A cooperative patient with COPD exacerbation has RR 32/min, pH 7.27 and PaCO2 68 mmHg after bronchodilators and controlled oxygen. Hemodynamics and

Question

A cooperative patient with COPD exacerbation has RR 32/min, pH 7.27 and PaCO2 68 mmHg after bronchodilators and controlled oxygen. Hemodynamics and mentation are preserved. What is the next ventilatory step?

Accepted Answer

Start bilevel non-invasive ventilation and monitor closely for failure

Answer

Use high-flow nasal oxygen alone to correct the respiratory acidosis

Answer

Intubate immediately because any pH below 7.30 predicts NIV failure

Answer

Use CPAP alone because inspiratory pressure support increases CO2 retention

Answer

Continue controlled oxygen alone until repeat blood gas in two hours

COPD exacerbation with acute hypercapnic respiratory failure — RCPSC EM MCQ

A cooperative patient with COPD exacerbation has RR 32/min, pH 7.27 and PaCO2 68 mmHg after bronchodilators and controlled oxygen. Hemodynamics and mentation are preserved. What is the next ventilatory step?