Great video of breathing pattern in severe acidosis.

Be worried if you have to intubate someone like this. Any apnea will make CO2 ⬆️ and pH ⬇️

Also, near impossible to match minute ventilation of someone like this who is very actively breathing in and out.

If intubation unavoidable

Minimize apnea time during induction, BVM, or ketamine only in select case

ETCO2 helps, try to match pre tube ETCO2 to post tube ETCO2. Get a blood gas to correlate

PaCO2 target~serum bicarb + 15 mm Hg

Most will tolerate RR 30/min (if no obstruction)
Have vasopressors hanging, these tend to get unstable

Use of sodium bicarb peri-intubation is controversial here with no good studies.

Aggressively correct underlying cause. The ventilator is only supportive.
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