Permissive hypercapnia is an accepted part of respiratory management in ICU. The key guiding question is:

Will the treatment required to lower the CO₂ cause more harm than the hypercapnia itself?

Reasonable steps are:

• Increase respiratory rate.
• Reduce sedation.
• Treat the underlying cause.

However:

• Do not increase pressures or volumes beyond safe limits.
• If the patient is breathing spontaneously, taking over their ventilation may paradoxically increase CO₂—ensure you can raise overall minute ventilation given the reduced compliance before proceeding.
• Some experts may use sodium bicarbonate or other buffers to correct respiratory acidosis, but this approach is not widely accepted.