Acute Resp Acidosis

I am the only CDI at my hospital, and I do not have anyone really to run things by so I'm need opinions please.  I have a patient that is s/p lumbar fusion who has chronic pain issues.  She was having issues with pain control after surgery, so her PCA amount was increased and a prn pain med added.  She become lethargic and her respirations dropped to 6 per min.  She was moved to our stepdown and place on BIPAP.  I have an ABG, but it was done while patient was on a non Nrb mask .   pH 7.222 pCO2 65.1 pO2 129.0. She was only on BIPAP for a couple of hours. The MD documented Acute Respiratory Acidosis.  Should I query for Acute Respiratory failure?  Thanks for any help.

Comments

  • I would - Acute Hypercapnic Respiratory Failure due to adverse effect of drug.
  • Although the condition seems obvious, I'd not code the ARF unless so stated.  This would require a query.

    From a risk reporting standpoint,  the condition would be reported as "N" for POA and potentially as an adverse effect of a drug provided while hospitalized.


    P. Evans, RHIA, CCDS

  • A NRB delivers 100% O2.   What were her pulse ox levels and amount of oxygen being delivered when the decision was made to escalate O2 therapy (prior to the NRB?)

    On the other hand, adding O2 won't fix CO2 retention, but if her respiratory failure was only 6, I assume she was also severely hypoxic BEFORE upping the oxygen.

    We know Bipap helps fix C02 retention which is obviously why they made the decision to add BIPAP once they saw the gases on the NRB.

    As you know respiratory failure can be defined by a number of criteria, one of which is a CO2 >50.  Another of which is escalating oxygen demands.  A third definition is that it is defined by either the failure to adequately oxygenate or remove excess C02 from the lungs/blood.

    A query did seem in order.

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