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Chronic Type 2 Respiratory Failure — FRCA Final MCQ

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ModeratePreoperative AssessmentChronic Type 2 Respiratory FailureFRCA Final

A 65-year-old man (ASA III) with severe COPD and home oxygen is scheduled for a laparoscopic cholecystectomy. Pre-operative ABG on 2L O2: pH 7.36, PaCO2 7.5 kPa, PaO2 8.8 kPa, HCO3⁻ 34 mmol/L. What type of respiratory failure does he have?

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Correct answer: B — No respiratory failure – values are normal for COPD

This patient has type 2 (hypercapnic) respiratory failure: PaCO2 >6.0 kPa with relative hypoxaemia. The compensated metabolic alkalosis (elevated HCO3⁻ 34) indicates this is chronic (renal compensation has occurred over days-weeks). The pH is near-normal (7.36) confirming adequate compensation. This is his baseline state. Perioperative implications: use controlled FiO2 (target SpO2 88-92%), avoid excessive oxygen administration, consider regional techniques to minimise respiratory depression, and plan for HDU post-operatively.

Reference: BTS – 2017 – Oxygen guidelines; NICE – 2018 – NG115 COPD; RCOA – 2023 – Respiratory disease