Chronic respiratory acidosis management. Therapeutic measures are guided by the presence or absence of severe hypercapnic encephalopathy or hemodynamic instability. An aggressive approach that favors the early use of ventilator assistance is most appropriate for patients with acute respiratory acidosis. In contrast, a more conservative approach is advisable in patients with chronic hypercapnia because of the great difficulty often encountered in weaning these patients from ventilators. As a rule, the lowest possible inspired fraction of oxygen that achieves adequate oxygenation (PaO2 on the order of 60 mm Hg) is used. Contrary to acute respiratory acidosis, the underlying cause of chronic respiratory aci-dosis only rarely can be resolved [1,9].

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