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COPD exacerbation with acute hypercapnic respiratory failure — SCE Acute Medicine MCQ

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ModerateRespiratory medicineCOPD exacerbation with acute hypercapnic respiratory failureSCE Acute Medicine

A 71-year-old man with severe COPD is admitted with drowsiness, productive cough and increasing breathlessness. ABG on 28% Venturi oxygen shows pH 7.26, PaCO2 9.4 kPa, PaO2 8.1 kPa and bicarbonate 34 mmol/L. Chest radiograph shows hyperinflation without pneumothorax, and he is protecting his airway. What is the most appropriate next step in management?

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Correct answer: C — Start non-invasive ventilation with controlled oxygen targeting saturations of 88–92%

The ABG shows acute-on-chronic hypercapnic respiratory failure with acidaemia in a COPD exacerbation, for which NIV plus controlled oxygen is indicated if there is no immediate need for intubation. High-concentration oxygen can worsen hypercapnia in COPD and is a common harmful reflex. NIV should be started promptly alongside bronchodilators, steroids and antibiotics when clinically indicated.

Reference: BTS/ICS guideline for ventilatory management of acute hypercapnic respiratory failure; NICE NG115 COPD