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Monday, December 9, 2013
C2 retainer- rare case
Question: My father is a C2 retainer. He had a car accident four years ago and his ribs were broken and placed up near his heart. He has also been exposed to many harmful chemicals within the last 20 years. He is now on a v pap to help him breath as his right heart is not working very well and his lung walls wont expand. We have been told many different things but all end in him not having very long. Is there anything we should be checking into that we may have overlooked that would help? Why do C2 retainers not have long when the machine works for them? Is it that rare to be awake and functioning with blood gases of 82?
I may need a bit more information to answer the question completely.
Patients can retain CO2 (carbon dioxide) for a variety of reasons. A normal CO2 level is 40 and if his level is 87, then that is very high, indeed. Some of the common causes of a high CO2 include emphysema, obesity with sleep apnea, hypothyroidism (low levels of thyroid hormone), and restrictive lung disease due to spine or rib abnormalities. The first step is to determine the cause of the high carbon dioxide level.
BiPAP is a device that is used to help the breathing muscles work stronger in order to get rid of carbon dioxide that builds up in the blood stream. As far as how the high carbon dioxide level affects a person, it really depends on how rapidly the carbon dioxide level rises. A normal person who has a sudden rise in their carbon dioxide from 40 to 60 in a few hours will be more severely affected than a person who has a slow rise in the carbon dioxide level to 87 over many months or years. Nevertheless, 87 is quite high and indicates fairly severe lung disease.
When BiPAP no longer provides satisfactory control, one option for some patients can be a permanent tracheostomy and mechanical ventilator. This is a fairly drastic measure for many patients and may not even be an option for some patients.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University