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AECOPD with Type 2 Respiratory Failure — RACP Adult Medicine MCQ

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EasyRespiratoryAECOPD with Type 2 Respiratory FailureRACP Adult Medicine

A 55-year-old man with COPD presents with acute exacerbation (increased dyspnoea, increased sputum volume and purulence). He has type 2 respiratory failure (PaO₂ 52 mmHg, PaCO₂ 68 mmHg, pH 7.30) on 2L O₂. What is the most appropriate ventilatory support?

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Correct answer: B — Non-invasive ventilation (BiPAP)

Acute hypercapnic respiratory failure (pH 7.25–7.35) in COPD exacerbation is the primary indication for NIV (BiPAP). NIV reduces intubation rates by 65%, mortality by 50%, and length of stay. Typical starting pressures: IPAP 12–15 cmH₂O, EPAP 4–5 cmH₂O. Contraindications include: facial trauma, vomiting, GCS <8, haemodynamic instability.

Reference: COPD-X Australian/NZ Guidelines 2024; BTS/ICS NIV 2024