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.

#FOAMed
#FOAMcc https://twitter.com/grepmeded/status/1306608128256077824
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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