Hypocarbia: Multidisciplinary Perspectives in Respiratory Care, Pharmacologic Management, and Nursing Interventions

Abstract

Background: Hypocarbia—reduced blood CO₂ content, often manifesting as hypocapnia (PaCO₂ <35 mm Hg)—is tightly linked to respiratory alkalosis and broad systemic effects on cerebrovascular tone, myocardial excitability, and oxygen delivery. It arises from an imbalance between metabolic CO₂ production and alveolar elimination, most commonly due to hyperventilation.

Aim: To synthesize multidisciplinary perspectives—respiratory care, pharmacologic management, and nursing interventions—on the etiology, evaluation, and treatment of hypocarbia across clinical settings.

Methods: Narrative integration of physiologic principles (Henderson–Hasselbalch), epidemiologic patterns in critical care, clinical presentation, diagnostic algorithms (ABG, electrolytes, imaging), and condition‑specific management (ventilator strategies, antimicrobials, anticoagulation, anxiolytics, behavioral therapy).

Results: Hypocarbia is prevalent in ICU populations and frequently secondary to hypoxemia, sepsis, pulmonary embolism, asthma/COPD exacerbations, psychogenic hyperventilation, endocrine/toxic triggers, or iatrogenic ventilator settings. Consequences include cerebral vasoconstriction, arrhythmias, and altered oxygen delivery; prognosis hinges on the underlying disease rather than PaCO₂ alone. Team‑based care with standardized monitoring (ABG trends, oxygenation, ventilator reassessment) and targeted therapy improves safety and outcomes.

Conclusion: Effective management prioritizes correction of precipitating causes, avoidance of excessive CO₂ clearance (especially on mechanical ventilation), and patient education to prevent recurrence.