Treatment of Respiratory Alkalosis

Etiology-Based Treatment Approach

Utilize rebreathing techniques to temporarily increase CO2 levels in patients with psychogenic hyperventilation, and provide reassurance and coaching on controlled breathing techniques, as recommended by the American Thoracic Society 1
Provide adequate analgesia to reduce pain-triggered hyperventilation in patients with pain-induced hyperventilation, according to the American Academy of Sleep Medicine 2
Administer sedation if needed for severe cases of pain-induced hyperventilation, as suggested by the American Heart Association 3

Administer supplemental oxygen to maintain SpO2 94-98% in most patients with hypoxemia-induced hyperventilation, and target SpO2 88-92% in patients with COPD or other risk factors for hypercapnic respiratory failure, as recommended by the British Thoracic Society 4

Adjust ventilator settings to normalize PaCO2 in patients with mechanical ventilation-induced respiratory alkalosis, and decrease respiratory rate or tidal volume as needed, according to the Society of Critical Care Medicine 5
Increase dead space if necessary to normalize PaCO2 in patients with mechanical ventilation-induced respiratory alkalosis, as suggested by the American Thoracic Society 1

Treat underlying neurological condition and consider sedation in severe cases of central nervous system disorders, according to the American Heart Association 3
Focus on treating the underlying infection and provide appropriate fluid resuscitation and hemodynamic support in patients with sepsis-related respiratory alkalosis, as recommended by the Society of Critical Care Medicine 5, 6
Address underlying chronic conditions, such as chronic liver disease or heart failure, in patients with chronic respiratory alkalosis, according to the Society of Critical Care Medicine 7
Maintain appropriate ventilation without inducing respiratory alkalosis in patients with pulmonary hypertension, and consider controlled respiratory alkalosis as a therapeutic strategy in persistent pulmonary hypertension of the newborn, as recommended by the American Heart Association 8, 9

Use continuous pulse oximetry to monitor oxygen saturation in patients with respiratory alkalosis, as recommended by the British Thoracic Society 4