Which condition requires careful monitoring because it can lead to respiratory alkalosis during mechanical ventilation?

Central nervous system disorders, such as head trauma, stroke, or seizure activity, can significantly affect respiratory function and the regulation of breathing patterns. In cases of hyperventilation, which can occur due to anxiety, pain, or CNS disturbances, there is an increased rate of carbon dioxide (CO2) elimination. This excessive removal of CO2 leads to a decrease in the partial pressure of carbon dioxide (PaCO2) in the bloodstream, resulting in respiratory alkalosis.

During mechanical ventilation, patients with central nervous system disorders may exhibit altered respiratory drive or patterns, making it crucial for healthcare providers to closely monitor their ventilation settings to avoid exacerbating the alkalosis. Adjustments may be necessary to ensure that the patient is receiving appropriate levels of CO2, as overly aggressive ventilation can further disturb their acid-base balance, leading to complications.

The other conditions listed may also have respiratory implications, but they are less directly linked to the development of respiratory alkalosis during mechanical ventilation compared to central nervous system disorders. For example, pneumothorax can lead to respiratory failure due to decreased lung compliance or functional lung tissue, while sepsis and respiratory infections typically lead to respiratory acidosis rather than alkalosis because they often involve impaired gas exchange or increased carbon dioxide retention.