A 74-year-old man with severe COPD (FEV1 30% predicted) is admitted with an acute exacerbation. Arterial blood gas on 28% Venturi mask shows pH 7.29, ...

Question

A 74-year-old man with severe COPD (FEV1 30% predicted) is admitted with an acute exacerbation. Arterial blood gas on 28% Venturi mask shows pH 7.29, PaCO2 8.5 kPa, PaO2 7.8 kPa, HCO3- 30 mmol/L. He is drowsy with use of accessory muscles. What is the most appropriate immediate management?

Accepted Answer

Start non-invasive ventilation (BiPAP) and titrate oxygen to target saturations 88-92%

Answer

Increase oxygen to 100% via non-rebreather mask

Answer

Intubate immediately without trial of non-invasive ventilation

Answer

Stop oxygen to avoid further CO2 retention

Answer

Give only bronchodilators and observe closely

ca-mccqe1 MCQ (SBA): Acute hypercapnic respiratory failure in COPD

A 74-year-old man with severe COPD (FEV1 30% predicted) is admitted with an acute exacerbation. Arterial blood gas on 28% Venturi mask shows pH 7.29, PaCO2 8.5 kPa, PaO2 7.8 kPa, HCO3- 30 mmol/L. He is drowsy with use of accessory muscles. What is the most appropriate immediate management?