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Acute Exacerbation of COPD with Type 2 Respiratory Failure — UKMLA MCQ

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HardRespiratory MedicineAcute Exacerbation of COPD with Type 2 Respiratory FailureUKMLAMRCP Part 1MRCEM SBAPARA

A patient with an acute COPD exacerbation has persistent pH 7.30 and PaCO2 8.5 kPa despite controlled oxygen and optimal initial medical treatment. What respiratory support is indicated?

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Correct answer: E — Use non-invasive ventilation with serial blood-gas reassessment

The best answer is “Use non-invasive ventilation with serial blood-gas reassessment”. Persistent hypercapnic respiratory failure with acidosis during a COPD exacerbation is an indication for non-invasive ventilation when no contraindication exists. Controlled oxygen and bronchodilators continue, with close blood-gas and clinical review. Invasive ventilation is reserved for NIV failure, contraindication or immediate need; simply increasing oxygen can worsen hypercapnia without correcting ventilation.

Reference: NICE NG115: COPD in over 16s — diagnosis and management: https://www.nice.org.uk/guidance/ng115/chapter/Recommendations