 12 hours after all of these events he woke up and now is following commands and writting notes, and he appears to have no neurological deficits all body systems appear to be normal. All pressors are turned off and remains on a vent at this time. My questions is how can a co2 level get so high in such a short period of time and what you guys thought caused the cardiac arrest to begin with? Keep him in your prayers! Thanks.

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Specializes in NICU.

I have no answers but... holy crap! So glad he's on the upswing!

That PO2 makes me curious. It seems out of place to me, with the pH and PCO2 being what they were.

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.
I am an ICU RN and currently my father is in ICU following right upper lobectomy for cancer. A little history on my father is that he is a ex-smoker with a 1 ppd x 35 years, has COPD. Doctors stated that the surgery went well, minimal blood loss. They woke him up in the OR he opened his eyes sat up and looked around a little then went back to sleep (According to the Doctor's). He was extubated in the OR and sent to the recovery room. 15-20 minutes after being in the recovery room they couldn't arouse him. Blood gases were obtained which indicated the following ph 6.9, pco2 143, po2 112. Other labs were obtained and the only abnormal was a K+ that wasn't critically high. He was reintubated at this time. Few minutes later he went into PEA and ACLS was performed. Throughout the day he coded a total of 5 times. He was placed on levophed, epinephrine, vasopressin, all of which were maxed out trying to keep a MAP bp of >65. Throughout the day MI profiles have been obtained mulptiple times with no indicating evidence of an MI but was taken to the cath lab anyways. Heart cath was negative. About 12 hours after all of these events he woke up and now is following commands and writting notes, and he appears to have no neurological deficits all body systems appear to be normal. All pressors are turned off and remains on a vent at this time. My questions is how can a co2 level get so high in such a short period of time and what you guys thought caused the cardiac arrest to begin with? Keep him in your prayers! Thanks.[/quote

Did he have a baseline ABG? COPDers retain CO2 normally so some respiratory depression from sedation and his CO2 would shoot up. I'm glad he is neorologically intact. [[HUGS]]

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Specializes in Trauma/Surgical ICU.

His baseline ABG's a week prior to surgery were a ph of 7.4 co2 44, po2 was 80. Heck of a lot better than i would have assumed considering his COPD, and his age is 64 if this adds any other useful information.

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.

I have NEVER seen an abg look THAT bad and someone not suffer neurological deficits. Honestly I have never seen an abg that bad and someone live. I would assume he is in pretty good health otherwise for this to be the case. If it were for a short period of time he may have been able to pull through with no issues. Is it possible this abg was an error? Did they draw others and they were similar? Thats pretty hard to believe but that is great news and it sounds like he is heading in the right direction! Hope all goes well and keep us posted on how things progress!

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.
His baseline ABG's a week prior to surgery were a ph of 7.4 co2 44, po2 was 80. Heck of a lot better than i would have assumed considering his COPD, and his age is 64 if this adds any other useful information.

All I can think is that he was a little over sedated along with the fact that he had lung surgery.Did they rule out PE? Or is he too sick?

Is he is anticoagulated now(lovenox,etc)? I know he's s/p surgery,it might be hard to know what exactly happened to him but it's great that they got him back.

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Specializes in Trauma/Surgical ICU.

I didn't really think about a PE because he was oxygenating well the whole time. They never did take him to CT because he was too critical at the time. The only type of prophalatic DVT he is on currenlty is SCD's nothing else that I am aware of. Oh yea something else I forgot to mention earlier is that he had 3 stents placed a few years ago and has been on plavix/aspirin since, he stopped taking these a week prior to the surgery and started him on heparin 5000 units bid. I just went to visit him and he seems in good spirits and they now placed him on a dilaudid pca and he feels like he is on cloud 9 with it :)

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.

It's great that he's feeling better. :)

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What was he coded for? Respiratory Depression? BP?

I had a pt with similar BG's who had blood in her lungs...she was very anxious, SOB, cyanotic in her face. she had a trach, and I was suctioning frank blood out. It was specualted that she had been sxmn'd too much or too deeply cusing some kind of tear, i dont know. she was on a heparin gtt. RT was called, she bagged and sxn'd, retook bg, much better. Her blood cleared up a day later, but had black stools, so she was bleeding somewhere, she was transferred to icu, so I never knew what happened with her. Yes, these are the non-icu pts on our 'intermediate' floor.

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Specializes in ICU/Critical Care.

They probably should have waited for the sedation to wear off before extubating is my guess.

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Specializes in CVICU, Burns, Trauma, BMT, Infection control.
They probably should have waited for the sedation to wear off before extubating is my guess.

Definitely!

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Specializes in Trauma/Surgical ICU.
What was he coded for? Respiratory Depression? BP?

I had a pt with similar BG's who had blood in her lungs...she was very anxious, SOB, cyanotic in her face. she had a trach, and I was suctioning frank blood out. It was specualted that she had been sxmn'd too much or too deeply cusing some kind of tear, i dont know. she was on a heparin gtt. RT was called, she bagged and sxn'd, retook bg, much better. Her blood cleared up a day later, but had black stools, so she was bleeding somewhere, she was transferred to icu, so I never knew what happened with her. Yes, these are the non-icu pts on our 'intermediate' floor.

He was coded for bradycardia that soon resulted to PEA. He never had bloody secretions of any sort.

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