NIV Response Assessment pH Target — FRCA Final MCQ

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ModerateIntensive Care MedicineNIV Response Assessment pH TargetFRCA Final

A 65-year-old man (ASA III) in ICU has an acute exacerbation of COPD. He is commenced on NIV (BiPAP). What is the target pH for assessing NIV response at 1-2 hours?

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Correct answer: E — No specific target – continue NIV regardless of ABG

BTS/ICS NIV guidelines (2016) recommend: check ABG at 1-2 hours after commencing NIV. Success is indicated by: improvement in pH (ideally pH rising by ≥0.05, or pH >7.26), reduction in PaCO2, improvement in respiratory rate and clinical condition. If pH has NOT improved at 1-2 hours despite optimised NIV settings, escalation should be considered (increase IPAP, review for complications, consider intubation if appropriate given ceiling of care). NIV should NOT be continued unchanged if there is no improvement in pH – this delays definitive management.

Reference: BTS/ICS – 2016 – NIV for acute hypercapnic respiratory failure; NICE – 2018 – NG115 COPD