To normalize a high PaCO2, which action is appropriate?

To normalize a high PaCO2, the most appropriate action is to remove mechanical deadspace. Mechanical deadspace refers to areas in the ventilatory system where gas exchange does not occur, such as equipment or tubing that adds volume but does not contribute to ventilation. By minimizing deadspace, you can enhance the efficiency of ventilation, allowing more effective clearance of carbon dioxide from the patient's system.

In clinical practice, reducing mechanical deadspace can help increase the amount of fresh gas that reaches the alveoli for gas exchange, thus improving ventilation and reducing PaCO2 levels. This approach is particularly useful in patients with compromised ventilation or those who are receiving mechanical ventilation.

While increasing tidal volume or peak inspiratory pressure could also help improve ventilation, it may not specifically address the issues associated with deadspace. Increasing FIO2 would primarily affect oxygenation rather than directly influencing CO2 removal. Decreasing the respiratory rate could worsen hypercapnia, as it reduces the number of breaths taken, thereby decreasing the overall ventilation and CO2 elimination. Consequently, focusing on removing mechanical deadspace directly targets the problem of inadequate CO2 clearance.