Quick Tip for Families in Intensive Care: My Mother is in ICU with High CO2 (PCO2 71) but Her Oxygen Saturation is Normal – What Should We Do?

“My mother is in ICU with high CO2 at 71, but her oxygen saturation is normal. What should we do?”

My name is Patrik Hutzel from intensivecarehotline.com where we help families of critically ill patients in intensive care to make informed decisions, have peace of mind, control, power, and influence so that your loved one gets best care and treatment always and help you feel like you’re not alone in this journey.

In today’s blog and video is in response to a question we received from a concerned family member who said, “Hi, Patrik. My mother has been an asthma patient for over 20 years, but in the last 2 years, her health has been getting worse. She was recently admitted to the ICU with very high CO2 (Carbon Dioxide), PCO2 (partial pressure of carbon dioxide) at 71 in the arterial blood gas, and low oxygen saturation. After 4 days of ICU treatment, her oxygen levels are back to normal, but her CO2 remains at 71 in the arterial blood gas. What should we do next?”

Let’s break this down. What does high CO2, which is also known as hypercapnia with normal oxygen levels, what does that mean? So, if your mother is in ICU with a PCO2 of 71, that is dangerously high. The normal range is between 35 and 45 mmHg. Even if oxygen levels are back to normal, that doesn’t mean everything is okay. It just means the oxygen issue is under control for now, probably with supplemental oxygen or ventilator and BIPAP (Bi-level Positive Airway Pressure) support.

But, CO2 is a different story. If CO2 stays too high, it can and inevitably will lead to drowsiness, confusion, lethargy, even coma or death if not treated properly. This is also known as type 2 respiratory failure. Oxygen might be okay, but the lungs are not blowing off enough carbon dioxide.

Why is CO2 still high after 4 days in ICU? There are several reasons. Number 1, severe long-term asthma can lead to air trapping and poor exhalation causing CO2 to build up and be trapped in the lungs. Your mother may have also COPD, which is known as chronic obstructive pulmonary disease, or asthma-COPD overlap. Both conditions usually lead to high CO2 and CO2 retention.

Number 3, she might have chronic CO2 retention and the ICU team may not be managing this aggressively enough. She may need ventilation support that focuses on removing CO2, not just giving oxygen, which inevitably will lead to BIPAP ventilation.

So, what should be done now? Here is what I would do if this was my mother. Number 1, ask the ICU team, is she on BIPAP or any non-invasive ventilation? BIPAP is a non-invasive ventilator that can help remove CO2 and reduce the work of breathing. If not already started, this should be done as soon as possible and can’t really be delayed. Check oxygen levels carefully. Too much oxygen can be dangerous in patients who retain CO2 or carbon dioxide. Giving too much oxygen can make CO2 even go higher. Ask the ICU team, is her oxygen being titrated carefully? What’s her target oxygen saturation?

Number 3, request a respiratory or pulmonology specialist. If not already involved, get a specialist to review her treatment, this is absolutely critical. Plan for the long term, home BIPAP may be needed. If this is chronic, she may need non-invasive BIPAP ventilation at home to prevent hospital readmissions. This is where Intensive Care at Home comes in, so go and check out intensivecareathome.com for more information.

Number 5, ask for updated arterial blood gases, also known as ABGs. Is the CO2 or carbon dioxide trending down or staying the same? This gives you a clear picture of whether the current treatment is working or not. If current treatment on BIPAP is not working, BIPAP settings most likely need to be elevated. PEEP (Positive End-Expiratory Pressure) and pressure support or IPAP (Inspiratory Positive Airway Pressure) and EPAP (Expiratory Positive Airway Pressure) need to be increased.

So, what questions should you be asking the ICU team? Why is her CO2 still at 71 after 4 days? Is she on BIPAP? If yes, what are the settings? Has she had new ABGs or arterial blood gases today? Are we looking at long-term options like home ventilation support with Intensive Care at Home? What is the risk of CO2 narcosis or coma? What is the plan if the CO2 doesn’t come down?

Final thoughts. If your loved one or your mother is in ICU with a PCO2 of 71, you must act fast. Don’t let the ICU team discharge her or move her to a ward without addressing the CO2 issue. You need a long-term plan. Don’t let the ICU team start talking about palliative care, or hospice care, or end of life care, because this can be most likely reversed but it takes some work.

You also need to keep asking questions, keep pushing for answers, and don’t stop until you know your mother is getting what she needs and what you need as a family member is peace of mind, control, power, and influence, so that you know your mom gets best care and treatment always.

If you need help managing this situation or similar situations, if you have a loved one critically ill in intensive care, or if you feel like you’re not being heard or being told the full picture, that’s exactly what we do here at intensivecarehotline.com.

We offer one on one consulting and advocacy for families in ICU, so you take back control. Go to intensivecarehotline.com and book a call with me now, or call us directly on the numbers listed on the top of the website.

This is Patrick Hutzel from intensivecarehotline.com, and I’ll talk to you in the next video.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse unit manager for over 5 years in critical care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in ICU. You can verify that by looking at our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews.

Because our advice is absolutely life changing, the advice and advocacy that we’re providing is so life changing that, like I said, we have saved many lives, and we’re improving the lives of our clients and our members instantly, so that they can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get best care and treatment always.

That’s why you can join a growing number of members and clients that we have helped over the years. Once again, to improve their lives instantly, making sure they can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get the best care and treatment, always.

That’s exactly why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. When I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I talk to doctors and nurses directly either one on one or I have you on the phone with them, or I’ll set you up with the right questions to ask.

I also represent you in family meetings with intensive care teams so that you can have clinical advocacy and representation on the family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 videos and 21 e-books that I have personally written and recorded. All of that, once again, will help you to improve your life instantly so that you make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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I also do a weekly YouTube live where I answer your questions live on a show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you are a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.­­­

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