Carbon Dioxide Toxicity Management

Pathophysiology and Primary Management Approach

The primary pathophysiology of suffocation by excessive carbon dioxide involves respiratory failure, hypercapnia, and respiratory acidosis, which demands medical management through airway support, controlled oxygen delivery, and mechanical ventilation when necessary, as recommended by the American Thoracic Society 1, 2
Monitoring arterial blood gases regularly is crucial to assess PaCO2 levels and pH status, as hypercapnia can progress rapidly (0.4-0.8 kPa/min or 3-6 mm Hg/min) 1
Cerebral vasodilation from elevated CO2 leads to increased cerebral blood flow, headache, and altered consciousness, and respiratory acidosis from acute CO2 retention causes pH disturbances that affect multiple organ systems, according to the European Respiratory Society 3, 1

For patients at risk of hypercapnic respiratory failure, such as those with chronic obstructive pulmonary disease (COPD), controlled oxygen therapy targeting saturations of 88-92% rather than 100% oxygen is recommended by the Global Initiative for Chronic Obstructive Lung Disease 4
Excessive oxygen in COPD patients can worsen hypercapnia through elimination of hypoxic pulmonary vasoconstriction and worsening V/Q mismatch, and the use of Venturi masks (24% or 28%) or low-flow nasal cannula is advised in known COPD patients even during acute CO2 exposure 4