With umbilical artery blood gas readings of pH 7.23 and PaCO2 59 torr, what is the recommended course of action?

In the scenario presented, the umbilical artery blood gas readings indicate a significant acid-base imbalance, with a pH of 7.23 suggesting acidosis, and a PaCO2 of 59 torr indicating hypercapnia (elevated carbon dioxide levels). These readings indicate a potentially serious condition that requires immediate intervention to correct the acid-base disturbance and support the infant's respiratory function.

Initiating mechanical ventilation is the appropriate response here, as it allows for greater control over the infant’s ventilation and ensures adequate exchange of gases. Mechanical ventilation can assist in rapidly reducing the elevated carbon dioxide levels, thus correcting the acidosis more effectively than other methods. It provides a means to manage respiratory function in situations where the infant cannot maintain adequate gas exchange through spontaneous breathing or existing respiratory support methods like nasal CPAP.

In contrast, increasing PEEP or continuing with nasal CPAP might not provide sufficient support in the presence of significant respiratory failure as indicated by the blood gas results. Administering additional oxygen is helpful for hypoxemia, but it does not address the fundamental issue of hypercapnia and acidosis. Therefore, the need for mechanical ventilation becomes crucial in this context.