In CPAP therapy, what is the main risk of not having an intentional leak?

In Continuous Positive Airway Pressure (CPAP) therapy, having an intentional leak is important for maintaining the proper balance of pressure and ensuring the efficacy of the treatment. If there is no intentional leak, the main risk is indeed related to higher CO2 retention.

When CPAP is administered, the device supplies a constant flow of air to keep the airway open. Without an intentional leak, the pressure in the system can build too high, which may not only result in discomfort for the patient but also hinder the body's ability to exhale fully. This improper pressure can lead to an inadequate exhalation, causing CO2 levels to accumulate in the lungs. Adequate ventilation relies on a patient's ability to exhale the CO2 produced during respiration, and without sufficient leakage, this balance is disrupted, leading to potential respiratory complications.

In contrast, while increased airway pressure, reduced efficacy, and patient discomfort may also be issues associated with a lack of intentional leak, the critical risk tied directly to respiratory physiology and the effectiveness of gas exchange is the higher risk of CO2 retention.