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Failure of non-invasive ventilation in COPD exacerbation — SCE Acute Medicine MCQ

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ModerateCritical care medicineFailure of non-invasive ventilation in COPD exacerbationSCE Acute Medicine

A 69-year-old woman with COPD has pH 7.22 and PaCO2 10.1 kPa despite 1 hour of optimised NIV. She is increasingly agitated, has copious secretions and cannot tolerate the mask. Her treatment escalation plan states full escalation if reversible illness is present. What is the most appropriate next step in management?

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Correct answer: A — Urgent critical care review for invasive ventilation suitability

Worsening acidosis, inability to tolerate NIV and copious secretions suggest NIV failure and require urgent critical care review for intubation if consistent with the escalation plan. Sedating a patient to tolerate NIV on an unmonitored ward is unsafe. Controlled oxygen remains important, but oxygen alone does not treat ventilatory failure.

Reference: BTS/ICS acute hypercapnic respiratory failure guideline