Draft

198  Locke Pccgr

198.1 Summary

  • PCCGR Aug 12, 2025: Update on Hypercapnic Respiratory Failure Care at Intermountain
  • Agenda
  • Hypercapnic Respiratory Failure:
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Goal PaCO2
  • PAO2 FiO2 (PB-47)β€”(PaCO2/R) οƒ  O2 17.8 mmHg lower at 4500ft
  • Hypercapnic Respiratory Failure management is a large, tractable, & neglected problem
  • Hypercapnic Respiratory Failure is Common

198.2 Slide outline

198.2.1 Slide 1

  • PCCGR Aug 12, 2025: Update on Hypercapnic Respiratory Failure Care at Intermountain
  • Brian W Locke MD MSCI
  • Assistant Professor
  • Shock Trauma ICU and Schmidt Chest Clinic
  • Pulmonary and Critical Care, Intermountain Medical Center
  • COI: Mountain Biometrics (time-series machine learning on continuous sensor data)
  • Funding for this work:
  • American Thoracic Society Academic Sleep Pulmonary Integrated Research/Clinical Fellowship
  • NIH NHLBI T32 University of Utah PCCM
  • Intermountain Fund PCCM Seed Grant: Follow-Up Needs after Discharge with Hypercapnia (FUND-Hypercapnia)
  • Partial support for datasets within the Utah Population Database provided by the Huntsman Cancer Institute (HCI) & HCI Cancer Center Support grant P30 CA2014 from the National Cancer Institute
  • Notebook on Hypercap. R.F. ### Slide 2
  • Agenda
  • 01
  • The problem: Hypercapnic Respiratory Failure Managementβ€¦πŸ€·β€β™‚οΈ
  • 02
  • Intermountain Hypercapnic Respiratory Failure Research Agenda
  • 03
  • Intermountain Hypercapnic Respiratory Failure Clinical Agenda
  • 04
  • New National Coverage Determinations for DME ### Slide 3
  • Hypercapnic Respiratory Failure:
  • Hypercapnia is a finding; Failure indicates failed homeostasis
  • Finding: Hypercapnia PaCO2 β‰₯ expected range
  • 45 mmHg (at sea level); 41-42 mmHg in SLC
  • Threshold based on abnormality (like FEV1), not consequence (like blood pressure)
  • Failure: a syndrome (pattern of signs/symptoms)
  • β€œFailure” implies failed homeostasis – an imbalance between VCO2 and Va
  • Not explainable by metabolic alkalosis (respiratory success)
  • There’s no operational definition beyond hypercapnia ### Slide 4
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • π‘Ήπ’†π’’π’–π’Šπ’“π’†π’… π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ βˆπ‘‰π‘’π‘›π‘‘π‘–π‘™π‘Žπ‘‘π‘–π‘œπ‘› π‘Šπ‘Žπ‘ π‘‘π‘’π‘‘+ 𝑇𝑖𝑠𝑠𝑒𝑒 π‘ƒπ‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘œπ‘› π‘œπ‘“ 𝐢𝑂2π‘ƒπ‘ŽπΆπ‘‚2 π‘‡π‘Žπ‘Ÿπ‘”π‘’π‘‘βˆ—
  • Demand and Supply
  • Demand depends on VΜ‡COβ‚‚, Vd/Vt, target PaCOβ‚‚;
  • Supply depends on muscle capacity, mechanics, control stability, loads.
  • Supply-Demand mismatch respiratory failure ### Slide 5
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Variable
  • Vd
  • VCO2
  • Goal PaCO2
  • Pathophys.
  • Deadspace Fraction
  • Met. Rate & Resp Quot.
  • Compen-sation
  • Examples
  • PE, Parenchymal Lung, Anatomic
  • Overdose,
  • Overfeeding, Obesity
  • Met. Acidosis/Alkalosis
  • π‘Ήπ’†π’’π’–π’Šπ’“π’†π’… π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ βˆπ‘‰π‘’π‘›π‘‘π‘–π‘™π‘Žπ‘‘π‘–π‘œπ‘› π‘Šπ‘Žπ‘ π‘‘π‘’π‘‘+ 𝑇𝑖𝑠𝑠𝑒𝑒 π‘ƒπ‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘œπ‘› π‘œπ‘“ 𝐢𝑂2π‘ƒπ‘ŽπΆπ‘‚2 π‘‡π‘Žπ‘Ÿπ‘”π‘’π‘‘βˆ— ### Slide 6
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Variable
  • Vd
  • VCO2
  • Goal PaCO2
  • Muscle Capacity
  • Control Stability
  • Respiratory System Loads
  • Pathophys.
  • Deadspace Fraction
  • Met. Rate & Resp Quot.
  • Compen-sation
  • Strength, Mech Advantage
  • Chemoreflex & breath generator
  • Resistive,
  • Elastic,
  • Threshold/Inertial
  • Examples
  • PE, Parenchymal Lung, Anatomic
  • Overdose,
  • Overfeeding, Obesity
  • Met. Acidosis/Alkalosis
  • NMD, COPD, Pleural Dz
  • Opiates,
  • Sleep
  • COPD, CHF, OHS
  • π‘Ήπ’†π’’π’–π’Šπ’“π’†π’… π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ βˆπ‘‰π‘’π‘›π‘‘π‘–π‘™π‘Žπ‘‘π‘–π‘œπ‘› π‘Šπ‘Žπ‘ π‘‘π‘’π‘‘+ 𝑇𝑖𝑠𝑠𝑒𝑒 π‘ƒπ‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘œπ‘› π‘œπ‘“ 𝐢𝑂2π‘ƒπ‘ŽπΆπ‘‚2 π‘‡π‘Žπ‘Ÿπ‘”π‘’π‘‘βˆ— ### Slide 7
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Variable
  • Vd
  • VCO2
  • Goal PaCO2
  • Muscle Capacity
  • Control Stability
  • Respiratory System Loads
  • Pathophys.
  • Deadspace Fraction
  • Met. Rate & Resp Quot.
  • Compen-sation
  • Strength, Mech Advantage
  • Chemoreflex & breath generator
  • Resistive,
  • Elastic,
  • Threshold/Inertial
  • Examples
  • PE, Parenchymal Lung, Anatomic
  • Overdose,
  • Overfeeding, Obesity
  • Met. Acidosis/Alkalosis
  • NMD, COPD, Pleural Dz
  • Opiates,
  • Sleep
  • COPD, CHF, OHS
  • π‘Ήπ’†π’’π’–π’Šπ’“π’†π’… π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ βˆπ‘‰π‘’π‘›π‘‘π‘–π‘™π‘Žπ‘‘π‘–π‘œπ‘› π‘Šπ‘Žπ‘ π‘‘π‘’π‘‘+ 𝑇𝑖𝑠𝑠𝑒𝑒 π‘ƒπ‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘œπ‘› π‘œπ‘“ 𝐢𝑂2π‘ƒπ‘ŽπΆπ‘‚2 π‘‡π‘Žπ‘Ÿπ‘”π‘’π‘‘βˆ—
  • Req.
  • Max.
  • Ventilatory frailty endotypes
  • Baseline Req Max
  • Predisposed to ↑ Req
  • Predisposed to ↓ Max ### Slide 8
  • Goal PaCO2
  • π‘Ήπ’†π’’π’–π’Šπ’“π’†π’… π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ βˆπ‘‰π‘’π‘›π‘‘π‘–π‘™π‘Žπ‘‘π‘–π‘œπ‘› π‘Šπ‘Žπ‘ π‘‘π‘’π‘‘+ 𝑇𝑖𝑠𝑠𝑒𝑒 π‘ƒπ‘Ÿπ‘œπ‘‘π‘’π‘π‘‘π‘–π‘œπ‘› π‘œπ‘“ 𝐢𝑂2π‘ƒπ‘ŽπΆπ‘‚2 π‘‡π‘Žπ‘Ÿπ‘”π‘’π‘‘βˆ—
  • Q: Why is the goal PaCO2 roughly 40 mmHg, and not higher?
  • pH can be maintained at any PaCO2 with a certain HCO3-
  • The process of adaptation is poorly understood… likely relates to the cost of less oxygen buffer vs. costs of breathing
  • Persistent severe hypercapnia is only possible since supp O2
  • Coma in polio (1952) was β€œcerebrelia” - thought to be viral encephalitis – actually discovered to be hypercapnic RF. ### Slide 9
  • PAO2 FiO2 (PB-47)β€”(PaCO2/R) οƒ  O2 17.8 mmHg lower at 4500ft
  • Hypercapnia in SLC
  • SpO2 is routinely obtained in clinical practice, PaCO2 (or TcCO2) is not
  • SLC οƒ  earlier identification ### Slide 10
  • Hypercapnic Respiratory Failure management is a large, tractable, & neglected problem ### Slide 11
  • Hypercapnic Respiratory Failure is Common
  • Population-standardized period prevalence of PaCO2 β‰₯ 45 mmHg (excluding iatrogenic causes):
  • 150 per 100,000 person/year
  • Reference: Decompensated Cirrhosis 94.9 (US, 2017) per 100,000 person-year ### Slide 12
  • Hypercapnic Respiratory Failure is Common
  • Denver VA. 277 consec admits BMI β‰₯ 35, all received ABG β†’ 31% PaCO2 β‰₯ 42 mmHg
  • Ascertainment
  • Population-standardized period prevalence of PaCO2 β‰₯ 45 mmHg (excluding iatrogenic causes):
  • 150 per 100,000 person/year
  • Reference: Decompensated Cirrhosis 94.9 (US, 2017) per 100,000 person-year ### Slide 13
  • Hypercapnic Respiratory Failure is Common
  • Table 2
  • 2016
  • 2017
  • 2018
  • 2019
  • Any ICD, Period Prevalence (n)
  • 4064
  • 4104
  • 4520
  • 4728
  • Cases per 100,000 (Utah pop.)
  • 133.5
  • 132.2
  • 143.3
  • 147.6 ### Slide 14
  • Hypercapnic Respiratory Failure is Common
  • Ascertainment
  • β€œThe Consistency of Hypercapnic Respiratory Failure Case Definitions in Electronic Health Record Data”, Locke …. Peltan, Brown, CHEST (2025)
  • Table 2
  • 2016
  • 2017
  • 2018
  • 2019
  • Any ICD, Period Prevalence (n)
  • 4064
  • 4104
  • 4520
  • 4728
  • Cases per 100,000 (Utah pop.)
  • 133.5
  • 132.2
  • 143.3
  • 147.6 ### Slide 15
  • Hypercapnic Respiratory Failure is Prognostically Important
  • Inpatient ICD code for Hypercapnic Respiratory Failure @ U of VT
  • 23% 30d readmission rate
  • Same as CHF, more than MI
  • Usually (66%) with recurrent hypercapnia ### Slide 16
  • Hypercapnic Respiratory Failure is Prognostically Important
  • De-identified, patient-level data
  • Federated Health Record Data
  • 80 US Healthcare Orgs
  • Dx code: Hypercapnic Respiratory Failure in 2022 (n29,009)
  • Age (years)
  • 64 (Β±15)
  • Arterial PCO2
  • 55.1 (Β±19.5)
  • Serum Bicarbonate (measured)
  • 27.1 (Β±7.4)
  • Died (1 month)
  • 13% (3,876)
  • Died (2 months)
  • 21% (6,089)
  • Month of Death
  • 1 (0,2)
  • Months to death or censoring
  • 9 (2,13)
  • EHR-recorded death
  • 30% (8,725)
  • Decompensated Cirrhosis
  • TriNetX database ### Slide 17
  • Hypercapnic Respiratory Failure is Prognostically Important
  • AIM-HIGH (Artificial Intelligence for Modifiable Health Indicators in Groups with High needs). w/
  • David Hedges, PhD
  • Rylan Fowers, PhD
  • Sam Brown, MD MSc ### Slide 18
  • Therapeutic options exist: ### Slide 19
  • Therapeutic options exist:
  • Overall, OSA is identified in ICU patients with hypercapnic respiratory failure at a roughly 5-fold higher rate (63%–88% [4 studies]) when sleep testing is performed compared to when clinicians’ assessment
  • of the cause is used (12%, 1 study). ### Slide 20
  • TODO: No text extracted from this slide. ### Slide 21
  • Why a CRF subspecialty (now)?
  • Rationale:
  • ~300 HMV providers in U.S.
  • Shared therapeutic paradigms between causes (e.g. NIV, weight loss)
  • Distinct Skillset (vent management)
  • Structured care processes (e.g. DME needs, RT support, home monitoring) ### Slide 22
  • Holes in the post-discharge hypercapnic respiratory failure evidence base stymy effective care ### Slide 23
  • Two problems:
    1. Patients in real life often have multiple contributing causes for their hypercapnia
  • All Recognized Cases
  • (Multifactorial Causes,
  • Relapsing-Recurrent)
  • ???
  • Chronic ↑CO2 COPD
  • Obesity Hypovent
  • ALS ### Slide 24
  • Two problems:
    1. Hypercapnic respiratory failure often precedes diagnosis of the causative disease
  • Outpatient Diagnosis
  • Disease Worsens or exacerbates
  • Hypercapnic Resp. Failure
  • Stabilized
  • No established Diagnosis
  • Presentation with hypercapnia
  • Stabilized; outpt. workup ordered
  • Initial outpt. management?
  • Management as per guideline
  • Transition in care
  • Reliable? ### Slide 25
  • Low diagnostic testing rates
  • Testing for most common causes of hypercapnia (e.g. spirometry, sleep testing) occurs after hospitalization.
  • Diagnostics require special resources, referrals, and high patient engagement; barriers may reduce workup completion rates.
  • Workup should, presumably, include tests for the commonest causes.
  • Identified Hypercapnia
  • Appropriate diagnostic testing
  • Β± Qualification for treatments
  • Effective management ### Slide 26
  • Utah All Payor Claims and Health Facilities Databases
  • All hospitalizations (90 % commercially-insured, β‰ˆ 70 % other care from ’15-’19
  • Inpatient & Emergency Encounters with Hypercapnic Resp. Failure ICD-10-CM
  • COβ‚‚-PATH (Post-Acute Trajectories of Hypercapnia) Cohort ### Slide 27
  • Post-discharge workflow:
  • Discharge after Hypercapnia
  • Discharging Provider Prescribes HMV
  • DME Company Receives Order
  • Discharging Provider Refers to PDNs
  • DME Company Sends RT for Setup
  • Discharging Provider orders Sleep Referral
  • DME RT educates family
  • Scheduled with Pulm Provider
  • In-lab PSG ordered
  • PFTs before provider visit
  • PSG Completed
  • Discuss with Sleep provider
  • Discuss with Pulm provider
  • Many(!) opportunities for pathway to de-rail ### Slide 28
  • Clinical Implications β†’ Ongoing Research Efforts:
  • Current burden of disease and health system performance needs further benchmarking
  • Patients with hypercapnic respiratory failure by ICD, ABG, VBG β†’ testing, emergency care, and mortality rates across the state (COβ‚‚-PATH Cohort)
  • Risk-based, rather than diagnosis-based, referral method likely optimal to allow expedited workup and empiric management when needed
  • Testing needs; qualification criteria; early post-discharge coordination.
  • Risk stratification (cost, utilization) of patients with hypercapnic respiratory failure who receive care at Intermountain via Select Health (AIM-HIGH) ### Slide 29
  • Chronic Resp. Failure @ Schmidt: capacity and referral gates
  • Three referral streams:
  • High-risk post-discharge (via PDNs)
  • Internal clinic referrals/comgmt potential NIV starts
  • Neuromuscular disorders clinic
  • Additional potential sources:
  • PMR, post-acute facilities, Re-triage from Sleep.
  • Tele pulmonary / Remote?
  • Referral criteria? (~500 ICD; 4000 blood gas yearly system-wide)
  • How to refer: iCentra/Epic message (Brian Locke) or brian.locke@imail.org
  • 50ish patients managed.
  • PDNs: Claire Davies and Megan Hepworth
  • ~1 clinic per week & add’n PDN visits ### Slide 30
  • 64F w/ BMI 38, β€œCOPD”– no testing. Readmit. Tx for β€˜PNa/AECOPD/CHF’ PaCO2 95. HCO3- 38. What device can we get? ### Slide 31
  • Devices for home non-invasive ventilation:
  • Respiratory Assist Devices (RAD)
  • Home Mechanical Ventilator (HMV)
  • HCPCS code E470 (spontaneous) or E0471 (backup rate)
  • HCPCS code E0465, E0466, E0467
  • BPAP, BPAP-ST, VAPS
  • Add: Adjustable EPAP (AVAPS-AE), mouthpiece vent, HFNO, trach vent.
  • Pressure max ~25-30 cmH2O
  • Pressure max ~50-60 cmH2O
  • Requires outlet
  • Battery power
  • Remote setting adjustment
  • No remote setting adjustment
  • E.g. Aircurve ST, Aircurve STA, Luna G3
  • Trilogy (EVO), Astral , Vivo, Luisa, VOCSN
  • Rent-to-own
  • Rent
  • No home support
  • Home RT support
  • Mean IPAP in contemporary COPD trials mid 20s. ### Slide 32
  • Prior National Coverage Determination: RADs ### Slide 33
  • New NCD for RADs
  • NMD: No change
  • β€œCOPD” Outpatient
  • β€œCOPD” on Discharge
  • Chronic Respiratory Failure Dx [β€œCOPD” includes all non OSA hypercap]. No PFTs required
  • Acute on Chronic Respiratory Failure Dx. No PFTs required
  • PaCO2 β‰₯ 52 mmHg 2+ weeks after hosp or without exac of symptoms
  • document full settings of RAD use within 24h of discharge
  • Sleep apnea is not the sole cause. No PSG or ONO required.
  • RAD needed to avoid symptoms or rapid PaCO2 rise
  • Q6month Continued Usage Criteria: confirm medically necessary, avg 5h/24hr usage, and any of improved (CO2, exacerbations, symptoms) ### Slide 34
  • Prior National Coverage Determination: HMVs
  • Patient has a NMD, Thoracic Restrictive Disease, or Chronic Respiratory Failure from COPD
  • Where β€œthe condition is life-threatening where interruption of respiratory support would quickly lead to serious harm or death.”
  • Unlike RADs, no definitions of medical conditions or what constitutes life-threatening were given ### Slide 35
  • New NCS for HMVs
  • β€œCOPD” Outpatient
  • β€œCOPD” on Discharge
  • Qualify for RAD + 1 of:
  • Acute on Chronic Respiratory Failure Dx with PaCO2 52 mmHg
  • Need volume targeted mode
  • IPAP must be over 20 cmH2o
  • Failure of RAD to improve symptoms, CO2, or exacerbations
  • HMV needed to avoid symptoms or rapid PaCO2 rise
  • β€œcapabilities exceed RAD” (e.g. vol targeted)
  • Need FiO2 > 36% (~4L)
  • 8+ hr/day use
  • Need battery
  • document full settings of HMV use within 24h of discharge
  • Q6month Continued Usage Criteria: confirm medically necessary, avg 5h/24hr usage, and any of improved (CO2, exacerbations, symptoms) ### Slide 36
  • With research support from:
  • The Intermountain Foundation
  • ATS ASPIRE Fellowship
  • NIH/NHLBI T32 University of Utah PCCM
  • Partial support for all datasets within the Utah Population Database provided by:
  • U of Utah Huntsman Cancer Institute (HCI)
  • HCI Cancer Center Support grant P30 CA2014 from the National Cancer Institute
  • Clinical Support from
  • PDNs (Claire Davies and Megan Hepworth)
  • Schmidt Chest Clinic
  • Intermountain Health:
  • Ithan Peltan, MD MSc
  • Sam Brown, MD MSc
  • Select Health:
  • Rylan Fowers, PhD
  • David Hedges, PhD
  • Utah Population Database:
  • Myke Madsen, MStat
  • Marie Gibson, CCRP
  • University of Utah:
  • Ram Gouripeddi, MBBS MSc
  • Jeanette Brown MD PhD
  • Joseph Finkelstein MD PhD
  • University of California, Davis:
  • Krishna Sundar, MD
  • Contact: brian.locke@imail.org or EHR message
  • Notebook LM on Hypercap. R.F.

198.3 Learning objectives

  • PCCGR Aug 12, 2025: Update on Hypercapnic Respiratory Failure Care at Intermountain
  • Agenda
  • Hypercapnic Respiratory Failure:
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Goal PaCO2

198.4 Bottom line / summary

  • PCCGR Aug 12, 2025: Update on Hypercapnic Respiratory Failure Care at Intermountain
  • Agenda
  • Hypercapnic Respiratory Failure:
  • π‘΄π’‚π’™π’Šπ’Žπ’–π’Ž π‘Ίπ’–π’”π’•π’‚π’Šπ’π’‚π’ƒπ’π’† π‘½π’†π’π’•π’Šπ’π’‚π’•π’Šπ’π’ 𝐹(𝑀𝑒𝑠𝑐𝑙𝑒 πΆπ‘Žπ‘π‘Žπ‘π‘–π‘‘π‘¦, πΆπ‘œπ‘›π‘‘π‘Ÿπ‘œπ‘™ π‘†π‘‘π‘Žπ‘π‘–π‘™π‘–π‘‘π‘¦, π‘…π‘’π‘ π‘π‘–π‘Ÿπ‘Žπ‘‘π‘œπ‘Ÿπ‘¦ π‘†π‘¦π‘ π‘‘π‘’π‘š πΏπ‘œπ‘Žπ‘‘π‘ )
  • Goal PaCO2

198.5 Approach

  1. TODO: Outline the initial assessment or decision point.
  2. TODO: Outline the next diagnostic or management step.
  3. TODO: Outline follow-up or escalation criteria.

198.6 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

198.7 Common pitfalls

  • TODO: Capture common errors or missed steps.

198.8 References

TODO: Add landmark references or guideline citations.

198.9 Slides and assets

198.10 Source materials