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Interactive Physiology and Grand Rounds in the ICU |

Rising Paco2 in the ICU Rising Paco2 in the ICU : Using a Physiologic Approach to Avoid Cognitive Biases

Richard M. Schwartzstein, MD, FCCP; Michael J. Parker, MD
Author and Funding Information

From the Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Correspondence to: Richard M. Schwartzstein, MD, FCCP, Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; e-mail: rschwart@bidmc.harvard.edu

Editor’s Note: In this series, interactive diagrams are an important part of each article and are referred to throughout. You can access the two diagrams for this article at View animation 1 and View animation 2. On accessing the online material, you may be prompted to update your browser’s Flash Player plug-in; this will enable you to view the diagrams as intended. If you are not prompted to update the plug-in and experience problems, download the latest version of the Flash Player at www.adobe.com/go/getflash.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Editor’s Note: In this series, interactive diagrams are an important part of each article and are referred to throughout. You can access the two diagrams for this article at View animation 1 and View animation 2. On accessing the online material, you may be prompted to update your browser’s Flash Player plug-in; this will enable you to view the diagrams as intended. If you are not prompted to update the plug-in and experience problems, download the latest version of the Flash Player at www.adobe.com/go/getflash.

Editor’s Note: In this series, interactive diagrams are an important part of each article and are referred to throughout. You can access the two diagrams for this article at View animation 1 and View animation 2. On accessing the online material, you may be prompted to update your browser’s Flash Player plug-in; this will enable you to view the diagrams as intended. If you are not prompted to update the plug-in and experience problems, download the latest version of the Flash Player at www.adobe.com/go/getflash.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1638-1642. doi:10.1378/chest.11-2377
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At 9:22 pm, you receive a phone call from the resident covering the ICU. “Mr Porter is a 68-year-old man with a history of chronic renal failure (requiring dialysis) and cirrhosis complicated by ascites, who underwent upper-extremity vascular surgery 2 weeks ago. He has been mechanically ventilated since then because of respiratory failure due to pneumonia and has had a rise in his Paco2 from 40 to 70 mm Hg over the past 4 hours, even though we have not made any changes in the ventilator. His chest radiograph shows improving infiltrates; there is no pneumothorax. I want to get a CT scan angiogram to assess for a pulmonary embolism.”

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