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NIV Failure Decision-Making Without ADRT — SCE Palliative Medicine MCQ

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ModerateNon-Malignant Palliative CareNIV Failure Decision-Making Without ADRTSCE Palliative Medicine

A 74‑year‑old man with advanced COPD develops acute‑on‑chronic respiratory failure during an exacerbation. He is on non‑invasive ventilation (NIV). Despite 4 hours of optimal NIV, his pH remains 7.20 and he is increasingly drowsy. He has no ADRT or ReSPECT form. His family are present. What is the most appropriate next step?

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Correct answer: B — Hold an urgent as the preferred next management strategy in this patient

At 4 hours with no improvement (pH still 7.20) and drowsiness, this represents NIV failure and requires urgent review with documented escalation and ceiling of care, per NICE NG115 and BTS quality standards. In the absence of ADRT/ReSPECT, a shared decision‑making conversation with family is required to determine whether invasive ventilation is appropriate or whether comfort‑focused care is more suitable. Option E bypasses patient consent and fails to consider poor prognosis. Option C is clinically unsafe. Option D ignores the requirement for timely reassessment. Option A lacks ethical and legal discussion and fails to involve family.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care