Hypercapnic Respiratory Failure from the Hospitalist Perspective: Recognition, Risk, and Perioperative Insights

In this episode of Respiratory Exchange, Dr. Dan Culver speaks with hospitalist and anesthesia outcomes researcher Dr. Roop Kaw about the practical recognition and management of hypercapnic respiratory failure across the inpatient setting. The discussion explores how hospitalists can identify subtle early warning signs, distinguish acute from chronic hypercapnia and use tools such as venous blood gas testing, pulse oximetry and clinical context to guide care. Dr. Kaw highlights high-risk scenarios, including postoperative patients, obesity hypoventilation syndrome, heart failure, neuromuscular disease, opioid exposure and sleep-disordered breathing, while also addressing escalation of care, noninvasive ventilation, oxygen use and the importance of perioperative screening. This episode offers a clinically grounded overview for physicians seeking to improve recognition of an often underdiagnosed but high-impact cause of respiratory deterioration.